Title: Clifford P. Black, M.D. v. Holley Lynn Comer
Citation: N/A
Docket Number: 1070652
State: Alabama
Issuer: Alabama Supreme Court
Date: June 19, 2009

REL: 06/19/2009 
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, 2008-2009 
1070652 
C l i f f o r d P. B l a c k , M.D. 
v. 
H o l l e y Lynn Comer 
Appeal from Calhoun 
C i r c u i t 
Court 
(CV-97-144) 
SMITH, 
J u s t i c e . 
C l i f f o r d P. B l a c k , M.D., a p p e a l s 
f r o m a j u d g m e n t 
e n t e r e d 
a g a i n s t h i m i n an a c t i o n 
f i l e d b y H o l l e y L y n n Comer. 
We 
a f f i r m . 
1070652 
F a c t s and P r o c e d u r a l H i s t o r y 
T h i s 
c a s e has p r e v i o u s l y b e e n b e f o r e 
t h i s 
C o u r t . 
See 
B l a c k v . Comer, 920 So. 2d 1083 ( A l a . 2005) ( " B l a c k I " ) . 
The 
f o l l o w i n g f a c t u a l b a c k g r o u n d 
f r o m B l a c k I i s r e l e v a n t t o t h i s 
a p p e a l : 
" I n e a r l y 1995 Comer, who was t h e n 40 y e a r s 
o l d , 
s o u g h t t r e a t m e n t f r o m h i s p r i m a r y - c a r e p h y s i c i a n f o r 
n i g h t 
s w e a t s , 
w e i g h t 
l o s s , 
and ' l a t e d a y ' f e v e r s . 
A d d i t i o n a l l y , 
he 
h a d 
r e c e n t l y 
e x p e r i e n c e d 
an 
a x i l l a r y 
( a r m p i t ) v e i n t h r o m b o s i s . 
Comer's 
c l i n i c a l 
p r e s e n t a t i o n p l a c e d a d i a g n o s i s o f lymphoma (a t u m o r 
o f t h e l y m p h n o d e s ) h i g h on t h e i n d e x o f s u s p i c i o n . 
H i s 
p r i m a r y - c a r e 
p h y s i c i a n 
o r d e r e d 
a CT 
s c a n 
o f 
Comer's abdomen. 
... 
"Comer's p r i m a r y - c a r e p h y s i c i a n 
r e f e r r e d 
Comer 
t o D r . B l a c k , a b o a r d - c e r t i f i e d g e n e r a l s u r g e o n , f o r 
a c o l o n o s c o p y . 
D r . B l a c k p e r f o r m e d t h e c o l o n o s c o p y 
and 
f o u n d 
n o t h i n g 
t o 
e x p l a i n 
Comer's 
symptoms. 
B e c a u s e 
t h o s e 
symptoms 
c o n t i n u e d 
t o 
s u g g e s t 
a 
lymphoma o r a t l e a s t some t y p e o f h i d d e n t u m o r , D r . 
B l a c k 
recommended 
a 
d i a g n o s t i c 
a b d o m i n a l 
l a p a r o s c o p y , a p r o c e d u r e i n w h i c h t h e d o c t o r 
v i e w s 
t h e 
a b d o m i n a l 
c a v i t y 
t h r o u g h 
a 
l a p a r o s c o p e , 
an 
o p t i c a l s u r g i c a l i n s t r u m e n t i n s e r t e d t h r o u g h a s m a l l 
c u t i n o r n e a r t h e p a t i e n t ' s 
n a v e l . 
I f D r . B l a c k 
c o u l d 
n o t 
a d e q u a t e l y 
e v a l u a t e 
Comer's 
c o n d i t i o n 
u s i n g 
t h e l a p a r o s c o p e , he w a n t e d t o c o n v e r t t h e 
p r o c e d u r e t o an e x p l o r a t o r y l a p a r o t o m y , a p r o c e d u r e 
i n 
w h i c h t h e s u r g e o n 
opens t h e p a t i e n t ' s 
abdomen. 
He 
e x p l a i n e d b o t h 
p r o c e d u r e s 
t o Comer. D r . 
B l a c k 
t o l d Comer 
t h a t he m i g h t ' h a v e t o remove t i s s u e i n 
o r d e r 
t o make a d i a g n o s i s o r t o 
t r e a t 
what [ h e ] 
f o u n d ' and t h a t he m i g h t have t o 'do some p r o c e d u r e 
... a p p r o p r i a t e f o r what he f o u n d . ' 
D r . B l a c k 
a l s o 
d i s c u s s e d w i t h Comer ' t h a t i t 
m i g h t become 
n e c e s s a r y 
t o 
remove 
a b n o r m a l 
t i s s u e 
d e p e n d i n g 
upon 
t h e 
2 
1070652 
f i n d i n g s o f t h e 
l a p a r o s c o p y and 
p o s s i b l e 
l a p a r o t o m y 
[ a n d ] Comer d i d c o n s e n t 
t o 
t h e 
r e m o v a l o f 
a b n o r m a l 
t i s s u e w h i c h c o u l d be 
t h e c a u s e o f h i s s y m p t o m s . ' 
"Comer 
was 
a d m i t t e d 
t o 
N o r t h e a s t 
A l a b a m a 
R e g i o n a l 
M e d i c a l 
C e n t e r 
on 
May 
18, 
1995. 
He 
a u t h o r i z e d 
D r . 
B l a c k 
t o p e r f o r m 
t h e 
p r o c e d u r e s 
by 
s i g n i n g a c o n s e n t f o r m t h a t r e a d , 
i n p e r t i n e n t 
p a r t : 
" ' I h e r e b y a u t h o r i z e Dr. 
C l i f f o r d B l a c k 
and 
whomsoever 
he 
... 
may 
d e s i g n a t e 
as 
a s s i s t a n t 
t o p e r f o r m upon m y s e l f 
... 
[a] 
D i a g n o s t i c 
L a p a r o s c o p y [ , ] 
p o s s i b l e 
open 
L a p a r o t o m y [ , ] 
and 
s u c h 
a d d i t i o n a l 
o p e r a t i o n s / p r o c e d u r e s d u r i n g t h e c o u r s e o f 
t h e above as a r e c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y o r 
a d v i s a b l e 
i n t h e 
e x e r c i s e 
o f 
p r o f e s s i o n a l j u d g m e n t . 
"'The 
n a t u r e 
and 
p u r p o s e 
o f 
t h e 
o p e r a t i o n / p r o c e d u r e , 
t h e 
r e a s o n 
i t 
i s 
c o n s i d e r e d 
n e c e s s a r y , 
t h e 
p o s s i b l e 
r i s k s 
i n v o l v e d , t h e 
p o s s i b i l i t y o f 
c o m p l i c a t i o n s 
and 
a l t e r n a t i v e methods o f t r e a t m e n t have 
b e e n 
f u l l y 
e x p l a i n e d 
t o 
me 
and 
t o 
my 
s a t i s f a c t i o n 
by 
my 
p h y s i c i a n 
o r 
h i s 
d e s i g n e e . 
" ' I f u r t h e r a c k n o w l e d g e t h a t no 
g u a r a n t e e s 
have b e e n made t o me c o n c e r n i n g t h e r e s u l t s 
o f t h e 
o p e r a t i o n / p r o c e d u r e . 
" ' I a u t h o r i z e 
t h e above named p h y s i c i a n 
t o 
p r o v i d e 
s u c h a d d i t i o n a l s e r v i c e s as deemed 
r e a s o n a b l e 
and 
n e c e s s a r y 
a c c o r d i n g 
t o 
m e d i c a l j u d g m e n t i n c l u d i n g , b u t n o t 
l i m i t e d 
t o , t h e s e r v i c e s o f p a t h o l o g y and 
r a d i o l o g y 
and 
t h e 
a d m i n i s t r a t i o n 
and 
m a i n t e n a n c e 
o f 
a n e s t h e s i a 
w i t h 
t h e 
e x c e p t i o n 
o f none. 
3 
1070652 
" ' I 
a u t h o r i z e 
t h e 
h o s p i t a l 
t o 
r e t a i n 
o r 
d i s p o s e 
o f 
any 
t i s s u e 
o r 
p a r t s 
i n 
a c c o r d a n c e w i t h t h e c u s t o m a r y p r a c t i c e 
o f 
t h e 
h o s p i t a l . 
" ' I have r e a d 
o r have had 
r e a d 
t o me 
t h e 
above s t a t e m e n t s 
and a g r e e w i t h a l l e x c e p t 
n o n e . ' 
"Comer's s i g n i n g o f t h e c o n s e n t 
f o r m was 
w i t n e s s e d 
by 
a 
n u r s e 
and 
by 
R e b e c c a 
C o m e r , Comer's 
w i f e . 
Comer d o e s n o t c h a l l e n g e i n any way 
t h e v a l i d i t y 
o r 
e n f o r c e a b i l i t y 
o f 
t h e 
w r i t t e n c o n s e n t ; 
r a t h e r , he 
s i m p l y a r g u e s t h a t Dr. B l a c k ' s a c t i o n s e x c e e d e d 
t h e 
s c o p e 
o f h i s c o n s e n t 
and 
t h a t t h e 
w r i t t e n 
c o n s e n t 
' s h o u l d be 
i n t e r p r e t e d by 
t h e c o u r t 
l i k e 
any 
o t h e r 
c o n t r a c t ' t o d e t e r m i n e 
i t s s c o p e . ( C o m e r ' s b r i e f , p. 
