Title: Veronica D. Giles v. Brookwood Health Services, Inc., et al.
Citation: N/A
Docket Number: 1060883
State: Alabama
Issuer: Alabama Supreme Court
Date: June 27, 2008

rel: 06/27/2008
Notice: This opinion is subject to formal revision before publication in the advance
sheets of Southern Reporter.  Readers are requested to notify the Reporter of Decisions,
Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334)
229-0649), of any typographical or other errors, in order that corrections may be made
before the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
 OCTOBER TERM, 2007-2008
_________________________
1060883
_________________________
Veronica D. Giles
v.
Brookwood Health Services, Inc., et al.
Appeal from Jefferson Circuit Court
(CV-03-7119)
COBB, Chief Justice.
Veronica D. Giles seeks the reversal of a summary
judgment entered by the Jefferson Circuit Court on her claims
alleging medical malpractice, failure to obtain informed
consent, and spoliation of evidence against Brookwood Health
1060883
Dr. Anthony DeSalvo, Giles's medical expert, testified
1
that the term "andexum" refers to the fallopian tube and
ovary.
2
Services, Inc. ("Brookwood"), the entity that operates
Brookwood Medical Center, Dr. Jon Adcock, Dr. C. Paul Perry,
and OB-GYN South, P.C. ("OB-GYN South").  We affirm.
Facts
A.
Giles's medical history, the surgical procedure, and the
subsequent medical treatment
In July 2001 Giles visited Advocate South Suburban
Hospital in Chicago, Illinois, where an ultrasound was
performed on her pelvis.  The following note is contained in
that ultrasound report:
"There is a mild solid enlargement of the left
adnexal area measuring 4.5 cm and probably due to a
hemorrhagic 
cyst, 
endometrioma, 
or 
malignancy.
Gynecological consult recommended. ... The right
adnexum
 is not remarkable."
[1]
On August 28, 2001, Giles was seen by Dr. Adcock, a
gynecologist with OB-GYN South.  At Dr. Adcock's office Giles
underwent another ultrasound.  The second ultrasound report
states that the "[u]ltrasound revealed left ovarian complex
mass. ...  Right ovary is normal."
Dr. Adcock's notes regarding Giles's August 28, 2001,
visit state that Giles 
1060883
The record does not indicate whether the "O.R. Journal"
2
is a document from the records of Brookwood, OB-GYN South, or
some other entity.  The record also does not indicate the
identity of the person who submitted the August 28, 2001,
request to schedule an operating room for a left oophorectomy
for Giles.
The record does not include Dr. Emig's first name.
3
3
"presented to [Dr. Adcock] with pain in her ovaries.
An ultrasound revealed an ovarian mass.  She is
status-post hysterectomy.... She states that she
feels a yanking feeling that comes and goes.  It is
increasing [in] frequency.  She has felt it twice in
the last two weeks.  The left side is greater than
the right."
At the conclusion of the notes for the August 28 visit,
Dr. Adcock wrote that his "assessment" was "[l]eft ovarian
complex mass that is persistent and recurrent with pain."  He
described his "plan" as follows: "We will proceed with
diagnostic laparoscopy and probable left oophorectomy."
The procedure was scheduled; an "O.R. Journal" note in
the record indicates that a request was made on August 28,
2001, to schedule an operating room at Brookwood Medical
Center for a "left oophorectomy" for Giles.   However, Giles's
2
insurance company would not agree to pay for the procedure,
and the procedure did not go forward as originally scheduled.
On October 3, 2001, Giles consulted another doctor, Dr.
Emig,  who practiced at a different clinic than Dr. Adcock.
3
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4
Dr. Emig's notes from Giles's October 3 visit to Dr. Emig's
office state:
"The patient had an [ultrasound] today to reevaluate
her left adnexa. [Ultrasound] revealed a persistent
complex left ovarian cyst....  Her records from Dr.
Adcock in Brookwood were reviewed and this cyst is
consistent with measurements of a complex left
ovarian cyst obtained in his office in August of
2001.  The patient reported that she was essentially
pain-free at the time she saw me on September 21st,
but since then has had some intermittent pain on her
left side. ...  We plan to schedule an operative lap
with possible left ovarian cystectomy in November."
On October 31, 2001, Giles returned to Dr. Adcock for
another appointment.  On this date, she had another
ultrasound, which indicated that the left ovarian mass had
increased slightly in size since the August 28, 2001,
ultrasound.  The October 31, 2001, ultrasound report indicated
"0" adnexal masses on the right side.
At 5:32 p.m. on November 6, 2001, Dr. Adcock dictated the
following notes:
"Veronica [Giles] is a 45 year-old married female,
para 2-0-0-2 who came to me in August noting to have
a 
complex 
ovarian 
cyst. 
She 
is 
status 
post
hysterectomy in the past. She denies any significant
complaints other than some mild pain in that area. An
ultrasound 
in 
August 
revealed 
a 
complex 
cyst
measuring 3.2 x 2.6 x 2.9 and follow-up two months
later revealed a slightly enlarged ovarian cyst with
continued complexity. She was unable to proceed with
surgery at the time of evaluation due to the fact
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5
that her insurance would not pay. She has no other
GYN complaints....
"PAST SURGICAL HISTORY: Cesarean section X2 and
hysterectomy in 1995.
"PHYSICAL EXAMINATION: .... Tender in the left adnexa
-- greater than right....
"ULTRASOUND: Revealed the above noted complex ovarian
cyst.
"IMPRESSION:
1. Complex ovarian cyst that is persistent.
"PLAN
1. laparoscopic bilateral salpingo-oophorectomy on
11/7/01."
"Pre-admit" orders sent to Brookwood from Dr. Adcock's
office requested a permit for "L[eft] oophorectomy" and listed
"complex ovarian mass" as the diagnosis. However, the words
"L[eft] oophorectomy" on those orders were crossed out and
underneath them were written the words "Right oophorectomy
B.G."  Bonnie Green, a Brookwood nurse, stated in her
deposition that she was the person who revised the order.
Nurse Green stated that she believed she changed the order at
Dr. Adcock's direction after she consulted him in an effort to
resolve the fact that the order for a "left oophorectomy"
differed from Dr. Adcock's November 6, 2001, notes indicating
a planned "laparoscopic bilateral salpingo-oophorectomy."
1060883
6
However, under oath, Dr. Adcock denied that he told Nurse
Green 
to 
change 
the 
pre-admit 
orders 
from 
"L[eft]
oophorectomy" to "Right oophorectomy" or that he knew anything
about how or why the pre-admit orders were changed.  
A Brookwood "pre-anaesthetic interview" form indicates
that, on November 6, 2007, a nurse interviewed Giles in
preparation for a "L[ef]t oophorectomy."
On November 7, 2001, Giles went to Brookwood Medical
Center for the surgery.  At 8:50 a.m. on November 7, 2001,
Giles signed a "Consent for Surgery and/or Anesthetics or
Special Diagnostic or Therapeutic Procedures," which included
the following language:
"Your doctor has recommended the following operation
or procedure: Laparoscopic Right Oophorectomy. By
signing this form you authorize and consent to this
operation or procedure.  You also agree and consent
to 
the 
administration 
of 
such 
anaesthesia,
monitoring, venous, and arterial access as your
doctor(s) deem necessary for the operation or
procedure.  The operation or procedures will be
performed 
by 
your 
doctor(s) 
Adcock 
and 
with
assistants he/she selects. ...  Any different or
further procedures, which in the opinion of your
doctor may be indicated due to any emergency, may be
performed on you.  During the course of the
procedure, unforseen conditions may be revealed that
necessitate 
the 
extension 
of 
the 
original
procedure(s) than those explained to you by your
doctor [sic].  By signing this form, you, therefore,
authorize and request that your doctor, his/her
1060883
7
assistants 
or 
his/her 
associates 
perform 
such
surgical or other procedures as are necessary and
desirable in the exercise of his/her or their
professional judgement and do hereby grant authority
to your doctors to treat all conditions which may
require treatment although such condition may not be
discovered until after the operation or procedure is
commenced."
