Title: Deborah M. Kelley, as personal representative of the Estate of Ann Marie Moore, deceased v. Jackson Medical Center, LLC, and Ikram Hussain, M.D. (Appeal from Clarke Circuit Court: CV-20-900061).
Citation: N/A
Docket Number: SC-2023-0137
State: Alabama
Issuer: Alabama Supreme Court
Date: June 21, 2024

Rel: June 21, 2024 
 
 
 
 
 
 
 
Notice: This opinion is subject to formal revision before publication in the advance sheets of 
Southern Reporter.  Readers are requested to notify the Reporter of Decisions, Alabama 
Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-0650), of any 
typographical or other errors, in order that corrections may be made before the opinion is printed in 
Southern Reporter. 
 
 
SUPREME COURT OF ALABAMA 
 
OCTOBER TERM, 2023-2024 
_________________________ 
 
SC-2023-0137 
_________________________ 
 
Deborah M. Kelley, as personal representative of the Estate of 
Ann Marie Moore, deceased 
 
v.  
 
Jackson Medical Center, LLC, and Ikram Hussain, M.D. 
 
 
Appeal from Clarke Circuit Court 
(CV-20-900061) 
 
BRYAN, Justice. 
 
 
AFFIRMED.  NO OPINION. 
 
See Rule 53(a)(1) and (a)(2)(E), Ala. R. App. P. 
SC-2023-0137 
2 
 
 
Parker, C.J., and Shaw, Wise, Mendheim, Stewart, Mitchell, and 
Cook, JJ., concur. 
 
Sellers, J., concurs specially, with opinion.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SC-2023-0137 
3 
 
SELLERS, Justice (concurring specially). 
Deborah M. Kelley, as the personal representative of the estate of 
her deceased mother, Ann Marie Moore, appeals from a summary 
judgment entered by the Clarke Circuit Court in favor Jackson Medical 
Center, LLC ("Jackson Medical"), and Dr. Ikram Hussain, a physician 
employed by Jackson Medical, in this medical-malpractice, wrongful-
death action.  This Court affirms the summary judgment in favor of 
Jackson Medical and Dr. Hussain, without an opinion. I write specially 
to point out what an expert in a medical-malpractice, wrongful-death 
action should include in his or her testimony.  Here, Kelley's expert, Dr. 
Umer Ahmad, a board-certified physician in internal medicine, opined 
in his affidavit that Dr. Hussain's breach of the applicable standard of 
care probably caused Moore's death.  The relevant facts indicate that, 
on June 23, 2018, Moore, who was 74 years old at the time, was 
admitted to the hospital operated by Jackson Medical after suffering a 
pelvic fracture in a fall.  While at the hospital, Moore was administered 
narcotic pain medication for her pelvic fracture; she was also treated for 
various other medical conditions, including hyponatremia (a low level of 
sodium) and chronic obstructive pulmonary disease ("COPD") (a lung 
SC-2023-0137 
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disease).  Dr. Hussain, among others, treated Moore during her 
admission to the hospital. On June 30, 2018, Moore was transferred to 
Mobile Infirmary Medical Center to receive a higher level of care due to 
the levels of carbon dioxide in her blood.  On July 11, 2018, Moore was 
released to Jackson County Nursing Home, where she died on February 
3, 2019.  Moore's death certificate listed her cause of death as "Chronic 
Obstructive Pulmonary Disease." In her complaint, Kelley alleged, in 
relevant part, that Jackson Medical and Dr. Hussain had negligently 
and wantonly breached the standard of care owed to Moore by (1) 
administering or overprescribing narcotic pain medication; (2) failing to 
monitor her respiratory condition, leading to a decline in oxygen levels, 
or complete oxygen deprivation, to the brain; and (3) failing to treat her 
hyponatremia.  Kelley alleged that, as a proximate cause of the breach 
of the standard of care, Moore had suffered "respiratory distress or 
failure, a brain injury, and other injuries" and that she had died as a 
result of those injuries.  Kelley's expert, Dr. Ahmad, submitted an 
affidavit, testifying, in relevant part:    
"a.  [Dr. Hussain] breached the standard of 
care by not adequately addressing Mrs. Moore's 
hyponatremia. 
 