32.) 
" D u r i n g t h e l a p a r o s c o p y , Dr. B l a c k d i s c o v e r e d 'a 
h a r d - f e e l i n g 
t i s s u e ' 
i n Comer's 
r e t r o p e r i t o n e u m - ¬
t h e 
s p a c e b e t w e e n 
t h e 
l i n i n g 
o f 
t h e 
a b d o m i n a l 
and 
p e l v i c 
c a v i t i e s 
and 
t h e 
m u s c l e s 
and 
b o n e s 
o f 
t h e 
p o s t e r i o r 
a b d o m i n a l 
w a l l . 
He 
c o u l d 
n o t 
see 
t h i s 
t i s s u e w i t h t h e l a p a r o s c o p e b e c a u s e h i s v i e w o f 
t h e 
a r e a 
i n w h i c h 
t h e 
t i s s u e 
l a y was 
b l o c k e d 
by 
t h e 
l i n i n g 
and 
by 
a 
l a y e r 
o f 
f a t t y 
t i s s u e . 
Dr. 
B l a c k 
e l e c t e d 
t o 
c o n v e r t 
t h e 
p r o c e d u r e 
t o 
an 
open 
l a p a r o t o m y . 
"When 
Dr. 
B l a c k 
p a l p a t e d 
t h e 
r e t r o p e r i t o n e u m 
t h r o u g h 
t h e 
s u r g i c a l o p e n i n g , he 
f e l t Comer's 
r i g h t 
k i d n e y 
and what he b e l i e v e d t o be 
t h e 
l e f t 
k i d n e y . 
He a l s o p a l p a t e d t h e h a r d - f e e l i n g t i s s u e mass he 
had 
d e t e c t e d u s i n g t h e l a p a r o s c o p e , p o s i t i o n e d b e l o w h i p 
l e v e l , a l l t h e way 
i n t h e b a c k o f t h e a b d o m e n ; i t 
was 
s i t t i n g 
a t t h e m i d - l i n e on 
t h e 
l o w e s t 
p a r t 
o f 
t h e 
v e r t e b r a l 
c o l u m n b e f o r e 
t h e 
s p i n e 
c u r v e s 
i n t o 
t h e 
p e l v i s . 
The 
mass was 
l o c a t e d a b o u t 
10 
i n c h e s 
away f r o m where a k i d n e y n o r m a l l y w o u l d be 
s i t u a t e d . 
4 
1070652 
I t was 
composed o f s e v e r a l h a r d l o b e s and was 
q u i t e 
a 
b i t 
s m a l l e r 
t h a n 
a 
n o r m a l 
k i d n e y . 
Dr. 
B l a c k 
s u r g i c a l l y 
e n t e r e d 
t h e 
r e t r o p e r i t o n e u m 
t o 
f u r t h e r 
e x a m i n e t h e mass. 
B e c a u s e i t was 
e n c a s e d i n 
f a t t y 
t i s s u e he 
c o u l d n o t 
see 
i t c l e a r l y , b u t 
n o t h i n g 
he 
c o u l d 
see 
s u g g e s t e d 
t o 
him 
t h a t 
t h e 
mass 
was 
a 
k i d n e y . 
The 
v a s c u l a t u r e u s u a l l y p r e s e n t 
t o s e r v e 
a 
n o r m a l l y p l a c e d k i d n e y was 
n o t 
p r e s e n t . 
"Dr. 
B l a c k 
b e l i e v e d t h e 
i r r e g u l a r mass 
t o 
be 
m a t t e d 
t o g e t h e r 
l y m p h 
n o d e s , 
c h a r a c t e r i s t i c 
o f 
lymphoma and o t h e r t u m o r s . 
The 
l o c a t i o n o f t h e mass 
was 
t y p i c a l 
f o r 
l y m p h 
n o d e s 
and 
a t y p i c a l 
f o r 
a 
k i d n e y . 
Dr. 
B l a c k 
d i d n o t 
c o n s i d e r 
t h a t t h e mass 
m i g h t be 
an 
e c t o p i c ( m i s p l a c e d ) 
k i d n e y b e c a u s e 
he 
b e l i e v e d 
t h a t he 
had 
l o c a t e d b o t h 
k i d n e y s 
w h i l e 
he 
was 
p a l p a t i n g t h e o r g a n s . 
... 
" B e c a u s e 
Dr. 
B l a c k 
d i d n o t 
know t h e 
v a s c u l a r 
c o m p o s i t i o n 
o f t h e m a s s , he had 
t o c o n s i d e r w h e t h e r 
t a k i n g 
a s m a l l p o r t i o n o f 
i t t o s e n d t o 
p a t h o l o g y 
m i g h t c a u s e u n c o n t r o l l a b l e b l e e d i n g . 
A l s o , he 
was 
c o n c e r n e d 
t h a t 
i f 
he 
t o o k 
a 
s m a l l 
p o r t i o n 
f o r 
a n a l y s i s and i t was 
m a l i g n a n t , he w o u l d r u n t h e 
r i s k 
o f 
s e e d i n g 
t h e 
abdomen 
w i t h 
c a n c e r 
c e l l s 
and 
p o s s i b l y 
i n t r o d u c i n g 
c a n c e r 
t o 
o t h e r 
s i t e s . 
C o n s e q u e n t l y , 
Dr. B l a c k e l e c t e d t o remove t h e 
e n t i r e 
mass. 
A f t e r 
he 
had done s o , he 
c u t 
a s a m p l e 
f r o m 
t h e mass 
and 
s e n t 
i t t o 
t h e 
h o s p i t a l ' s 
p a t h o l o g y 
d e p a r t m e n t 
f o r 
i d e n t i f i c a t i o n . 
A b o u t 
15 
m i n u t e s 
l a t e r 
t h e 
p a t h o l o g y 
d e p a r t m e n t 
r e p o r t e d 
t h a t 
t h e 
s a m p l e seemed t o be k i d n e y t i s s u e . 
The r e m a i n d e r o f 
t h e mass was 
s u b m i t t e d t o p a t h o l o g y , and t h e e x c i s e d 
mass 
was 
u l t i m a t e l y 
d e t e r m i n e d 
t o 
be 
a 
74-gram 
k i d n e y 
w i t h 
a 
s h o r t 
segment 
o f 
u r e t e r 
a t t a c h e d . 
A c c o r d i n g 
t o Dr. 
B l a c k , a n o r m a l k i d n e y w e i g h s 
175 
g r a m s . 
Dr. 
B l a c k 
l a t e r 
t e s t i f i e d 
t h a t 
had 
he 
r e a l i z e d d u r i n g t h e s u r g i c a l p r o c e d u r e 
t h a t t h e mass 
was 
an e c t o p i c k i d n e y , he w o u l d n o t have r e m o v e d i t 
w i t h o u t 
f i r s t 
c o n s u l t i n g w i t h 
a u r o l o g i s t . 
A f t e r 
g e t t i n g t h e 
i n i t i a l r e p o r t f r o m p a t h o l o g y , Dr. 
B l a c k 
5 
1070652 
c l o s e d Comer's 
s u r g i c a l 
i n c i s i o n 
and 
s e n t 
him 
t o 
r e c o v e r y . 
"On 
t h e 
e v e n i n g 
o f 
t h e 
day 
o f 
s u r g e r y , 
Comer 
b e g a n 
h a v i n g 
t r o u b l e 
b r e a t h i n g 
and 
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 
p a i n . 
H i s 
s t o m a c h 
s t a r t e d 
s w e l l i n g , 
and 
h i s r e d b l o o d - c e l l c o u n t d r o p p e d . 
He 
was 
r e t u r n e d 
t o 
s u r g e r y , 
where 
i t was 
d i s c o v e r e d 
t h a t he was 
b l e e d i n g f r o m two 
s m a l l a r t e r i e s 
i n 
t h e 
a r e a where t h e e c t o p i c k i d n e y 
had b e e n r e m o v e d . 
The 
b l e e d i n g 
was 
s t o p p e d , 
and 
t h e r e 
were 
no 
o t h e r 
p o s t s u r g i c a l c o m p l i c a t i o n s . 
I n t h e weeks and months 
f o l l o w i n g t h e s u r g e r y , Comer g a i n e d w e i g h t , and 
t h e 
o t h e r 
symptoms t h a t 
had 
l e d him 
t o s e e k 
t r e a t m e n t 
f r o m Dr. 
B l a c k 
d i s a p p e a r e d . 
"On 
F e b r u a r y 14, 1997, Comer s u e d ... 
Dr. 
B l a c k , 
... 
a l l e g i n g 
t h e 
' w r o n g f u l 
t a k i n g ' 
o f 
h i s 
l e f t 
k i d n e y . 
Comer 
a s s e r t e d 
t h a t 
Dr. 
B l a c k 
had 
b e e n 
n e g l i g e n t 
i n v a r i o u s 
s p e c i f i e d 
r e s p e c t s 
i n c l u d i n g 
' f a i l i n g t o o b t a i n c o n s e n t . ' 
Comer a l s o a s s e r t e d 
a 
c l a i m a g a i n s t Dr. 