According to Dr. Adcock's deposition testimony, on the
morning of the operation, he discussed with Giles the scope of
the operation and the risks involved and the possibility that
he would remove either or both ovaries during the operation.
Giles testified in her deposition that she did not recall the
substance of her conversations with Dr. Adcock that morning.
By 9:04 a.m. on November 7, 2001, Giles was in the
operating room undergoing the operation.  Dr. Perry, another
gynecologist with OB-GYN South, assisted Dr. Adcock with the
surgery.  The surgery was videotaped.
The surgery was completed by 12:00 p.m. on November 7,
2001. A handwritten "Post Operative Note" by Dr. Adcock dated
November 7, 2001, at 12:00 p.m. states that Dr. Adcock's "Pre-
Op diagnosis" was "R[ight] complex ovarian cyst," and that his
"Post Op Diagnoses" were the "SAME" and, in addition, "severe
adhesive disease."  The postoperative note listed "bowel
laceration" as a complication resulting from the procedure.
1060883
8
Giles's husband later signed a sworn affidavit in which
he recounted the events related to Giles's treatment and
surgery as follows:
"My name is Edward Giles and I am the husband of
Veronica Giles.  This affidavit is given based on my
personal knowledge of the event that took place prior
to and after her admission to Brookwood Hospital for
surgery on November 7, 2001.  I accompanied [m]y wife
to Defendant, [Brookwood], on November 7, 2001.  I
went into the prep room with her for one day surgery.
I talked with two ladies who were dressed in
hospital nursing and/or anesthesia attire.  I told
them to tell the doctor that the left ovary was to be
removed because the male anesthesiologist person
talking to my wife indicated that the right ovary was
to be removed.  I told them to take good care of my
wife and they assured me they would.  
"Two and one half (2 ½) hours later, a nurse
notified me in the waiting area that there was [a]
phone call for me.  The nurse on the phone notified
me that the doctor wanted to inform me that it may
take a little longer to finish because my wife has a
lot of scar tissue, and to please be patient and
don't worry.
"One and one half (1 ½) hours later, Dr. Adcock
came to the lobby of the waiting room and advised me
that the procedure went okay, but scar tissue gave
him a bit of a problem, and that her bowel has a
small abrasion -- nothing serious or to worry about.
I asked the doctor, 'Did you make sure you took out
the left ovary on the left side[?']  He said, 'No, I
took out the ovary on the right side[.'] He asked me
'are you sure, because I remember the right side'; he
said he []would check and get back to me.
"One (1) hour later. Dr. Adcock returned to the
lobby waiting room and stated that I was absolutely
1060883
9
right, that it was the left side that should have
been removed.  'I am so sorry Mr. Giles, could you
please come into this room so I may speak with
you[.'] We went into a small area, a private room
that was located near the lobby waiting area. Dr.
Adcock stated[,] 'I am truly sorry, I am so sorry.'
He stated that he was thinking of our talks in the
office and he took for granted that it was the right
when he saw all of the scar tissue, that the right
was the correct ovary to take out, and your wife
pointed to the right side just before the surgery.
I advised Dr. Adcock that she was in a nervous and/or
sedated state of mind, and that I asked the nurses to
tell you to check your records before beginning
surgery, because the male anesthesiologist that was
in the room indicated that you were scheduled to
remove the right.  I asked Dr. Adcock, how could that
be right that the right ovary was removed?  He stated
that he just took it for granted that the right ovary
was the correct one.  Dr. Adcock advised me that he
forgot to look at the charts or his notes before
starting the surgery.  He stated that he remembered
after I mentioned the left ovary, he stated again,
'Mr. Giles, I am so sorry ... we can always go back
after maybe four to six weeks to get the correct one,
I did see some growth on the right ovary that we took
out.[']
"I asked him to please help to get my wife well
so we could go home; he stated that he would like to
keep her overnight for observation, because of the
scar tissue.  I said okay.  Dr. Adcock said that he
had a taping of the procedure and that he would give
it to me.  He did give it to me.  He stated that he
would tell my wife of the mistake about the ovary
when she was in her room.  My wife was moved to room
324 on November 7th. 
"On that evening of November 7th, Dr. Adcock
came to our room and sat on the bed and told my wife
that he took out the wrong ovary and how very sorry
he was. He advised her that down the road, we could
1060883
10
go back for the correct ovary (left) in maybe four to
six weeks, depending on how she felt about it later.
He told her that he and Dr. Perry performed the
surgery and that Dr. Perry would be up to the room
later to see her.
"The next day, November 8th, Dr. Adcock had the
head doctor stop in to see us. I do not recall his
name.  Dr. Adcock also at that time asked for the
tape back so that the chief administrator could look
at it.  He stated that he would return it.  I gave
him the tape he had previously given me which I had
not had an opportunity to view.  Dr. Adcock later
returned a tape to me and in viewing the tape of two
to three minutes of video and after that there
appears to be twenty to thirty minutes edited or
erased and then a thirty (30) to forty-five (45)
second closing.  The tape appears to have been
changed. 
"Dr. Perry did come to see my wife.  He never
mentioned anything about the fact that the incorrect
ovary was removed during the surgery ... that he and
Dr. Adcock performed.  He kept his conversation
focused on her condition and when she might be able
to go home.  Dr. Adcock mentioned that he has to go
out of town and would be leaving on Friday, November
9th, and that Dr. Perry would stop by and keep [a]
check on my wife for him.  My wife was released from
the hospital on November 9th. At the time of my
wife's release, she was running a fever.  Dr. Perry
advised us that unless it got above 104 degrees to
not worry. She later develop[ed] peritonitis and
required three surgeries to correct a perforation of
the bowel which Dr. Adcock said occurred and they had
taken care of by sewing it up."
During Dr. Adcock's deposition, Dr. Adcock confirmed many
of the details set out in Mr. Giles's affidavit, but he denied
1060883
11
that he had told Mr. Giles that he had removed the wrong ovary
or that he had apologized for removing the wrong ovary. 
Around 5:00 p.m. on November 7, Dr. Adcock made the
following note:
"P[atien]t alert & awake.  Discussed the surgery -–
pre op diagnosis was a Left ovarian mass but the
surgery that took place was a Right S&O.  Extensive
adhesions discussed and inability to even visualize
the left adnexa. P[atien]t's husband is aware of
this, and was present for conversation."
Dr. Adcock dictated further notes at 5:31 p.m. on November
7 as follows: 
"PREOPERATIVE DIAGNOSIS: LEFT COMPLEX OVARIAN MASS
"POSTOPERATIVE DIAGNOSIS: SAME PLUS EXTENSIVE PELVIC
AND ABDOMINAL ADHESION DISEASE AND RIGHT OVARIAN MASS
"OPERATION: 
LAPAROSCOPIC RIGHT SALPINGO-OOPHORECTOMY
EXTENSIVE ADHESIOLYSIS
CYSTOSCOPY....
"COMPLICATIONS: Inability to remove left adnexa
"....
"FINDINGS: Extensive bowel to abdomen adhesions as
well as bladder to abdominal wall adhesions. Left
tube and ovary completely covered by adhesions. Right
tube and ovary somewhat freer but still adherent to
the midline and lateral wall as well as abdominal
wall. 
Cystoscopy 
findings 
revealed 
bilaterally
functioning ureters.
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12
"INDICATIONS: 45 year old married black female status
post hysterectomy in the past with persistent complex
left ovarian cyst that was essentially stable in
size. Recommended operative removal. Patient was
counseled regarding the risks and benefits of the
procedure including bowel, bladder injury, infection
and bleeding. She desired to proceed.
"OPERATIVE PROCEDURE: The patient was taken to the
operating Room where general anesthesia was obtained
without difficulty. She was then prepped and draped
in the normal sterile fashion. ...  A left upper
quadrant incision was used due to the previous
incisions. ...  We were then able to only visualize
right lateral, extreme lateral and left extreme
lateral abdominal walls. ...  We were unable to
visualize the left adnexa at all due to adhesions.