SC-2023-0137 
5 
 
"b.  The standard of care was breached by 
inadequately delaying treatment and response to 
Mrs. Moore's unresponsive condition and signs of 
respiratory distress or failure, including, but not 
limited [to,] monitoring arterial blood gases. 
 
"c.  The standard of care was breached by 
failing to monitor and delaying treatment for 
Mrs. 
Moore's 
response 
to 
narcotic 
pain 
medication. 
 
"6.  These breaches of the standard of care, more likely 
than not, caused her to suffer an anoxic brain injury and 
worsened her condition, significantly raising her mortality 
risk, and ultimately contributed to her decline.  In my 
opinion, prompt medical treatment, more likely than not, 
would have prevented her anoxic brain injury and her 
ultimate decline."  
 
(Emphasis added.) 
Dr. Ahmad's affidavit testimony not only failed to define the 
applicable standard of care, but also failed to establish a proximate 
causal connection between Dr. Hussain's treatment of Moore between 
June 23-30, 2018, and her death almost eight months later in February 
2019.  In essence, Dr. Ahmad opined that "prompt medical treatment, 
more 
likely 
than 
not, 
would 
have 
prevented 
[Moore's] 
anoxic brain injury and her ultimate decline." However, the necessary 
evidentiary foundation for such an opinion does not exist. For example, 
although Kelley alleged that Moore had suffered a "brain injury" as a 
SC-2023-0137 
6 
 
result of either declining oxygen levels or a complete deprivation of 
oxygen, Dr. Ahmad's affidavit provides no details or specific facts 
regarding when or how an anoxic brain injury occurred.  In fact, as 
Jackson Medical and Dr. Hussain assert in their brief, the discharge 
diagnoses from the hospital do not include anoxic brain injury, Moore 
was never diagnosed with anoxic brain injury during her admission to 
Mobile Infirmary, and the discharge diagnoses from Mobile Infirmary 
do not include anoxic brain injury. Jackson Medical and Dr. Hussain's 
brief at 21.  They also state that, over the course of her stay at Jackson 
County Nursing Home, Moore experienced various medical issues, 
including "episodes of hyponatremia with altered mental status, COPD 
exacerbation[,] and multiple falls with injuries resulting in contusions 
and lacerations to her head, a large hematoma to the right occipital 
region of her scalp[,] and lower extremity injuries."  Id.  Dr. Ahmad's 
affidavit provides no reference to Moore's cause of death, which is listed 
on the death certificate as COPD, a chronic medical condition that 
Moore suffered before, during, and after her discharge from the 
hospital.  Jennifer Dowling, a registered nurse at the hospital, stated in 
her affidavit that Moore was admitted to the hospital for pain 
SC-2023-0137 
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management as a result of her pelvic injury, as well as for treatment for 
her existing underlying medical conditions, including, among other 
things, COPD.  In a medical-malpractice, wrongful-death action, a 
similarly situated health-care provider must provide an expert opinion 
to show a direct causal connection between the deficiencies in medical 
care and the death of the patient.  Dr. Ahmad's affidavit contains no 
testimony of what actually caused Moore's death or how her death could 
have been prevented by Dr. Hussain.  As indicated, the death certificate 
states that Moore died of  COPD, a lung disease, but Dr. Ahmad's 
testimony discusses anoxic brain injury.  How an anoxic brain injury led 
to death from a lung disease such as COPD is a question of material 
fact, the answer to which is missing from Dr. Ahmad's testimony. Based 
on the foregoing, I view Dr. Ahmad's opinion, as stated in his affidavit, 
as merely conclusory.  See Bradley v. Miller, 878 So. 2d 262, 266 (Ala. 
2003) ("An expert witness's opinion that is conclusory, speculative, and 
without a proper evidentiary foundation cannot create a genuine issue 
of material fact.").  Accordingly, the trial court properly entered a 
summary judgment in favor of both Jackson Medical and Dr. Hussain.