B l a c k o f 
' [ b ] a t t e r y i n r e m o v i n g a 
v i a b l e 
o r g a n w i t h o u t 
Comer's c o n s e n t . ' 
Dr. 
B l a c k 
a n s w e r e d t h e 
c o m p l a i n t , 
d e n y i n g 
l i a b i l i t y 
t o Comer 
on any 
o f t h e a d v a n c e d t h e o r i e s . 
"On 
S e p t e m b e r 
9, 
2 0 0 3 , Comer 
f i l e d 
a 
m o t i o n 
r e q u e s t i n g 
a 
p a r t i a l 
summary j u d g m e n t 
a g a i n s t 
Dr. 
B l a c k 
as 
t o 
l i a b i l i t y 
on 
t h e 
f a i l u r e - t o - o b t a i n -
c o n s e n t and 
b a t t e r y 
c l a i m s .
1 
f l 
"
1 A l t h o u g h 
Comer s t a t e d i n t h e m o t i o n t h a t 
he 
s o u g h t 
a summary j u d g m e n t 
'as 
t o 
l i a b i l i t y 
on 
h i s 
c l a i m s 
f o r f a i l u r e o f i n f o r m e d 
c o n s e n t and 
b a t t e r y ' 
( e m p h a s i s 
s u p p l i e d ) 
and 
a l t h o u g h 
Dr. 
B l a c k ' s 
o p p o s i t i o n 
t o 
t h e 
m o t i o n 
a d d r e s s e d , 
i n 
p e r t i n e n t 
p a r t , t h e c a u s e o f a c t i o n a r i s i n g o u t 
o f 
p e r f o r m i n g 
a 
m e d i c a l 
p r o c e d u r e 
w i t h o u t 
o b t a i n i n g 
i n f o r m e d 
6 
1070652 
c o n s e n t f r o m t h e p a t i e n t , t h e p a r t i e s 
s u b s e q u e n t l y 
c o n v e r t e d t h e c l a i m t o one a s s e r t i n g 
s i m p l y 
a 
l a c k 
o f c o n s e n t . 
S p e c i f i c a l l y , Comer f i l e d a r e s p o n s e t o 
Dr. 
B l a c k ' s 
o p p o s i t i o n i n w h i c h Comer e x p l a i n e d 
t h a t 
a f t e r he h a d f i l e d h i s 
m o t i o n , t h i s C o u r t i s s u e d i t s 
o p i n i o n 
i n C a i n v . H o w o r t h , 877 So. 2d 566 ( A l a . 
2 0 0 3 ) , 
d i s t i n g u i s h i n g b e t w e e n a c l a i m o f a l a c k o f 
c o n s e n t t o t h e p e r f o r m a n c e o f a m e d i c a l 
p r o c e d u r e 
and a c l a i m o f a ' l a c k o f i n f o r m e d c o n s e n t . ' 
Comer 
a d v i s e d 
t h a t t h e c l a i m he h a d p l e a d e d as ' n e g l i g e n c e 
i n 
f a i l i n g 
t o 
o b t a i n 
c o n s e n t ' 
s h o u l d 
now 
be 
u n d e r s t o o d 
as one 
' a l l e g [ i n g ] 
f a i l u r e 
t o 
o b t a i n 
c o n s e n t 
( r a t h e r t h a n i n f o r m e d c o n s e n t ) . ' 
Dr. 
B l a c k 
a c c e p t e d t h a t r e c a s t i n g o f t h e c l a i m , 
c h a r a c t e r i z i n g 
t h e 
c l a i m i n h i s s u b s e q u e n t s u b m i s s i o n t o t h e 
t r i a l 
c o u r t 
as one o f 
' l a c k 
o f c o n s e n t , ' 
and he 
d o e s 
l i k e w i s e 
t h r o u g h o u t 
h i s 
b r i e f s 
t o 
t h i s 
C o u r t . 
A c c o r d i n g l y , 
we 
a d d r e s s 
o n l y 
a 
c l a i m 
o f 
l a c k o f 
c o n s e n t , as o p p o s e d t o a c l a i m o f l a c k o f i n f o r m e d 
c o n s e n t . " 
920 
So. 2d a t 1 0 8 4 - 8 8 . 
The 
t r i a l 
c o u r t 
i n B l a c k 
I e n t e r e d a p a r t i a l 
summary 
j u d g m e n t 
i n f a v o r 
o f Comer on h i s l a c k - o f - c o n s e n t 
c l a i m . 
Comer l a t e r v o l u n t a r i l y d i s m i s s e d h i s 
r e m a i n i n g c l a i m s 
a g a i n s t 
Dr. 
B l a c k , 
" t h e r e b y 
g i v i n g 
t h e 
c o u r t ' s 
p a r t i a l 
summary 
j u d g m e n t t h e e f f e c t o f a f i n a l summary j u d g m e n t on t h e i s s u e 
o f 
l i a b i l i t y . " 
920 So. 2d a t 1088. 
The i s s u e o f damages was 
t r i e d 
b e f o r e a j u r y ; " t h e j u r y 
a w a r d e d Comer 
c o m p e n s a t o r y 
damages 
o f $15 
0,000--$100,000 
f o r Comer's 
p a s t 
p a i n 
and 
s u f f e r i n g and m e n t a l a n g u i s h a n d $50,000 f o r 
h i s f u t u r e m e n t a l 
a n g u i s h . " 
920 So. 2d a t 1088. 
7 
1070652 
T h i s C o u r t i n B l a c k I r e v e r s e d t h e j u d g m e n t e n t e r e d on 
t h a t 
j u r y 
v e r d i c t . 
We n o t e d t h e f o l l o w i n g a r g u m e n t s o f 
t h e 
p a r t i e s : 
"Comer made t h e f o l l o w i n g a r g u m e n t c o n c e r n i n g 
t h e 
i s s u e o f c o n s e n t i n h i s m o t i o n f o r a 
p a r t i a l 
summary j u d g m e n t : 
" ' [ C o m e r ] a g r e e d t o t h e r e m o v a l o f a t u m o r . 
I t i s 
u n d i s p u t e d t h a t no tumor was f o u n d a t 
t h e t i m e o f t h e s u r g e r y o r s i n c e . The f a c t 
t h a t 
D r . 
B l a c k 
n e g l i g e n t l y 
f a i l e d 
t o 
i d e n t i f y an o r g a n b e f o r e r e m o v i n g 
i t , 
d o e s 
n o t 
t h e n 
e x t e n d 
c o n s e n t 
t o t h e w r o n g f u l 
r e m o v a l 
o f an o r g a n , 
s i m p l y b e c a u s e D r . 
B l a c k f a i l e d t o i d e n t i f y t h e known p a r t o f 
t h e 
b o d y , a n d m i s t o o k 
t h e k i d n e y f o r a 
t u m o r . ... ' 
" I n o p p o s i t i o n t o Comer's m o t i o n f o r 
a 
p a r t i a l 
summary 
j u d g m e n t , 
D r . B l a c k made 
t h e 
f o l l o w i n g 
a r g u m e n t c o n c e r n i n g t h e s c o p e o f t h e c o n s e n t 
g i v e n 
by C o m e r : 
"'Dr. 
B l a c k 
h a d 
[ C o m e r ' s ] 
c o n s e n t 
t o 
p e r f o r m t h e open 
l a p a r o t o m y , 
t o p e r f o r m 
" s u c h 
a d d i t i o n a l 
o p e r a t i o n s / p r o c e d u r e s 
d u r i n g 
t h e c o u r s e 
o f t h e above 
as a r e 
c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y o r 
a d v i s a b l e i n t h e e x e r c i s e o f p r o f e s s i o n a l 
j u d g m e n t " 
[ a n d ] [ " ] t o 
p r o v i d e 
s u c h 
a d d i t i o n a l 
s e r v i c e s as deemed 
r e a s o n a b l e 
and 
n e c e s s a r y 
a c c o r d i n g 
t o 
m e d i c a l 
j u d g m e n t " a n d t o remove 
t i s s u e 
t h a t D r . 
B l a c k b e l i e v e d t o 
be a b n o r m a l o r c a n c e r o u s . 
A t t h e v e r y l e a s t , 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 D r . B l a c k , 
g e n u i n e i s s u e s o f m a t e r i a l f a c t e x i s t as 
t o 
w h e t h e r D r . B l a c k h a d [ C o m e r ' s ] c o n s e n t t o 
remove t h e e c t o p i c k i d n e y w h i c h he b e l i e v e d 
8 
1070652 
t o 
be 
a b n o r m a l 
t i s s u e 
t h a t 
was 
p o s s i b l y 
c a n c e r o u s . ' " 
920 
So. 
2d a t 
1090. 
We 
t h e n 
s t a t e d : 
"As 
d e m o n s t r a t e d by 
t h e 
a r g u m e n t s 
t h e 
p a r t i e s 
made t o t h e 
t r i a l 
c o u r t , t h e r e 
i s a d i s p u t e 
i n 
t h i s 
c a s e as t o t h e p a r a m e t e r s o f t h e c o n s e n t Comer gave 
Dr. 
B l a c k 
f o r t h e 
o p e r a t i o n . 
f l 
"... 