The right adnexa was visualized and there appeared to
be a right ovarian enlargement and probable mass.  We
proceeded 
with 
very 
careful 
sharp 
dissection,
coagulating as we went, noting to be away from bowel
and bladder. ...  We were careful not to leave any
ovarian capsule on the right side. We ... were able
to ... complete the right salpingo-oophorectomy. ...
We did oversew one area near the bowel that was
abraded. ...  The patient tolerated the procedure
well 
and 
was 
sent 
to 
the 
Recovery 
Room 
in
satisfactory condition.  She will stay 23 hour
observation due to the extensive adhesiolysis.  The
patient's husband was informed of the above findings
and that we failed to remove the previously noted
diseased ovary but did remove the other ovary.  He
voiced understanding."
 On November 8, 2001, Dr. Donald R. Simmons of Cunningham
Pathology, 
P.C., 
signed 
a 
"Surgical 
Pathology 
Report"
regarding Giles's right ovary and fallopian tube.  The report
states:
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13
"FINAL DIAGNOSIS:
Fallopian tube and ovary, right:
-No pathologic abnormality. ...
"GROSS DESCRIPTION:
Received labeled 'right ovary and tube' is a somewhat
fragmented apparent tubo-ovarian complex in which the
tissue overall measures 5 x 3 x 2.5 cm. Cut section
demonstrates no gross abnormalities. ...
"MICROSCOPIC DESCRIPTION:
Sections of fallopian tube and ovary demonstrate
normal physiologic structures with no evidence of
neoplasia.  There is a cyst with old hemorrhage and
no 
residual 
lining 
epithelium. 
No 
diagnostic
endometriosis is identified."
On November 9, 2001, Dr. Perry dictated the following
"Discharge Summary," which Dr. Adcock signed:
"Patient 
underwent 
right 
S&O 
with 
extensive
adhesiolysis, had postoperative ileus and this has
resolved 
over 
the 
course 
of 
48 
hours 
of
hospitalization. She will be discharged on [certain
medications]. The patient will return to see Dr.
Adcock in two weeks."
On November 13, 2001, Giles returned to Dr. Adcock
complaining of severe pain, and she was dehydrated.  On
November 14, Giles was admitted to Brookwood Medical Center
where it was discovered that her bowel had a perforation and
that she had contracted peritonitis.  Giles underwent several
extensive 
surgeries 
and 
hospitalizations 
to 
treat 
the
peritonitis.
1060883
14
B.
Testimony of Dr. Anthony DeSalvo, Giles's medical expert
In answering questions during his deposition, Giles's
medical expert, Dr. Anthony DeSalvo, described the nature of
Giles's operation as follows:
"Q:
And [Dr. Adcock] wrote 'diagnostic laparoscopy
and probable left oophorectomy'?
"A:
Yes, sir.
"Q:
Is that a guarantee that he is going to remove
the left ovary?
"A:
No.
"Q:
Why not?
"A:
Because if he can't see it, if he looks at it
and it's perfectly normal, if he doesn't think
it's causing her symptoms.
"Q:
By definition, based on what we've talked about
before, diagnostic laparoscopy means he is going
to put the laparoscope in and look and see if he
can find explanations for her pain, correct?
"A:
Yes.
"Q:
He might find one explanation, he might find
two, he might find more, couldn't he?
"A:
Yes.
"Q:
All right.  And 'probable left oophorectomy,' is
he saying to the patient, 'Probably we'll remove
your left ovary based on what I see going in,
but I can't guarantee it?'
"A:
I think that's a fair statement."
1060883
15
Dr. DeSalvo further made clear in his deposition that, in
his opinion, Dr. Adcock would have met the standard of care
if, during the surgery, he attempted to remove the left ovary,
decided not to remove that ovary due to the risks posed by the
severe adhesions, and, in the process of the surgery, removed
the right ovary after observing what appeared to be a cyst on
that ovary.  For example, Dr. DeSalvo testified as follows:
"Q:
... You've reviewed the operative note, haven't
you?
"A:
Yes.
"Q:
Does the operative note describe a fairly
difficult operative area?
"A:
Yes.
"Q:
Was the -- were the physicians able to see the
left ovary?
"A:
No.
"Q: Was that because of the scar tissue?
"A:
Yes.
"Q
If there is a lot of scar tissue and you can't
see the left ovary, does that pose risks to
going to get it?
"A:
Yes.
"Q:
The greater the limitation of visibility by scar
tissue is it the greater the risk of injuring a
bowel or some other organ?
1060883
16
"A:
Correct.
"Q:
Okay.  Did you see they were able to visualize
the right adnexa?
"A:
Yes.
"....
"Q:
All right.  And when the doctors saw the right
adnexa, there appeared to be a right ovarian
enlargement and probable mass?
"A:
Yes.
"Q:
And would it be reasonable, knowing she had
right-sided pain, knowing she had adhesions,
seeing a right ovarian enlargement and probable
mass, to remove it, given the discussions he had
had with the patient?
"A:
Yes.
"Q:
And, in fact, that's what [Dr. Adcock] did?
"A:
Yes.
"....
"Q:
...  Now one option, as I understand a doctor would
have in this situation is, once he got in and saw the
adhesions, would be just to quit, correct?
"A:
Yes. Yes.
"Q:
Of course, if he does that, he doesn't address
the pain on either side, does he?
"A:
Correct.
1060883
17
"Q:
All right.  And another option would be to
continue laparoscopically and try to get to that
left ovary, wouldn't it?
"A:
Yes.
"Q:
And, of course, you've already said there would
be increased risk to the patient if you did
that.  If a doctor did that and injured organs
in the face of these heavy adhesions, could he
fall below the standard of care?
"A:
You know, this is where judgment is important.
You know, if -- if he feels comfortable in doing
it, I'm not going to fault somebody for -- you
know, for doing it.  But if he feels that it's
not appropriate, then, you can't fault him for
saying it's not appropriate.
"....
"Q:
And if the decision was made that we don't think
it's safe for this patient to go get the left
ovary, that would be reasonable on their part,
wouldn't it?
"A:
Yes.
"Q:
Okay: Now, once the right ovary was removed,
we've already talked about the fact that there
was documented [in the surgical pathology
report] that there was a corpus luteum  cyst, an
old hemorrhagic cyst [on the right ovary],
correct?
"A:
Yes.  Yes.
"Q:
The mass, in hindsight, that [Dr. Adcock]
probably saw, do you think that was scar tissue
and ovary and tube or what?
"A:
I don't know.
1060883
18
"Q:
Okay.  Would the doctors who did the operation
be in the best position to speak to that?
"A:
Yeah.  Yes.
"Q:
I mean, the fact that the pathology report
doesn't show some big mass isn't inconsistent
with what they saw clinically during the
operation, is it?
"A:
Correct."
However, testifying elsewhere in his deposition, Dr.
DeSalvo expressed his opinion that Dr. Adcock breached the
standard of care because, according to Dr. DeSalvo, Dr. Adcock
entered the operating room intending to remove the right
ovary, not the left one.  According to Dr. DeSalvo, Dr. Adcock
entered the operating room with the mistaken belief that the
right ovary was the ovary that had been previously diagnosed
with a cyst based on the ultrasound images.  Dr. DeSalvo took
the position that, if Dr. Adcock had realized that the left
ovary was the ovary diagnosed with a cyst, Dr. Adcock would
have removed neither ovary, both ovaries, or only the left
ovary, but would not have removed only the right ovary.  In
this regard, Dr. DeSalvo testified:
"[Dr. DeSalvo]:  Okay, let's make some assumptions.
Let's assume that one ovary needs to come out
and let's assume that it's the left ovary
because that's the thing we've imaged fifty
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19
times. ... So, if you're going to get one of
them, you've got to get the left, okay?  Because
that's the one that images abnormal, okay?
"So, if you can happen to also get to the right
side, then, you get the right side. So ... [Dr.
Adcock] never had any intention of getting the
left. ...  And that is supported by his
preoperative 
diagnosis 
being 
right 
complex
ovarian cyst and it's also supported by the fact
that the consent had to be changed. ...  In that
consent, it doesn't say 'bilateral', but it's
okay to take out the right, absolutely.  But if
you're going to get one, get the [left].
"Q:
Why didn't he get the left?
"....
"A.
Because he couldn't see it.  But if you're going
to get one, get the ... left ovary.
"....
"So ... in my mind, you guys are all focusing on
the right ovary.  It's a distraction.  It's a
very simple process.  Left ovary, left ovary,
left ovary, left ovary.  Telephone call, right
ovary, and then [Dr. Adcock] writes right ovary.
Where did it go from left to right?  There was
a discrepancy in communication.  That's where
the error was made. ... The error was that [Dr.
Adcock] thought the cyst was on the ... right
side and that's ... the whole crux of the case."
At a later point in his deposition, Dr. DeSalvo testified
similarly:
"[Dr. DeSalvo:] ... [W]hen you review a case, you
have to try to understand what was going on and how
it was going on.  At [the conclusion of the
1060883
20
operation] before anything else happened except
finished [sic] the operation, [Dr. Adcock] sits down
writing some stuff down, he writes preoperative
diagnosis was right complex ovarian cyst.  That tells
me, in his mind, that what brought this patient into
this room was a right complex ovarian cyst.  And that
would explain why he operated on the right side only.
  
"Had -– had he known that it was a complex ovarian
cyst on the left and that was the one that really
needed to come out -– you know, now this is, you
know, Sunday quarterback, Monday morning quarterback
–- I'm the king of mixed metaphors -– you know, what
would he have done then?  And again, that's why I
think the range of the standard of care is that he
would have proceeded on the left side, he would have
stopped or he would have opened her, that the reality
is, is that the main thing that got her in the
operating room wasn't the right ovary, it was the
left."
When a defense attorney asked Dr. DeSalvo to explain Dr.
Adcock's postoperative note made later in the evening on the
date of the operation stating that Dr. Adcock attempted to
access the left adnexa but was unable to do so because of the
severe adhesions on that ovary, Dr. Desalvo stated that he
felt Dr. Adcock made that note because "at that time he
realizes, because he has checked his records or whatever,
that, okay, I should have taken the left out."  The defense
attorney then questioned Dr. DeSalvo as follows:
"Q:
Now, what are you basing that on?
"A:
I'm basing that on --
1060883
21
"Q:
Are you basing that on what these lawyers have
told you?
"A:
Discussions with –- everything.
"Q:
Well, you told me before that what's important
is what's in the record.  Now, where are you
getting this evidence?
"A:
How else -– there's no evidence.
"Q.
Where are you getting this evidence?
"A.
How else can I explain the difference in [Dr.
Adcock's] 
preoperative 
diagnosis 
that's
handwritten twice that says right side and,
then, his dictation at 5:00 p.m. that says left
side?
"Q.
He had the consent and the authority to remove
either or both [ovaries], didn't he?
"A.
He had the consent and the authority to do just
that, yes.
"Q:
Okay, thank you.  Now --
"A:
But it doesn't make sense as to why he didn't remove
the left.
"Q:
Well --
"A:
The preoperative diagnosis was left ovarian
cyst.
"Q:
Yes.
"A:
He says it on the dictation.
"Q:
All right, assume --
1060883
22
"A:
So, why do you proceed with a difficult
operation, cherry picking the one that's easy
and never getting the one that's hard?
"Q:
Assume for me that he went in expecting a left
complex ovarian cyst and he couldn't get to it,
first of all.
"A:
Wonderful, then stop.  We'll open her up.
"Q:
You've already testified it would be reasonable,
if he saw an explanation on the right side, to
go remove the right one, wouldn't you?
"A:
Preoperative diagnosis is --
"Q:
No.  No.  Answer my question.  Are you changing your
testimony from what you said awhile ago?
"A:
The preoperative diagnosis was left ovarian
cyst. ...  Then, why is it written here right
side?  Why is it written here right side?
"Q:
And I -- I'm not answering questions today.
"A:
Okay.  That's the question to me.  That's the
whole case.  That's it.
"Q:
You said the focus -- it's a misplaced focus on
the right side.  Did you know that that's why
they -- the claim in the lawsuit is that he
shouldn't have removed the right?  Have you ever
been told that?
"A:
No.
"Q:
Is this the -- you mean to tell me we are five
years out from this operation almost and the
first 
time 
you've 
ever 
been 
told 
is 
me
suggest[ing] it to you that they're claiming he
committed malpractice by removing the right?
You didn't know that?
1060883
23
"A:
No.
"....
"Q:
Dr. DeSalvo, during this operation, once he saw he
couldn't get to the left, was it an emergency to get
the left ovary out that day?
"A:
No.
"Q:
Okay.  Would it be reasonable to plan to come
back and get it at a later time?
"A:
Yes.
"Q:
If he had written postoperatively, instead of
right ovarian mass, left ovarian mass, you
wouldn't be criticizing him, would you?
"A:
No.
"Q:
We wouldn't -- you wouldn't be sitting here
today, would you?
"A:
No."
Elsewhere in his deposition, Dr. DeSalvo characterized the
surgery as a "wrong-site surgery," but he did not explain why
he characterized the surgery as a "wrong-site surgery."
Finally, with regard to the infliction of the injury to
Giles's bowel, Dr. DeSalvo testified:
"Q:
You do not express any criticism of the doctors
in this case by virtue of the fact that there
was a bowel injury, do you?
"A:
No, sir.
1060883
24
"Q:
That's an inherent and accepted risk of the
procedure?
"A:
In this particular case, yes."
Dr. DeSalvo further testified regarding the cause of the
bowel injury:
"Q:
All right.  Now I know you said it doesn't
matter and I know you're not critical, but do
you have any opinion of how the bowel was
injured?
"A:
I don't think we -- I think the best answer is
we don't know.
"Q:
Okay.
"A:
I think Dr. Adcock's explanation is reasonable,
but it's not really germane, because I'm not --
"Q:
Okay.
"A:
It wasn't a deviation.
"Q:
It doesn't matter whether it was a laceration or
an abrasion, does it?
"A:
This is when we talked earlier about -- I'm not
going to be critical about iatrogenic injuries.
Because in this particular case, this was --
unavoidable."
However, Dr. DeSalvo also testified that the infliction
of the injury to Giles's bowel represented a deviation from
the standard of care because, he said, the injury occurred
while Dr. Adcock was "trying to get out the right [ovary]
1060883
25
because it was the left that he should have been trying to get
out."  Dr. DeSalvo further testified that the right lower
bowel could have been injured on the right side if Dr. Adcock
had done a left-side surgery.
Regarding post-surgery treatment of the bowel injury, Dr.
DeSalvo testified that, based on his review of Giles's medical
records, at the time Giles was discharged from the hospital
"there was no evidence of a bowel perforation at that time."
Dr. DeSalvo opined that, on November 13, 2001, when Giles
returned to Dr. Adcock dehydrated and in pain, Dr. Adcock
should have sent her to the hospital that same day for tests
to investigate whether complications from a bowel injury were
causing her problems.  Dr. DeSalvo then testified:
"Q:
... You understand that, [Giles], in fact, was
admitted 
[to 
the 
hospital] 
the 
next 
day
[November 14, 2001]?
"A:
Yes.
"Q:
Can we agree that, if she had been admitted on
the 13th, as opposed to the 14th, her outcome
would have been the same.
"[Giles's attorney]:
We object to that.  I think
it's speculative.
"A:
I don't know that I can testify to that.
1060883
26
"Q:
Well, you can't testify, then, that admitting
her on the 13th would have changed her outcome,
can you?
"A:
I think that, as a gynecologist, I can testify
to the standard of care for the management of
postoperative gynecologic surgery.