[T]he 
p i v o t a l i s s u e i n t h e 
t r i a l 
c o u r t 
and 
on 
a p p e a l 
i s t h e 
s c o p e 
o f 
t h e 
c o n s e n t . 
We 
a g r e e 
w i t h Dr. B l a c k t h a t t h e l a n g u a g e o f t h e c o n s e n t d o e s 
n o t 
s a y 
t h a t 
he 
had 
t h e 
a u t h o r i t y t o p e r f o r m 
o n l y 
t h o s e a d d i t i o n a l o p e r a t i o n s 
o r p r o c e d u r e s t h a t were 
i n 
f a c t 
t h e r a p e u t i c a l l y n e c e s s a r y 
o r 
a d v i s a b l e ; 
r a t h e r , 
t h e 
c o n s e n t p e r m i t t e d 
Dr. 
B l a c k 
t o 
p e r f o r m 
a d d i t i o n a l 
o p e r a t i o n s 
and 
p r o c e d u r e s 
he 
c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n 
t h e 
e x e r c i s e 
o f 
h i s 
p r o f e s s i o n a l 
j u d g m e n t . 
Comer 
u n d e r s t o o d 
t h a t 
n e i t h e r 
t h e 
l a p a r o s c o p y 
n o r 
t h e 
p o t e n t i a l 
l a p a r o t o m y 
was 
i n t e n d e d 
t o 
t a r g e t 
a 
p a r t i c u l a r 
o r g a n 
o r 
t o 
a c c o m p l i s h 
a 
p a r t i c u l a r 
t h e r a p e u t i c r e s u l t ; t h e p r o c e d u r e s were ' d i a g n o s t i c ' 
and 
e x p l o r a t o r y 
i n 
n a t u r e 
and 
c o u l d 
i n v o l v e 
t h e 
r e m o v a l 
o f 
t i s s u e , 
d e p e n d i n g 
upon 
Dr. 
B l a c k ' s 
f i n d i n g s d u r i n g t h e p r o c e d u r e s . 
Comer's c o n s e n t 
was 
b r o a d 
and 
e s s e n t i a l l y 
' o p e n - e n d e d , ' 
q u a l i f i e d 
and 
c o n d i t i o n e d 
o n l y 
by 
t h e 
l i m i t a t i o n 
t h a t 
any 
a d d i t i o n a l o p e r a t i o n s 
o r p r o c e d u r e s Dr. 
B l a c k 
m i g h t 
p e r f o r m must 
be 
t h o s e 
' c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n 
t h e 
e x e r c i s e 
o f 
p r o f e s s i o n a l j u d g m e n t . ' 
S u c h an a u t h o r i z a t i o n does 
n o t r e p r e s e n t 
u n l i m i t e d ' c a r t e b l a n c h e , ' h o w e v e r ; i t 
a p p l i e s o n l y t o t h o s e o p e r a t i o n s 
and p r o c e d u r e s 
t h a t 
m i g h t 
be 
c o n s i d e r e d 
t h e r a p e u t i c a l l y n e c e s s a r y 
o r 
a d v i s a b l e 
i n t h e e x e r c i s e o f p r o f e s s i o n a l j u d g m e n t . 
T h i s l a n g u a g e d i d n o t 
a u t h o r i z e 
Dr. 
B l a c k 
t o a c t 
i n 
9 
1070652 
w h a t e v e r 
f a s h i o n 
he 
m i g h t 
s u b j e c t i v e l y 
t h i n k 
a p p r o p r i a t e 
i n t h e e x e r c i s e 
o f h i s p r o f e s s i o n a l 
j u d g m e n t , r e g a r d l e s s o f how m e d i c a l l y 
a b e r r a n t 
t h a t 
j u d g m e n t m i g h t b e . R a t h e r , t h i s l a n g u a g e 
a u t h o r i z e d 
o n l y a d d i t i o n a l o p e r a t i o n s and p r o c e d u r e s 
c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
u n d e r t h e 
o b j e c t i v e 
s t a n d a r d 
o f 
c a r e 
t h a t 
c o n t r o l s 
t h e 
e x e r c i s e o f p r o f e s s i o n a l j u d g m e n t . 
" ' I n i t i a l l y , 
we 
n o t e 
t h a t 
t h e 
l e g i s l a t u r e has c o d i f i e d t h e s t a n d a r d 
o f 
c a r e t o be e x e r c i s e d by p h y s i c i a n s i n t h i s 
s t a t e . 
[ A l a . ] 
Code 
1975, 
§ 
6-5-484, 
p r o v i d e s 
as f o l l o w s : 
" ' " ( a ) 
I n 
p e r f o r m i n g 
p r o f e s s i o n a l 
s e r v i c e s 
f o r 
a 
p a t i e n t , 
a 
p h y s i c i a n ' s , 
s u r g e o n ' s , o r d e n t i s t ' s 
d u t y t o 
t h e 
p a t i e n t 
s h a l l be t o e x e r c i s e 
s u c h 
r e a s o n a b l e 
c a r e , 
d i l i g e n c e 
and 
s k i l l 
as 
p h y s i c i a n s , 
s u r g e o n s , 
and 
d e n t i s t s 
i n t h e 
same g e n e r a l n e i g h b o r h o o d , and 
i n 
t h e 
same 
g e n e r a l 
l i n e 
o f 
p r a c t i c e , 
o r d i n a r i l y 
have 
and 
e x e r c i s e i n a l i k e 
c a s e . I n t h e 
c a s e 
o f 
a 
h o s p i t a l 
r e n d e r i n g 
s e r v i c e s 
t o 
a 
p a t i e n t , 
t h e 
h o s p i t a l must u s e t h a t d e g r e e o f 
c a r e , 
s k i l l and d i l i g e n c e u s e d b y 
h o s p i t a l s 
g e n e r a l l y 
i n 
t h e 
c o m m u n i t y . 
" ' " ( b ) N e i t h e r 
a 
p h y s i c i a n , 
a 
s u r g e o n , 
a 
d e n t i s t 
n o r 
a 
h o s p i t a l 
s h a l l be 
c o n s i d e r e d 
an 
i n s u r e r o f t h e s u c c e s s f u l 
i s s u e 
o f t r e a t m e n t o r s e r v i c e . " ' 
"Shumaker v . J o h n s o n , 
571 So. 2d 991 , 
993 ( A l a . 
1 9 9 0 ) 
( d e c l a r i n g 
j u r y 
c h a r g e 
i n 
a 
m e d i c a l -
10 
1070652 
m a l p r a c t i c e c a s e t h a t a p h y s i c i a n i s n o t 
l i a b l e 
' f o r 
an h o n e s t m i s t a k e o r an h o n e s t e r r o r o r j u d g m e n t ' t o 
be 
r e v e r s i b l e e r r o r 
b e c a u s e 
§ 6-5-484 
' c l e a r l y 
s t a t e s an o b j e c t i v e s t a n d a r d 
f o r t h e p e r f o r m a n c e 
o f 
p r o f e s s i o n a l d u t i e s by 
p h y s i c i a n s ' ) . 
"Dr. B l a c k e x p l a i n e d 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 h e 
c o n v e r g e n c e 
o f 
s i g n s , 
symptoms, 
d i a g n o s t i c 
p o s s i b i l i t i e s , 
i n t r a o p e r a t i v e 
f i n d i n g s , 
and 
t h e 
t h e r a p e u t i c 
o p t i o n s 
a v a i l a b l e 
u n d e r 
t h e 
c i r c u m s t a n c e s 
t h a t c a u s e d him t o c o n s i d e r t h e 
c o u r s e 
o f c o n d u c t he 
t o o k t o be 
t h e r a p e u t i c a l l y n e c e s s a r y 
o r 
a d v i s a b l e 
i n 
t h e 
e x e r c i s e 
o f 
h i s 
p r o f e s s i o n a l 
j u d g m e n t . 
o r 
i n 
" ' ( a ) 
I n 
any 
a c t i o n 
f o r 
i n j u r y 
damages 
o r 
w r o n g f u l 
d e a t h , 
w h e t h e r 
c o n t r a c t o r i n t o r t , 
a g a i n s t 
a h e a l t h 
c a r e 
p r o v i d e r 
f o r 
b r e a c h 
o f 
t h e 
s t a n d a r d 
o f 
c a r e , 
t h e 
p l a i n t i f f s h a l l have t h e 
b u r d e n 
o f p r o v i n g by 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 
h e a l t h 
c a r e 
p r o v i d e r 
f a i l e d 
t o 
e x e r c i s e 
s u c h r e a s o n a b l e 
c a r e , 
s k i l l , 
and 
d i l i g e n c e 
as 
o t h e r 
s i m i l a r l y 
s i t u a t e d 
h e a l t h 
c a r e 
p r o v i d e r s 
i n 
t h e 
same 
g e n e r a l 
l i n e 
o f 
p r a c t i c e 
o r d i n a r i l y have and 
e x e r c i s e i n a 
l i k e 
c a s e . ' 
" A l a . 
Code 1975, 
§ 6-5-548. 
"When 
t h e 
t r i a l 
j u d g e 
e n t e r e d 
t h e 
p a r t i a l 
summary j u d g m e n t i n f a v o r o f Comer, c o n c l u d i n g 
t h a t 
D r . 