"Q:
And I'm asking about causation?
"A:
And that's where I'm, you know, I don't pretend
to be a general surgeon.
"Q:
Okay.  And fair enough, because that'll save me
a bunch of questions.  You're not going to
testify on causation in this case, then, are
you?
"A:
You know, would it have made a difference for
day five or day six, you know, the 13th or the
14th?  No.  I don't have the knowledge to
testify to that."
Standard of Review
"'"This Court's review of a summary judgment is
de novo. Williams v. State Farm Mut. Auto. Ins. Co.,
886 So. 2d 72, 74 (Ala. 2003).  We apply the same
standard of review as the trial court applied.
Specifically, we must determine whether the movant
has made a prima facie showing that no genuine issue
of material fact exists and that the movant is
entitled to a judgment as a matter of law.  Rule
56(c), Ala. R. Civ. P.; Blue Cross & Blue Shield of
Alabama v. Hodurski, 899 So. 2d 949, 952-53 (Ala.
2004). In making such a determination, we must review
the evidence in the light most favorable to the
nonmovant.  Wilson v. Brown, 496 So. 2d 756, 758
(Ala. 1986). Once the movant makes a prima facie
showing that there is no genuine issue of material
fact, the burden then shifts to the nonmovant to
produce 'substantial evidence' as to the existence 
of
1060883
27
a genuine issue of material fact.  Bass v. SouthTrust
Bank of Baldwin County, 538 So. 2d 794, 797-98 (Ala.
1989); Ala. Code 1975, § 12-21-12.  '[S]ubstantial
evidence is evidence of such weight and quality that
fair-minded persons in the exercise of impartial
judgment can reasonably infer the existence of the
fact sought to be proved.'  West v. Founders Life
Assur. Co. of Fla., 547 So. 2d 870, 871 (Ala.
1989)."'"
Gooden v. City of Talladega, 966 So. 2d 232, 235 (Ala. 2007)
(quoting Prince v. Poole, 935 So. 2d 431, 442 (Ala. 2006)).
Analysis
A.
Giles's malpractice claims against Dr. Perry
We first consider whether a genuine issue of material fact
exists as to Giles's malpractice claims against Dr. Perry and
whether Dr. Perry is entitled to judgment as a matter of law
on those claims.  To prevail on her medical-malpractice claim
against Dr. Perry, Giles must prove, among other things, that
Dr. Perry violated the duty to "'exercise such reasonable
care, diligence, and skill as physicians ... in the same
general neighborhood, and in the same general line of
practice, ordinarily have and exercise in a like case.'"
Pruitt v. Zeiger, 590 So. 2d 236, 237 (Ala. 1991) (quoting
Ala. Code 1975, § 6-5-484(a)).  Furthermore, under the
circumstances of this case, Giles must establish the standard
1060883
In Pruitt, this Court noted the usual rule that the
4
plaintiff in a medical-malpractice action must prove the
standard of care and the physician's breach of the standard of
care by expert testimony and that an exception to the usual
rule exists when "the breach of the standard of care is
obvious to the average layperson."  Pruitt, 590 So. 2d at 238.
This exception is not applicable to the treatment provided by
Dr. Perry or the other defendants in this case.
28
of care applicable to Dr. Perry and Dr. Perry's breach thereof
through expert testimony.  See 590 So. 2d at 237-38.   However,
4
Giles submitted no expert testimony indicating that Dr. Perry
was in any way negligent with regard to her medical care and
treatment.  Giles's medical expert, Dr. Anthony DeSalvo,
acknowledged during his deposition he was "in no way
expressing any criticisms of Dr. Perry in this case."
Therefore, no genuine issue of material fact exists as to
Giles's malpractice claims against Dr. Perry, and Dr. Perry is
entitled to judgment as a matter of law on those claims.  We
affirm the trial court's judgment in favor of Dr. Perry with
regard to Giles's malpractice claims against him.
B.
Giles's malpractice claims against Dr. Adcock
We next consider whether the summary judgment was
appropriate with regard to Giles's malpractice claims against
Dr. Adcock.  To prevail on a medical-malpractice claim, a
plaintiff must prove "'1) the appropriate standard of care, 2)
1060883
29
the doctor's deviation from that standard, and 3) a proximate
causal connection between the doctor's act or omission
constituting the breach and the injury sustained by the
plaintiff.'"  Pruitt, 590 So. 2d at 238 (quoting Bradford v.
McGee, 534 So 2d 1076, 1079 (Ala. 1988)).  With exceptions not
applicable in this case, the plaintiff "must ... establish the
defendant physician's negligence through expert testimony as
to the standard of care and the proper medical treatment."
590 So. 2d at 237-38.  The plaintiff must also "prove by
expert testimony that the physician breached the standard of
care and by the breach proximately caused the plaintiff's
injury."  University of Alabama Health Servs. Found. v. Bush,
638 So. 2d 794, 798 (Ala. 1994).
Dr. Adcock carried his burden, as the movant for summary
judgment, to establish that no genuine issue of material fact
existed and that he was entitled to judgment as a matter of
law on Giles's medical-malpractice claims.  Specifically, Dr.
Adcock 
submitted 
his 
own 
affidavit 
setting 
forth 
his
qualifications as an expert in the field of gynecology, his
familiarity with the standard of care and with Giles's case,
his opinion that his treatment of Giles met the standard of
1060883
30
care, and his opinion that "nothing [he] did or failed to do
in any way caused or contributed to the injuries alleged in
[Giles's] Complaint."
Therefore, the burden then shifted to Giles to produce
substantial evidence demonstrating the existence of a genuine
issue of material fact.  See Gooden v. City of Talladega, 966
So. 2d 232, 235 (Ala. 2007) (quoting Prince v. Poole, 935 So.
2d 431, 442 (Ala. 2006)).  The malpractice claims against Dr.
Adcock as alleged in Giles's complaint center around three
basic theories: first, that in failing to abandon the
laparoscopic surgery altogether or to perform an open
laparotomy for removal of the left ovary after discovering
severe adhesions obscuring the left adnexum Dr. Adcock did not
meet the standard of care; second, that Dr. Adcock negligently
injured Giles's bowel during the surgery; and, third, that Dr.
Adcock failed to treat the bowel injury properly.  Giles's
medical expert opined that Dr. Adcock breached the standard of
care in that he performed the surgery while under the mistaken
belief that the right ovary, not the left, was the ovary that
had been diagnosed with a cyst before the surgery.  According
to Giles's expert, Dr. Adcock violated the standard of care by
1060883
31
removing the right ovary only but would have met the standard
of care had he removed the left ovary only, both ovaries, or
neither ovary.
Giles points to Dr. Simmons's surgical pathology report,
particularly 
Dr. 
Simmons's 
observation 
of 
"no 
gross
abnormalities" on the cut section of the right ovary and his
diagnosis of "[n]o pathologic abnormality" as evidence
indicating that the right ovary was normal and should not have
been removed during the surgery.  However, Giles presented no
expert testimony to the effect that one could infer from Dr.
Simmons's surgical pathology report that Dr Adcock's action in
removing the right ovary was below the standard of care.
Rather, Giles's medical expert, Dr. DeSalvo, confirmed that
the findings in the pathology report were not inconsistent
with Dr. Adcock's observations of an abnormality in the
operating room that led him to remove Giles's right ovary.
Dr. DeSalvo also testified that, given Giles's medical history
and complaints and the observations of the physicians in the
operating room, removing the right ovary was a reasonable
action.  Thus, the fact that no pathologic abnormality was
ultimately found on the right ovary when the ovary was
1060883
32
examined in the laboratory does not, on this record,
constitute substantial evidence indicating that Dr. Adcock's
actions in removing the right ovary during the operation fell
below the standard of care. 
Further, the testimony of Giles's medical expert is not
sufficient to satisfy Giles's burden of producing substantial
evidence demonstrating the existence of a genuine issue of
material fact as to her medical-malpractice claims against Dr.
Adcock.  Even if portions of her expert's testimony could be
said to be sufficient to defeat a summary-judgment motion when
viewed "abstractly, independently, and separately from the
balance of his testimony," "we are not to view testimony so
abstractly."  Hines v. Armbrester, 477 So. 2d 302, 304 (Ala.
1985).  See also Malone v. Daugherty, 453 So. 2d 721, 723-24
(Ala. 1984).  Rather, as this Court stated in Hines:
"We are to view the [expert] testimony as a whole,
and, so viewing it, determine if the testimony is
sufficient to create a reasonable inference of the
fact the plaintiff seeks to prove. In other words,
can we say, considering the entire testimony of the
plaintiff's expert, that an inference that the
defendant doctor had acted contrary to recognized
standards of professional care was created?"
477 So. 2d at 304-05; see also Pruitt v. Zeiger, 590 So. 2d
236, 239 (Ala. 1991) (quoting Hines, 477 So. 2d at 304-05).
1060883
33
Similarly, in Malone v. Dougherty, supra, another medical-
malpractice case, we noted that a portion of the plaintiff's
medical expert's testimony in that case, 
"when 
viewed 
abstractly, 
independently, 
and
separately from the balance of his sworn statement,
would appear sufficient to defeat the [defendant's]
motion for summary judgment.  But our review of the
evidence cannot be so limited.  The test is whether
[the plaintiff's medical expert's] testimony, when
viewed as a whole, was sufficient to create a
reasonable inference of the fact Plaintiff sought to
prove.  That is to say, could a jury, as the finder
of fact, reasonably infer from this medical expert's
testimony, or any part thereof when viewed against
the whole, that the defendant doctor had acted
contrary to the recognized standards of professional
care in the instant case.
"Thus, in applying this test, we must examine
the expert witness's testimony as a whole."
453 So. 2d at 723; see also Downey v. Mobile Infirmary Med.
Ctr., 662 So. 2d 1152, 1154 (Ala. 1995) (noting that portions
of a medical expert's testimony must be viewed in the context
of 
the 
expert's 
testimony 
as 
a 
whole); 
Pendarvis 
v.
Pennington, 521 So. 2d 969, 970 (Ala. 1988) ("[W]e are bound
to consider the expert testimony as a whole.").
Viewed as a whole, Dr. DeSalvo's testimony does not create
a reasonable inference that Dr. Adcock violated the standard
of care or performed a "wrong-site surgery" when, after
1060883
34
discovering severe adhesions obscuring the left adnexum, he
did not abandon the laparoscopic surgery altogether or perform
an open laparotomy to remove the left ovary.  Dr. Adcock's
testimony and postoperative notes indicate that he did not
remove the left ovary because he found extensive adhesions
that prevented him from adequately visualizing the left
adnexum.  There was not substantial evidence contradicting Dr.
Adcock's evidence that he investigated removing the left ovary
but decided not to proceed with removing that ovary because of
the adhesions.  Dr. DeSalvo testified in deposition that
deciding not to proceed with removing the left ovary after
discovering the extent of the adhesions on the left adnexum
would fall within the standard of care.  Further, Dr. DeSalvo
testified that proceeding with the laparoscopy, checking the
right ovary for abnormalities, and removing the right ovary
after discovering what appeared to be a cyst on the right
ovary would also have been within the standard of care, given
Dr. Adcock's observations when he looked at the right ovary
during the surgical procedure.  Thus, in light of his
testimony as a whole, the portions of Dr. DeSalvo's testimony
cited by Giles, including his conclusory statements that Dr.
1060883
35
Adcock performed a "wrong-site surgery," do not constitute
substantial evidence indicating that Dr. Adcock in fact
operated on the "wrong site" when he removed the right ovary
or that his actions in not abandoning the surgery altogether
or converting the procedure to an open laparotomy after
viewing the extent of the adhesions on the left ovary fell
below the applicable standard of care. 
Further, Dr. DeSalvo's opinion that Dr. Adcock violated
the standard of care by performing the surgery under the
mistaken belief that the right ovary, not the left, was the
ovary that had been diagnosed before the surgery with a cyst
also does not amount to substantial evidence of malpractice
when viewed in light of Dr. DeSalvo's testimony as a whole.
According to Dr. DeSalvo, Dr. Adcock would not have removed
only the right ovary had he realized it was the left ovary
that had previously been diagnosed as abnormal.  As Dr.
DeSalvo testified:
"Had -- had [Dr. Adcock] known that it was a complex
ovarian cyst on the left and that was the one that
really needed to come out -- you know, now this is,
you 
know, 
Sunday 
quarterback, 
Monday 
morning
quarterback -- I'm the king of mixed metaphors -- you
know, what would he have done then?  And again,
that's why I think the range of the standard of care
is that he would have proceeded on the left side, he
1060883
36
would have stopped or he would have opened her, that
the reality is, is that the main thing that got her
in the operating room wasn't the right ovary, it was
the left."
Assuming for the sake of argument that Dr. DeSalvo
correctly described Dr. Adcock's belief during the surgery as
to which ovary had previously been diagnosed as having a cyst,
Dr. DeSalvo's testimony, taken as a whole, does not constitute
substantial evidence that any belief by Dr. Adcock that the
previously diagnosed cyst was located on the right ovary
rather than the left caused him to remove the "wrong" ovary in
this case or to otherwise negligently perform the surgery.
See University of Alabama Health Servs. Found. v. Bush, 638
So. 2d at 798 (noting that a plaintiff in a medical-
malpractice case must prove through expert testimony that the
defendant 
physician's 
breach 
of 
the 
standard 
of 
care
proximately 
caused 
the 
plaintiff's 
injury). 
 
The
uncontradicted evidence establishes that, regardless of which
ovary he believed had been previously diagnosed as having a
cyst, Dr. Adcock investigated removing both ovaries during the
procedure, decided not to remove the left ovary because of the
risks 
and 
difficulties 
posed 
by 
the 
severe 
adhesions
surrounding that ovary, and removed the right ovary after the
1060883
37
laparoscopy revealed what appeared to be a cyst on that ovary.
Dr. DeSalvo opined that each of these three actions met the
applicable standard of care.  Thus, although Dr. DeSalvo
testified that Dr. Adcock had breached the standard of care by
entering the operating room under a mistaken belief as to
which ovary had previously been diagnosed with a cyst, neither
Dr. DeSalvo's testimony as a whole nor any part of it when
viewed against the whole supports the theory that Dr. Adcock's
belief as to which ovary was previously diagnosed with a cyst
proximately caused any injury to Giles in this particular
case.  See Bush, 638 So. 2d at 798; see also Malone, 453 So.
2d at 723-24; Downey v. Mobile Infirmary Med. Ctr., 662 So. 2d
1152, 1154 (Ala. 1995) ("This Court has consistently held that
the testimony of an expert witness in a medical malpractice
case must be viewed as a whole, and that a portion of it
should not be viewed abstractly, independently, or separately
from the balance of the expert's testimony."); Pruitt, 590 So.
2d at 239 (quoting Hines, 477 So. 2d at 304-05); Pendarvis v.
Pennington, 521 So. 2d at 970; Hines, 477 So. 2d at 304.
Additionally, when Mr. Giles's affidavit is viewed, as it
must be, in the light most favorable to Giles, Dr. Adcock's
1060883
38
apologies to Mr. Giles do not constitute expert testimony that
he injured Giles by breaching the standard of care.
"'The 
expert 
testimony 
which 
establishes
plaintiff's 
prima 
facie 
case 
may 
be 
that 
of
defendant, and extrajudicial admissions of defendant
have the same legal competency as direct expert
testimony to establish the critical averments of the
complaint, provided the statement constitutes an
admission of negligence of lack of the skill
ordinarily required for the performance of the work
undertaken; an extrajudicial statement amounting to
no more than an admission of bona fide mistake of
judgment or untoward result of treatment is not alone
sufficient to permit the inference of breach of duty.
...'"