B l a c k 
d i d 
n o t 
have 
m e d i c a l l y 
and 
l e g a l l y 
e f f i c a c i o u s 
c o n s e n t 
t o 
remove 
t h e 
t i s s u e 
mass 
u l t i m a t e l y 
d e t e r m i n e d 
t o be 
a k i d n e y , 
i t had 
b e e n 
n e i t h e r 
p r o v e n 
n o r 
d i s p r o v e n 
t h a t 
D r . 
B l a c k 
had 
e x e r c i s e d t h a t 
l e v e l 
o f r e a s o n a b l e 
c a r e , 
s k i l l , 
and 
d i l i g e n c e 
as 
a n o t h e r b o a r d - c e r t i f i e d s u r g e o n 
w o u l d 
have 
e x e r c i s e d 
i n 
a 
l i k e 
c a s e , 
g i v e n 
a l l o f 
t h e 
f a c t s 
t h e n 
a v a i l a b l e 
t o 
D r . 
B l a c k . 
W h e t h e r 
D r . 
B l a c k 
f a i l e d 
t o 
s a t i s f y 
t h e 
' r e l a t i v e 
s t a n d a r d 
o f 
c a r e ' 
i n t h a t r e g a r d 
(§ 6 - 5 - 5 4 8 ( e ) , A l a . Code 
1 9 7 5 ) 
11 
1070652 
r e q u i r e s 
p r o o f , 
one 
way 
o r 
t h e 
o t h e r , 
by 
e x p e r t 
t e s t i m o n y . 
I t c o u l d n o t be 
r e s o l v e d m e r e l y 
on 
t h e 
b a s i s 
o f 
a l a y u n d e r s t a n d i n g , 
w h i c h 
r e q u i r e s 
o n l y 
common 
k n o w l e d g e 
and 
e x p e r i e n c e . 
See 
Ex 
p a r t e 
H e a l t h S o u t h 
C o r p . , 851 
So. 
2d 33 
( A l a . 2 0 0 2 ) . Thus, 
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 
e x i s t e d i n 
t h a t 
r e g a r d , p r e c l u d i n g a summary j u d g m e n t on 
t h e 
i s s u e 
o f 
l i a b i l i t y . " 
920 
So. 
2d a t 1 0 9 0 - 9 2 . 
On 
remand, D r . 
B l a c k moved f o r a summary j u d g m e n t . 
A t 
t h e h e a r i n g on t h a t m o t i o n , 
t h e 
t r i a l c o u r t i n d i c a t e d i t w o u l d 
d e n y t h e m o t i o n . 
No o r d e r was 
e n t e r e d on t h e m o t i o n , 
h o w e v e r , 
and 
t h e c a s e 
u l t i m a t e l y was 
t r i e d b e f o r e 
a j u r y . 
A t 
t r i a l , 
D r . 
B l a c k moved 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 ("JML") a t 
t h e c l o s e o f Comer's c a s e - i n - c h i e f and a g a i n a t t h e c o n c l u s i o n 
o f a l l t h e e v i d e n c e . 
The 
t r i a l c o u r t d e n i e d b o t h m o t i o n s , 
and 
t h e 
j u r y 
r e t u r n e d 
a v e r d i c t 
i n Comer's f a v o r , a w a r d i n g 
h i m 
$ 3 5 0 , 0 0 0 i n c o m p e n s a t o r y damages, i n c l u d i n g damages f o r m e n t a l 
a n g u i s h . 
The 
t r i a l 
c o u r t e n t e r e d a j u d g m e n t on t h a t 
v e r d i c t . 
D r . 
B l a c k 
f i l e d 
a 
r e n e w e d 
m o t i o n 
f o r 
a 
JML 
o r , 
a l t e r n a t i v e l y , f o r a new 
t r i a l . 
D r . B l a c k a r g u e d , among o t h e r 
t h i n g s , t h a t Comer had n o t o f f e r e d e x p e r t t e s t i m o n y 
i n d i c a t i n g 
t h a t 
D r . 
B l a c k 
had 
e x c e e d e d 
t h e 
s c o p e 
o f 
t h e 
c o n s e n t . 
A l t e r n a t i v e l y , D r . B l a c k moved f o r a r e m i t t i t u r o f t h e damages 
12 
1070652 
a w a r d . 
The 
t r i a l 
c o u r t 
d e n i e d 
D r . 
B l a c k ' s 
p o s t j u d g m e n t 
m o t i o n , and D r . 
B l a c k 
a p p e a l s . 
S t a n d a r d 
o f R e v i e w 
"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 
t o 
a 
r u l i n g on a m o t i o n f o r a JML 
as t h e 
t r i a l c o u r t u s e d 
i n 
i n i t i a l l y 
d e c i d i n g t h e m o t i o n . 
T h i s s t a n d a r d 
i s 
' 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 . ' 
H a t h c o c k v. Wood, 
815 
So. 2d 502, 
506 
( A l a . 2 0 0 1 ) . 
We must d e c i d e w h e t h e r 
t h e r e was 
s u b s t a n t i a l 
e v i d e n c e , when v i e w e d 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 
p l a i n t i f f , 
t o w a r r a n t 
a 
j u r y 
d e t e r m i n a t i o n . 
C i t y 
o f 
B i r m i n g h a m 
v. 
S u t h e r l a n d , 
834 
So. 
2d 
755 
( A l a . 
2 0 0 2 ) . 
I n 
F l e e t w o o d 
E n t e r s . , 
I n c . 
v. 
H u t c h e s o n , 
791 
So. 
2d 
920, 
923 
( A l a . 
2 0 0 0 ) , 
t h i s 
C o u r t 
s t a t e d 
t h a t 
' " [ s ] u b s t a n t i a l e v i d e n c e 
i s e v i d e n c e 
o f s u c h w e i g h t 
and q u a l i t y t h a t f a i r - m i n d e d p e r s o n s i n t h e e x e r c i s e 
o f 
i m p a r t i a l 
j u d g m e n t 
c a n 
r e a s o n a b l y 
i n f e r 
t h e 
e x i s t e n c e 
o f 
t h e 
f a c t 
s o u g h t 
t o be 
p r o v e d . " ' 
791 
So. 
2d 
a t 
923 
( q u o t i n g 
West 
v. 
F o u n d e r s 
L i f e 
A s s u r a n c e Co. 
o f F l o r i d a , 
547 
So. 
2d 870, 
871 
( A l a . 
19 8 
9 ) ) . " 
A l a b a m a Power 
Co. 
v. 
A l d r i d g e , 
854 
So. 
2d 
554 , 
560 
( A l a . 
2 0 0 2 ) . 
D i s c u s s i o n 
Dr. B l a c k a r g u e s 
f i r s t 
t h a t he was 
e n t i t l e d t o a JML. 
I n 
s u p p o r t 
o f t h a t a r g u m e n t , Dr. B l a c k c o n t e n d s t h a t " [ t ] h e o n l y 
i s s u e 
b e f o r e 
t h e 
C o u r t 
i n B l a c k 
I was 
t h e 
p r o p r i e t y o f 
t h e 
j u d g m e n t 
on 
t h e 
c o n s e n t / b a t t e r y 
c l a i m 
and 
t h e 
o n l y 
i s s u e 
13 
1070652 
p r o p e r l y b e f o r e t h e c o u r t on 
r e t r i a l was 
t h e c o n s e n t 
c l a i m . " 
He c o n t e n d s 
t h a t 
" t h e 
o n l y b r e a c h 
o f t h e 
s t a n d a r d 
o f c a r e 
t h a t 
was 
p r o p e r l y 
a t 
i s s u e 
on 
remand 
i n 
t h i s 
c a s e 
was 
Dr. 
B l a c k ' s a l l e g e d b r e a c h 
r e l a t e d t o t h e 
c o n s e n t - - t h a t 
i s , w h e t h e r Dr. B l a c k 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 
d e t e r m i n i n g , 
i n 
h i s 
p r o f e s s i o n a l j u d g m e n t 
and 
b a s e d on t h e i n f o r m a t i o n t h e n a v a i l a b l e t o him, 
t h a t 
r e m o v a l o f t h e mass was 
t h e r a p e u t i c a l l y n e c e s s a r y 
o r 
a d v i s a b l e . 
The 
o n l y b r e a c h 
o f t h e s t a n d a r d o f 
c a r e 
t h a t w o u l d s u p p o r t 
[Comer's] l a c k o f c o n s e n t 
c l a i m 
was 
a b r e a c h 
by 
Dr. 
B l a c k 
i n d e t e r m i n i n g , 
i n h i s 
p r o f e s s i o n a l j u d g m e n t , t h a t r e m o v a l o f t h e mass 
was 
t h e r a p e u t i c a l l y n e c e s s a r y 
o r a d v i s a b l e , and 
[Comer] 
was 
r e q u i r e d t o 
o f f e r 
e x p e r t 
t e s t i m o n y 
as 
t o 
t h a t 
s p e c i f i c b r e a c h 
t o meet h i s b u r d e n o f p r o o f . 
B l a c k 
I , 
920 
So. 
2d a t 1092. 