Pappa v. Bonner, 268 Ala. 185, 191, 105 So. 2d 87, 92 (1958)
(quoting 70 C.J.S.  Physicians and Surgeons § 62, pp. 1008-
09).  When every reasonable factual inference is taken in
Giles's favor, Dr. Adcock's apologies, at most, amount to an
admission that he operated on Giles while he was under the
impression that the right ovary, rather than the left, was the
ovary that had been previously diagnosed with a cyst.
Further, Dr. Adcock's apologies indicate that he would have
performed the surgery differently had he realized during the
surgery that the left ovary was the ovary previously diagnosed
with a cyst.  However, Dr. Adcock's apologies, as recounted in
Mr. Giles's affidavit, do not contradict the evidence
1060883
39
indicating that Dr. Adcock investigated removing both ovaries,
decided not to proceed with removing the left ovary after
evaluating the risks and difficulties of removing that ovary,
and removed the right ovary after discovering what appeared to
be a cyst on that ovary.  Dr. Adcock's apologies also do not
contradict his testimony and the testimony of Giles's expert
that each of these three actions fell within the standard of
care.  In light of the testimony from Giles's expert as well
as from Dr. Adcock that each element of the surgery as
actually performed met the standard of care, it cannot be said
that Dr. Adcock's apologies qualify as "'an admission of
negligence of lack of the skill ordinarily required for the
performance of the work undertaken'" rather than "'no more
than an admission of bona fide mistake of judgment or untoward
result of treatment.'"  Pappa, 268 Ala. at 191, 105 So. 2d at
92.  Therefore, Mr. Giles's account of Dr. Adcock's apologies
does not provide substantial evidence creating a genuine issue
of material fact with regard to Giles's claims that Dr. Adcock
committed malpractice -- that is, that he negligently caused
injury to Mrs. Giles -- by removing the right ovary and not
removing the left or by entering the operating room under the
1060883
40
mistaken belief that the right ovary, not the left, had
previously been diagnosed with a cyst.
As to the injury to Giles's bowel, Dr. DeSalvo testified
that the infliction of the injury was "unavoidable" and
"wasn't a deviation" from the standard of care.  Dr. DeSalvo
later testified, after a break and upon questioning by Giles's
attorney, that the bowel injury represented a deviation from
the standard of care in that the injury occurred while Dr.
Adcock was "trying to get out the right [ovary] because it was
the left that he should have been trying to get out."
However, as explained above, Dr. DeSalvo's testimony as a
whole does not provide substantial evidence indicating that
Dr. Adcock breached the standard of care by removing the right
ovary. Rather, Dr. DeSalvo affirmatively testified multiple
times that investigating and ultimately removing the right
ovary during the surgery fell within the standard of care.
Taken as a whole, therefore, Dr. DeSalvo's testimony cannot
reasonably be interpreted as providing substantial evidence
that Dr. Adcock injured Giles's bowel as a result of breaching
the standard of care.
1060883
41
Dr. DeSalvo's testimony also fails to create a genuine
issue as to whether Dr. Adcock breached the standard of care
or injured Giles by failing to timely or adequately treat
Giles's bowel injury.  Although Dr. DeSalvo criticized Dr.
Adcock for waiting until November 14, 2001, to readmit Giles
to the hospital for treatment of the bowel injury, Dr. DeSalvo
further testified that he was not qualified to say whether
waiting until November 14 to admit Giles to the hospital made
any difference in Giles's case.  Taken as a whole, with every
reasonable inference drawn in favor of Giles, Dr. DeSalvo's
testimony does not constitute substantial evidence that Dr.
Adcock's treatment of Giles's bowel complications fell below
the standard of care or caused Giles any further injury.
Bush, 638 So. 2d at 798 (stating that the plaintiff in a
medical-malpractice action must prove by expert testimony
that, by breaching the standard of care, "the physician ...
proximately caused the plaintiff's injury").
For these reasons, Giles has not carried her burden to
rebut Dr. Adcock's prima facie showing that no genuine issue
of material fact exists.  Dr. Adcock was entitled to judgment
as a matter of law on Giles's malpractice claims, and the
1060883
42
trial court correctly entered a summary judgment on those
claims against him.
C.
Medical-negligence claims against Brookwood
Giles's medical-negligence claims against Brookwood are
based on allegations that various acts or omissions of
Brookwood or its agents caused Dr. Adcock to perform a "wrong-
site" surgery when he removed only her right ovary.  As
explained above, however, Giles failed to produce substantial
evidence creating a genuine issue of material fact as to
whether the removal of her right ovary was, in fact, a "wrong-
site surgery" rather than the proper exercise of Dr. Adcock's
professional judgment falling within the standard of care
governing the operation.  Therefore, Giles has also failed to
produce evidence creating a genuine issue of material fact as
to her medical-negligence claims against Brookwood.
D.
Failure-to-obtain-informed-consent claims
"The elements of a cause of action against a
physician for failure to obtain informed consent are:
(1) the physician's failure to inform the plaintiff
of all material risks associated with the procedure,
and (2) a showing that a reasonably prudent patient,
with all the characteristics of the plaintiff and in
the position of the plaintiff, would have declined
the procedure had the patient been properly informed
by the physician."
1060883
43
Phelps v. Dempsey, 656 So. 2d 377, 380 (Ala. 1995) (citing
Fain v. Smith, 479 So. 2d 1150 (Ala. 1985); Fore v. Brown, 544
So. 2d 955 (Ala. 1989)).
The test for determining whether the physician has
disclosed all the material risks to a patient is 
"a professional one, i.e., whether the physicians had
disclosed all the risks which a medical doctor
practicing in the same field and in the same
community would have disclosed.  Expert testimony is
required to establish what the practice is in the
general community."
Fain, 479 So. 2d at 1152.
Dr. Adcock established a prima facie case that no genuine
issue of material fact existed as to the first element of
Giles's failure-to-obtain-informed-consent claim and that he
was entitled to judgment as a matter of law on that claim.
According to Dr. Adcock's testimony and medical notes, he had
certain conversations with Giles regarding the intended scope
and 
potential 
risks 
of 
the 
operation, 
including 
the
possibility that either or both ovaries would be removed.  Dr.
DeSalvo testified that the conversations described by Dr.
Adcock's testimony and his contemporaneous notes would have
met the standard for informing Giles that he might remove
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44
either ovary, or both, and the risks and long-term effects of
doing so.
Therefore, the burden then shifted to Giles to put forth
evidence creating a genuine issue of material fact as to
whether Dr. Adcock failed to inform her of all material risks
associated with the procedure.  Giles did not meet this
burden.  She submitted no evidence that the conversations  Dr.
Adcock described did not occur.  At most, she provides
evidence indicating that she does not recall whether Dr.
Adcock had those conversations with her.  Giles's inability to
recall those conversations does not constitute substantial
evidence that the conversations did not occur, only that she
cannot remember whether they occurred or what Dr. Adcock
discussed with her.  Therefore, no genuine issue of material
fact exists, and Dr. Adcock is entitled to judgment as a
matter of law on Giles's failure-to-obtain- informed-consent
claim.
Giles's 
failure-to-obtain-informed-consent 
claims 
against
the remaining defendants fail as well, because there is no
genuine issue of material fact as to whether she was informed
of the material risks associated with the procedure, and Giles
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45
has produced no evidence, legal authority, or argument to
suggest that the other defendants breached a duty to provide
her with information beyond that provided by Dr. Adcock or to
obtain her consent.
E.
Spoliation-of-evidence claims
On appeal, Giles makes no argument and cites no authority
in support of her claims against the defendants alleging
spoliation of evidence; thus, she has abandoned any challenge
to the summary judgment on those claims, and we affirm the
trial court's summary judgment on those claims.  Butler v.
Town of Argo, 871 So. 2d 1, 20 (Ala. 2003)("'[I]t is not the
function of this Court to do a party's legal research or to
make and address legal arguments for a party ....'" (quoting
Dykes v. Lane Trucking, Inc., 652 So. 2d 248, 251 (Ala.