The 
e x p e r t t e s t i m o n y had 
t o 
be 
s p e c i f i c a l l y 
t a i l o r e d 
t o t h a t p a r t i c u l a r 
b r e a c h 
o f t h e 
s t a n d a r d 
o f c a r e b e c a u s e a l l o t h e r 
b r e a c h e s 
o f t h e s t a n d a r d o f c a r e t h a t were o r c o u l d have b e e n 
p l e a d [ e d ] 
were 
p r e c l u d e d 
by 
[Comer's] 
v o l u n t a r y 
d i s m i s s a l 
o f 
a l l o t h e r 
c l a i m s 
and 
t h e 
j u d g m e n t 
a p p e a l e d 
i n B l a c k I . " 
Dr. B l a c k ' s b r i e f , pp. 
3 0 - 3 1 . 
We 
a g r e e w i t h Dr. 
B l a c k 
t h a t t h e 
c o n s e n t 
c l a i m was 
t h e 
o n l y c l a i m b e f o r e t h e 
t r i a l c o u r t on remand. 
As n o t e d 
a b o v e , 
t h i s C o u r t 
i n B l a c k I e x p l a i n e d : 
" [ T ] t h e 
c o n s e n t 
p e r m i t t e d 
Dr. 
B l a c k 
t o 
p e r f o r m 
a d d i t i o n a l 
o p e r a t i o n s 
and 
p r o c e d u r e s 
he 
c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n 
t h e 
e x e r c i s e 
o f h i s p r o f e s s i o n a l j u d g m e n t . 
... 
Comer's 
c o n s e n t 
was 
b r o a d 
and 
e s s e n t i a l l y 
' o p e n - e n d e d , ' 
q u a l i f i e d 
and 
c o n d i t i o n e d 
o n l y 
by 
t h e 
l i m i t a t i o n 
t h a t 
any 
a d d i t i o n a l 
o p e r a t i o n s 
o r 
p r o c e d u r e s 
Dr. 
B l a c k 
m i g h t 
p e r f o r m 
must 
be 
t h o s e 
' c o n s i d e r e d 
14 
1070652 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n t h e 
e x e r c i s e 
o f 
p r o f e s s i o n a l 
j u d g m e n t . ' 
S u c h 
an 
a u t h o r i z a t i o n 
does n o t r e p r e s e n t 
u n l i m i t e d 
' c a r t e 
b l a n c h e , ' 
h o w e v e r ; 
i t a p p l i e s 
o n l y 
t o 
t h o s e 
o p e r a t i o n s a n d p r o c e d u r e s 
t h a t m i g h t be c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n t h e 
e x e r c i s e o f p r o f e s s i o n a l j u d g m e n t . 
T h i s 
l a n g u a g e 
d i d 
n o t a u t h o r i z e D r . B l a c k 
t o a c t i n w h a t e v e r 
f a s h i o n he m i g h t 
s u b j e c t i v e l y 
t h i n k a p p r o p r i a t e i n 
t h e 
e x e r c i s e 
o f 
h i s 
p r o f e s s i o n a l 
j u d g m e n t , 
r e g a r d l e s s o f how m e d i c a l l y a b e r r a n t 
t h a t j u d g m e n t 
m i g h t be . 
R a t h e r , 
t h i s 
l a n g u a g e 
a u t h o r i z e d 
o n l y 
a d d i t i o n a l 
o p e r a t i o n s 
a n d 
p r o c e d u r e s 
c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r a d v i s a b l e 
u n d e r t h e 
o b j e c t i v e 
s t a n d a r d 
o f 
c a r e 
t h a t 
c o n t r o l s t h e 
e x e r c i s e o f p r o f e s s i o n a l j u d g m e n t . " 
920 So. 2d a t 1091 ( e m p h a s i s a d d e d ) . 
We a l s o s t a t e d i n B l a c k 
I t h a t e x p e r t t e s t i m o n y was r e q u i r e d t o d e t e r m i n e 
w h e t h e r D r . 
B l a c k ' s d e c i s i o n t o remove t h e 
mass f e l l b e l o w t h e 
a p p l i c a b l e 
o b j e c t i v e s t a n d a r d o f c a r e : 
"When 
t h e 
t r i a l 
j u d g e 
e n t e r e d 
t h e 
p a r t i a l 
summary j u d g m e n t i n f a v o r o f Comer, c o n c l u d i n g 
t h a t 
Dr. 
B l a c k 
d i d n o t have 
m e d i c a l l y 
a n d 
l e g a l l y 
e f f i c a c i o u s 
c o n s e n t 
t o remove 
t h e 
t i s s u e 
mass 
u l t i m a t e l y 
d e t e r m i n e d 
t o be a k i d n e y , i t 
h a d b e e n 
n e i t h e r 
p r o v e n n o r d i s p r o v e n 
t h a t D r . B l a c k h a d 
e x e r c i s e d t h a t l e v e l o f r e a s o n a b l e 
c a r e , 
s k i l l , a n d 
d i l i g e n c e as a n o t h e r 
b o a r d - c e r t i f i e d 
s u r g e o n 
w o u l d 
have 
e x e r c i s e d i n a 
l i k e 
c a s e , 
g i v e n 
a l l o f t h e 
f a c t s 
t h e n 
a v a i l a b l e 
t o D r . B l a c k . 
W h e t h e r D r . 
B l a c k 
f a i l e d t o s a t i s f y t h e ' r e l a t i v e 
s t a n d a r d o f 
c a r e ' i n t h a t r e g a r d (§ 6 - 5 - 5 4 8 ( e ) , A l a . Code 1975) 
r e q u i r e s 
p r o o f , 
one way o r t h e o t h e r , by 
e x p e r t 
t e s t i m o n y . 
I t c o u l d n o t be r e s o l v e d m e r e l y on t h e 
b a s i s o f a l a y u n d e r s t a n d i n g , 
w h i c h 
r e q u i r e s 
o n l y 
common 
k n o w l e d g e 
a n d 
e x p e r i e n c e . 
See Ex 
p a r t e 
H e a l t h S o u t h 
C o r p . , 851 So. 2d 33 ( A l a . 2 0 0 2 ) . " 
15 
1070652 
920 
So. 
2d a t 
1092. 
A t 
t r i a l , Comer o f f e r e d t h e t e s t i m o n y o f Dr. Guy 
V o e l l e r , 
a b o a r d - c e r t i f i e d g e n e r a l s u r g e o n , 
s i m i l a r l y 
s i t u a t e d t o 
Dr. 
B l a c k . 
Dr. 
B l a c k ' s 
b r i e f 
t o 
t h i s 
C o u r t 
s u m m a r i z e s 
Dr. 
V o e l l e r ' s t e s t i m o n y 
as 
s t a t i n g t h a t t h e r e were 
" o n l y two i n s t a n c e s i n w h i c h Dr. B l a c k d e v i a t e d f r o m 
t h e 
a p p l i c a b l e s t a n d a r d 
o f c a r e . 
F i r s t , 
a c c o r d i n g 
t o 
V o e l l e r , 
Dr. 
B l a c k 
s h o u l d 
have 
s u s p e n d e d 
t h e 
o p e r a t i o n w h i c h was 
u n d e r w a y 
a t 
t h e 
p o i n t 
i n 
t i m e 
when he e n c o u n t e r e d 
t h e mass t h a t was 
n o t 
i d e n t i f i e d 
i n 
t h e 
r a d i o l o g y 
r e p o r t 
o f 
Dr. 
[ D a n i e l 
S h e r m a n ] 
F o e c k l e .
[ 1 ] 
S e c o n d , i f Dr. B l a c k s u s p e c t e d 
t h a t 
t h e 
mass u n d e r 
i n v e s t i g a t i o n 
was 
a lymphoma 
t h e n 
t h e 
e n t i r e 
mass 
s h o u l d 
n o t 
h a v e 
b e e n 
r e m o v e d , 
b u t 
r a t h e r , o n l y a s m a l l p o r t i o n o b t a i n e d 
(a b i o p s y ) 
f o r 
s u b m i s s i o n 
t o 
p a t h o l o g y . " 
Dr. B l a c k ' s b r i e f , pp. 
14-15 
( e m p h a s i s a d d e d ) . 
S p e c i f i c a l l y , 
Dr. V o e l l e r t e s t i f i e d as f o l l o w s on 
d i r e c t 
e x a m i n a t i o n : 
"Q. 
Dr. V o e l l e r , 
... 
do you have an o p i n i o n i n 
t h i s 
c a s e b a s e d on 
t h e m a t e r i a l s you have 
r e v i e w e d 
a b o u t t h e m e d i c a l 
c a r e r e n d e r e d 
t o Mr. Comer by 
Dr. 
B l a c k ? 
"A. 
I 
do. 
"Q. 
What i s t h a t 
o p i n i o n ? 
"A. 
T h a t i t f e l l b e l o w t h e s t a n d a r d o f 
c a r e . 
1 D r . 
F o e c k l e 
was 
o r i g i n a l l y 
named 
as 
a 
d e f e n d a n t 
i n 
Comer's 
c o m p l a i n t ; 
on 
Comer's 
m o t i o n , 
t h e 
t r i a l 
c o u r t 
d i s m i s s e d Dr. 
F o e c k l e as a d e f e n d a n t on F e b r u a r y 
11, 
2003. 
16 
1070652 
"Q. 
A r e t h e c i r c u m s t a n c e s u n d e r w h i c h Dr. B l a c k 
c a r e d 
f o r L y n n 
Comer 
c i r c u m s t a n c e s 
t h a t 
you a r e 
f a m i l i a r 
w i t h 
and 
a r e 
w i t h i n 
y o u r 
s u r g i c a l 
s p e c i a l t y ? 
"A. 
Y e s , s i r , t h e y a r e . 
"Q. 
C o u l d you t e l l u s , g e n e r a l l y s p e a k i n g , what 
t h o s e 
c i r c u m s t a n c e s were w i t h r e g a r d t o L y n n Comer? 
"A. 
W e l l , 
t h e p a t i e n t h a d b e e n 
h a v i n g 
some 
n i g h t s w e a t s and w e i g h t 
l o s s . 
I t h i n k t h e r e was a 
b l o o d c l o t i n t h e v e i n and t h e arm. 
And t h e y 
r e a l l y 
d i d n ' t know what was g o i n g on w i t h t h e p a t i e n t . 
" T h e r e was some, I t h i n k , a h i s t o r y o f C r o h n ' s 
d i s e a s e , w h i c h i s a d i s e a s e o f t h e i n t e s t i n e . 
And 
so t h e p r i m a r y 
c a r e 
p h y s i c i a n was 
d o i n g a w o r k - u p 
t r y i n g 
t o 
f i g u r e 
o u t and 
t r y i n g 
t o 
e x p l a i n t h e 
symptoms 
o f t h e p a t i e n t and h a d o r d e r e d 
CAT 
s c a n s 
and 
o t h e r 
t e s t s 
and 
r e a l l y 
s t i l l 
c o u l d n ' t 
e x p l a i n 
t h e symptoms o f t h e p a t i e n t and r e f e r r e d t h e p a t i e n t 
t o D r . B l a c k f o r e v a l u a t i o n i n h o p e s t h e y m i g h t be 
a b l e t o come up w i t h a d i a g n o s i s . 
And Dr. 
B l a c k 
o f f e r e d 
t h e 
o p t i o n 
o f 
what 
we 
c a l l 
d i a g n o s t i c 
l a p a r o s c o p y 
w h i c h 
i s where 
you 
p u t 
t h e 
l i t t l e 
t e l e s c o p e 
i n t o 
t h e a b d o m i n a l 
c a v i t y 
and you 
l o o k 
a r o u n d t o s e e i f you c a n make a d i a g n o s i s t o t r y 
t o 
e x p l a i n t h e n i g h t s w e a t s and w e i g h t 
l o s s and f e v e r 
and w h a t e v e r o t h e r symptoms Mr. Comer was 
h a v i n g . 
"Q. 
A l l r i g h t . 
L e t ' s 
t a l k 
a b o u t Dr. 
B l a c k ' s 
b a s i c 
k n o w l e d g e a t 
t h a t 
p o i n t 
i n t i m e . 
You 
h a d 
m e n t i o n e d 
t h a t 
t h e r e 
was 
a 
CAT 
s c a n 
p e r f o r m e d ; 
c o r r e c t , 
s i r ? 
"A. 
Y e s , s i r . 
17 
1070652 
"Q. 
And 
Dr. 
B l a c k 
had 
a v a i l a b l e t o him 
t h e 
r e p o r t o f t h a t CAT 
s c a n ? 
"A. 
He d i d . 
"Q. 
And do you r e c a l l t h a t i n p a r t t h e CAT 
s c a n 
s a i d 
t h a t 
t h e r e 
was 
no 
r e t r o p e r i t o n e a l a d e n o p a t h y 
s e e n a t t h e t i m e o f t h e CAT 
s c a n ? 
"A. 
Y e s , s i r . 
"Q. 
What does 
t h a t mean? 
"A. 
A d e n o p a t h y means s w o l l e n 
l y m p h n o d e s 
and 
l a r g e 
l y m p h 
n o d e s . 
So 
t h e y 
a r e j u s t 
s a y i n g 
i n t h e 
a r e a 
where 
t h e s e 
l y m p h 
nodes 
r u n , 
t h e r e 
were 
no 
a b n o r m a l l y 
e n l a r g e d 
l y m p h 
n o d e s . 
f l 
"Q. 
D i d you s e e , as you 
s a i d , where Dr. 
B l a c k 
p l a n n e d 
t h e d i a g n o s t i c 
l a p a r o s c o p y 
b e c a u s e 
he 
was 
w o r r i s o m e f o r lymphoma? 
"A. 
I d i d see t h a t . 
"Q. 
What i s lymphoma? 
"A. 
Lymphoma i s a tumor 
o f t h e l y m p h 
g l a n d s . 
T h e r e 
a r e 
v a r i o u s 
k i n d s 
o f lymphoma 
and 
I 
d o n ' t 
p r e t e n d 
t o know a l l t h e 
d i f f e r e n t 
k i n d s , b u t i t ' s 
s i m p l y a tumor i n t h e l y m p h 
s y s t e m . 
"Q. 
I n t e r m s 
o f t a k i n g a l o o k 
a r o u n d as 
you 
have d e s c r i b e d , do you a g r e e w i t h t h a t 
a p p r o a c h ? 
"A. 
I a g r e e w i t h 
t h e a p p r o a c h as f a r as 
t h e 
d i a g n o s t i c l a p a r o s c o p y 
l o o k i n g f o r lymphoma, I a g r e e 
w i t h t h e a p p r o a c h . I d o n ' t know t h a t I w o u l d 
have 
done 
i t w i t h 
a n o r m a l 
CAT 
s c a n , 
b u t 
I 
c e r t a i n l y 
a g r e e w i t h t h e a p p r o a c h . 
18 
1070652 
"Q. 
... 
D i d you 
see i n t h e r e c o r d s 
t h a t you have 
r e v i e w e d t h a t Dr. 
B l a c k 
d i c t a t e d an o p e r a t i v e 
n o t e ? 
"A. 
Y e s , s i r . 
f l 
"Q. 
... 
Do 
you 
r e c a l l 
i n h i s d i c t a t i o n t h a t 
Dr. 
B l a c k 
s a i d 
t h a t 
he 
f o u n d 
s o m e t h i n g 
t h a t 
was 
u n e x p e c t e d i n t h e a r e a o f t h e 
d i s t a l s m a l l b o w e l ; do 
you 
r e c a l l 
t h a t ? 
"A. 
I 
remember w o r d s - - 
I 
d o n ' t 
remember 
t h e 
e x a c t w o r d s , b u t w o r d s t o s o m e t h i n g 
l i k e 
t h a t . 
f l 
"Q. 
I n 
h i s 
a t t e m p t 
t o 
do 
a 
t h o r o u g h 
e x p l o r a t i o n , 
do 
you 
u n d e r s t a n d 
t h a t 
Dr. 
B l a c k 
i n d i c a t e d 
t h a t 
he 
f o u n d s o m e t h i n g 
t h a t 
was 
e i t h e r 
a b n o r m a l l y l o c a t e d o r s o m e t h i n g t h a t s h o u l d n ' t 
have 
b e e n 
t h e r e ? 
"A. 
Y e s , s i r . 
"Q. 
Why 
do 
you 
s a y 
t h a t ? 
"A. 
W e l l , 
he 
d e s c r i b e d 
t h i s mass t h a t we 
have 
b e e n 
t a l k i n g 
a b o u t 
t h a t 
t h e 
CAT 
s c a n 
c e r t a i n l y 
d i d n ' t 
d e s c r i b e , 
so 
he w a s n ' t p r e p a r e d t o see 
what 
he 
saw 
t h r o u g h t h e 
l a p a r o s c o p e 
b e c a u s e he 
had 
a 
CAT 
s c a n n o t m e n t i o n i n g 
t h a t . 
"Q. 
A t t h a t p r e c i s e moment, a t t h e moment t h a t 
he 
r e a l i z e s 
t h a t 
he 
s e e s 
s o m e t h i n g 
t h a t 
i s 
n o t 
m e n t i o n e d on 
t h e 
r e p o r t 
o f t h e 
CAT 
s c a n , what d o e s 
t h e 
s t a n d a r d 
o f c a r e 
r e q u i r e o f t h e g e n e r a l 
s u r g e o n 
l i k e 
Dr. 
B l a c k 
i n 1995 
t o do 
a t t h a t moment? 
"A. 
To 
go 
g e t 
t h e 
CAT 
s c a n and 
p r e f e r a b l y 
g e t 
w i t h t h e 
r a d i o l o g i s t t o go o v e r t h e CAT 
s c a n a t 
t h a t 
t i m e i n t h e 
o p e r a t i n g room o r i n r a d i o l o g y . 
19 
1070652 
"Q. 
I n f a i r n e s s t o Dr. B l a c k , t h e r e p o r t b y t h e 
r a d i o l o g i s t d o e s n o t m e n t i o n t h e e c t o p i c l o c a t i o n o f 
t h e 
l e f t 
k i d n e y , 
does 
i t ? 
"A. 
I t d o e s n o t . 
f l 
"Q. 