1994)); cf.  Chunn v. Whisenant, 877 So. 2d 595, 598 n.2 (Ala.
2003); Stover v. Alabama Farm Bureau Ins. Co., 467 So. 2d 251,
253 (Ala. 1985) ("While we attempt to avoid dismissing appeals
or affirming judgments on what may be seen as technicalities,
we are sometimes unable to address the merits of an
appellant's claim when the appellant fails to articulate that
claim and presents no authorities in support of that claim.").
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46
F.
Giles's claims against OB-GYN South
OB-GYN South did not move for a summary judgment.  The
trial court, however, entered a summary judgment for OB-GYN
South because Giles's claims against OB-GYN South were
derivative of her claims against Dr. Adcock and Dr. Perry and
because the trial court concluded that Dr. Adcock and Dr.
Perry were entitled to a summary judgment on all claims
against them.
Regarding the summary judgment for OB-GYN South, Giles
presents the following argument: 
"The summary ... judgment in favor of Dr. Adcock and
hence OB[-]GYN South should be reversed ....  OB[-]
GYN South had not filed a [summary-judgment] motion
and on this ground alone [the summary-judgment in
favor of OB-GYN South] might be subjected to reversal
but as the [trial] court aptly noted the action
against [OB-GYN South] is a derivative of the
claim[s] against Dr. Adcock and [Dr.] Perry hence the
Summary Judgment in [OB-GYN South's] favor should be
reversed."
This Court has previously held that "a trial court should
not sua sponte enter a summary judgment in favor of a party
who has not filed a motion seeking such a judgment without
affording 'an opportunity to present evidence in opposition to
it.'"  Alpine Assoc. Indus. Servs. v. Smitherman, 897 So. 2d
391, 395 (Ala. 2004) (quoting Moore v. Prudential Residential
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47
Servs. Ltd. P'ship, 849 So. 2d 914, 927 (Ala. 2002)).  This is
because "'[o]ne purpose of the procedural rights to notice and
hearing under Rule 56(c)[, Ala.R.Civ.P.,] is to allow the
nonmoving party the opportunity to discover and to present
evidence opposing the motion for summary judgment.'"  Moore,
849 So. 2d at 927 (quoting Van Knight v. Smoker, 778 So. 2d
801, 805 (Ala. 2000)).  We have reversed summary judgments
when neither party had filed a summary-judgment motion and
also when the losing party had no notice that a summary
judgment could be forthcoming and no opportunity to present
evidence in opposition to the summary judgment.  See, e.g.,
Moore, 849 So. 2d at 927 ("Because Rule 56 requires, at the
least, that the nonmoving party be provided with notice of a
summary-judgment motion and be given an opportunity to present
evidence in opposition to it, the trial court violates the
rights of the nonmoving party if it enters a summary judgment
on its own, without any motion having been filed by a
party.").   "'Rule 56 "is not prefaced upon whether or not the
opposing party may successfully defend against summary
judgment, [but] it does require that the opportunity to defend
be given"'" (quoting Van Knight, 778 So. 2d at 806, quoting in
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48
turn Tharp v. Union State Bank, 364 So. 2d 335, 338 (Ala. Civ
App. 1978)), although the right to notice of a potential
summary judgment may be waived. See id.
Giles does not argue that the summary judgment in favor
of OB-GYN South was improper because she had no notice or
opportunity to present evidence in opposition to such a
judgment.  Giles's statement that the summary judgment "might"
be reversed because OB-GYN South did not file a motion is not
sufficient to state or support an argument that Giles had no
opportunity to oppose the summary judgment for OB-GYN South.
Giles concedes that the trial court "aptly noted" that her
claims against OB-GYN South are derivative of her claims
against Dr. Adcock and Dr. Perry.  Because her claims against
OB-GYN South are premised solely on the principle of
respondeat superior, Giles's claims against OB-GYN South
require proof of the same elements as her claims against Dr.
Adcock and Dr. Perry and are premised on the same facts.  Cf.,
e.g., United Steelworkers of Am. AFL-CIO-CLC v. O'Neal, 437
So. 2d 101, 103 (Ala. 1983).  ("In a joint action in tort for
misfeasance or malfeasance against an agent and his principal,
where respondeat superior is the sole basis of recovery, a
1060883
49
verdict in favor of the agent works an automatic acquittal of
the principal so that a verdict against him must be set
aside.").
Giles presented briefs, arguments, and evidence to the
trial court in opposition to the summary-judgment motions of
Dr. Adcock and Dr. Perry.  Under the circumstances of this
case, Giles had sufficient notice and opportunity to fully
present all legal arguments and all relevant evidence in
opposition to the summary judgment the trial court ultimately
entered in favor of OB-GYN South on the ground that Dr. Adcock
and Dr. Perry were entitled to summary judgment.  Cf. Bibbs v.
MedCenter Inns of Alabama, Inc., 669 So. 2d 143, 144 & n.1
(Ala. 1995).
Giles contests the summary judgment in favor of OB-GYN
South by arguing that Dr. Adcock and Dr. Perry are not
entitled to a summary judgment; therefore, she argues, OB-GYN
South is not entitled to a summary judgment.  Because we hold
that Dr. Adcock and Dr. Perry are entitled to a summary
judgment on all claims against them, we reject Giles's
contention that OB-GYN South is not entitled to a summary
1060883
50
judgment on the ground that, according to Giles, Dr. Adcock
and Dr. Perry are not entitled to summary judgment.  
Accordingly, we affirm the summary judgment in favor of
OB-GYN South.  See Celotex Corp. v. Catrett, 477 U.S. 317,
323-24 (1986) ("One of the principal purposes of the summary
judgment rule is to isolate and dispose of factually
unsupported claims or defenses, and we think it should be
interpreted in a way that allows it to accomplish this
purpose."(footnote omitted)); Burton v. City of Belle Glade,
178 F.3d 1175, 1203-04 (11th Cir. 1999) ("A [trial] court
possesses the power to enter summary judgment sua sponte
provided the losing party 'was on notice that she had to come
forward with all of her evidence.'" (quoting Celotex, 477 U.S.
at 326)); Ex parte Novartis Pharms. Corp., 975 So. 2d 297, 300
n.2 (Ala. 2007) ("Federal cases construing the Federal Rules
of Civil Procedure are persuasive authority in construing the
Alabama Rules of Civil Procedure, which were patterned after
the Federal Rules of Civil Procedure." (citing Borders v. City
of Huntsville, 875 So. 2d 1168, 1176 n. 2 (Ala. 2003)); 10A
Charles Alan Wright, Arthur R. Miller & Mary Kay Kane, Federal
Practice and Procedure § 2720 (1998)("The major concern in
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51
cases in which the court wants to enter summary judgment
without a Rule 56 motion by either party is not really one of
power. ... Rather, the question raised ... is whether the
party against whom the judgment will be entered was given
sufficient advance notice and an adequate opportunity to
demonstrate why summary judgment should not be granted. ... If
the court provides this opportunity, however, there seems to
be no reason for preventing the court from acting on its own.
To conclude otherwise would result in unnecessary trials and
would be inconsistent with the objective of Rule 56 of
expediting the disposition of cases." (footnotes omitted));
see also Rule 56, Ala. R. Civ. P., Committee Comments on 1973
Adoption ("'Summary judgment ... is a liberal measure,
liberally designed for arriving at the truth.  Its purpose is
not to cut litigants off from their right of trial by jury if
they really have evidence which they will offer on a trial[;]
it is to carefully test this out[] in advance of trial by
inquiring and determining whether such evidence exists.'"
(quoting Whitaker v. Coleman, 115 F.2d 305, 307 (5th Cir.
1940)). 
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52
Conclusion
No genuine issue of material fact exists, and the
defendants are entitled to a judgment as a matter of law on
Giles's claims against them.  Therefore, we affirm the summary
judgment.
AFFIRMED.
See, Woodall, Smith, and Parker, JJ., concur.