W o u l d t h e s t a n d a r d o f c a r e 
e x i s t i n g a t t h e 
t i m e i n 1995 r e q u i r e Dr. B l a c k , i f 
u n s u r e a b o u t h i s 
own i n t e r p r e t a t i o n o f t h e CAT s c a n , t o g e t w i t h o r 
c o n s u l t 
w i t h 
t h e 
r a d i o l o g i s t 
a b o u t 
h i s 
i n t e r p r e t a t i o n o f t h e CAT s c a n ? 
"A. 
Y e s , 
s i r , 
and 
b e c a u s e 
we 
have 
t h e 
d i s c r e p a n c y . I mean we have a CAT s c a n t h a t ' s n o r m a l 
s u p p o s e d l y and we p u t o u r t e l e s c o p e 
i n a n d we s e e 
s o m e t h i n g 
t h a t has n o t b e e n on t h e r e p o r t , on t h e 
CAT s c a n r e p o r t , and you have t o t r y 
t o f i g u r e o u t 
w h a t ' s g o i n g on. 
So you have t o go g e t t h e f i l m s , 
you 
have t o l o o k a t i t and t r y t o p u t t h e 
p u z z l e 
t o g e t h e r . 
f l 
"Q. 
... [ B ] a s e d 
on e v e r y t h i n g 
you have 
s e e n , 
e v e r y t h i n g 
you know f r o m t h e c h a r t , d i d Dr. 
B l a c k 
know what he was r e v i e w i n g a t t h e t i m e t h a t he c u t 
t h e mass o u t ? 
f l 
"A. 
I c a n p r o m i s e you i f 
he knew what he was 
d o i n g , he w o u l d n ' t have r e m o v e d i t . 
"Q. 
Why i s t h a t t h e c a s e ? 
"A. 
S e v e r a l r e a s o n s . A g a i n , we g e t b a c k t o t h e 
s i t u a t i o n t h a t we have a n o r m a l CAT s c a n r e p o r t . 
We 
20 
1070652 
p u t 
o u r 
t e l e s c o p e 
i n and we 
see 
t h i s b i g t h i n g 
t h e r e 
t h a t ' s n o t 
on t h e r e p o r t , so t h a t ' s t h e 
f i r s t 
t h i n g . 
A l l 
r i g h t . 
So 
l e t ' s p r e t e n d t h a t we 
d o n ' t have 
t h e 
CAT 
s c a n r e p o r t , 
h y p o t h e t i c a l 
o r w h a t e v e r 
you 
want 
t o 
c a l l 
i t , and 
you 
a r e 
t h i n k i n g 
i t ' s lymphoma, 
w h i c h i s what Dr. 
B l a c k 
was 
t h i n k i n g , you 
know, 
we 
a r e 
h a v i n g 
t h e s e 
symptoms, 
c o u l d 
i t be 
lymphoma. 
A g a i n , 
t h e 
CAT 
s c a n d o e s n ' t e v e n 
t a l k 
a b o u t 
l y m p h 
nodes and 
i f I had 
a n o r m a l CAT 
s c a n I w o u l d n ' t e v e n 
p u t 
a l a p a r o s c o p e i n . Say 
you 
p u t 
t h e l a p a r o s c o p e i n 
and 
you 
a r e l o o k i n g f o r l y m p h nodes and 
you 
see 
t h i s 
b i g mass t h e r e , 
w e l l , 
i f you 
t h i n k 
i t ' s lymphoma, 
you 
b i o p s y 
i t , you 
p u t 
a n e e d l e 
i n t h e r e , 
you 
t a k e 
a p i e c e 
o f i t ; and t h e n t h e t r e a t m e n t o f t h a t i s 
n o t 
r e m o v a l , 
you 
d o n ' t remove t h i s . 
So e v e n i f i t 
was 
lymphoma, 
t h i s 
p a t i e n t 
d i d n ' t 
n e e d 
t h i s 
t h i n g 
r e m o v e d . 
The 
p a t i e n t 
n e e d e d 
a 
d i a g n o s i s 
i f 
we 
t h o u g h t 
i t 
was 
lymphoma; 
t h a t ' s 
what 
t h e y 
n e e d e d - - b u t 
t h e 
t r e a t m e n t 
o f 
lymphoma 
i s 
c h e m o t h e r a p y 
and 
r a d i a t i o n 
t h e r a p y 
b a s e d 
on 
t h e 
t y p e s o f lymphoma. 
R e m o v a l o f t h i s mass, e v e n i f i t 
was 
lymphoma, was 
n o t 
n e c e s s a r y . " 
On 
c r o s s - e x a m i n a t i o n , 
Dr. 
V o e l l e r t e s t i f i e d : 
"Q. 
... 
I s y o u r o p i n i o n 
... 
[ t ] h a t a t t h e 
t i m e 
he 
saw 
what 
he 
t h o u g h t 
was 
a mass, 
i t i s a t 
t h a t 
p o i n t 
t h a t 
he 
s h o u l d 
have s t o p p e d 
t h e 
s u r g e r y 
and 
gone up 
and 
l o o k e d 
a t t h e 
f i l m ? 
"A. 
Y e s , 
s i r ; o r had 
t h e 
f i l m b r o u g h t t o 
him. 
"Q. 
Or 
had 
t h e 
f i l m b r o u g h t t o him; 
c o r r e c t ? 
"A. 
Y e s , s i r . 
"Q. 
And 
t h a t 
i s 
y o u r 
o n l y 
o p i n i o n 
t h a t 
he 
d e v i a t e d 
f r o m 
t h e 
s t a n d a r d 
o f 
c a r e ; 
am 
I 
c o r r e c t 
a b o u t 
t h a t ? 
"A. 
W e l l , I t h i n k a l s o what I m e n t i o n e d 
e a r l i e r 
t h a t 
l e t ' s g i v e him 
t h e b e n e f i t o f t h e d o u b t and 
s a y 
21 
1070652 
o k a y , I 
t h i n k 
i t ' s a lymphoma; 
e v e n 
t h a t , 
i f he 
t h i n k s 
i t ' s a lymphoma, you d o n ' t open t h e p a t i e n t 
and remove a lymphoma. 
"Q. 
I want t o a s k you a b o u t t h a t i n a m i n u t e . 
"A. 
So I t h i n k t h a t 
w i l l be a d e v i a t i o n , 
a l s o . 
"Q. 
So two d e v i a t i o n s 
t h e n ; 
c o r r e c t ? 
"A. 
Y e s , s i r . 
"Q. 
One, s h o u l d have gone up and l o o k e d a t t h e 
f i l m when he saw t h e m a s s ? 
"A. 
And 
t h a t 
w o u l d 
n o t - - h a d 
he done 
t h a t , 
n o t h i n g 
e l s e w o u l d h a v e o c c u r r e d . 
B u t l e t ' s 
g i v e 
h i m 
t h i s 
m i s i n t e r p r e t a t i o n 
o r 
t h e n o t 
c o m p l e t e 
r e p o r t b y t h e r a d i o l o g i s t 
and he 
s t i l l 
t h i n k s he i s 
d e a l i n g 
w i t h a lymphoma, w h i c h i s n ' t t h e c a s e , 
t h e n 
you 
d o n ' t p r o c e e d t o open t h e p a t i e n t up and remove 
i t .
[
2
] 
"Q. 
A l l 
r i g h t . 
So e v e n i f i t was a lymphoma, 
you 
s a y he 
d e v i a t e d 
f r o m t h e s t a n d a r d o f c a r e i n 
r e m o v i n g i t ? 
"A. 
Y e s , s i r . " 
Dr. 
B l a c k 
a r g u e s t o t h i s 
C o u r t 
t h a t Comer 
" o f f e r e d 
no 
e x p e r t t e s t i m o n y t h a t Dr. B l a c k 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 
d e t e r m i n i n g , i n h i s p r o f e s s i o n a l j u d g m e n t , t h a t r e m o v a l o f 
2 I n h i s m a t e r i a l s 
t o t h i s C o u r t , Dr. B l a c k 
p l a c e s 
g r e a t 
e m p h a s i s on Comer's v o l u n t a r y 
d i s m i s s a l o f a l l e g a t i o n s i n 
h i s 
c o m p l a i n t 
t h a t Dr. B l a c k ' s 
f a i l u r e t o r e v i e w t h e CAT 
s c a n s 
f e l l 
b e l o w t h e s t a n d a r d 
o f 
c a r e . 
H o w e v e r , Dr. 
V o e l l e r ' s 
t e s t i m o n y was t h a t , e v e n i f t h e r e h a d b e e n no CAT 
s c a n , Dr. 
B l a c k ' s 
d e c i s i o n t o remove t h e mass 
s t i l l 
d e v i a t e d 
f r o m t h e 
a p p l i c a b l e 
s t a n d a r d o f 
c a r e . 
22 
1070652 
t h e mass was t h e r a p e u t i c a l l y n e c e s s a r y o r a d v i s a b l e , o r e v e n 
more g e n e r a l t e s t i m o n y t h a t D r . B l a c k 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 b y e x c e e d i n g 
t h e s c o p e o f t h e c o n s e n t . " 
Dr. 
B l a c k ' s 
b r i e f , pp. 31-32. 
We 
d i s a g r e e . 
A l t h o u g h 
Dr. 
B l a c k 
p r e s e n t e d 
e x p e r t 
t e s t i m o n y 
t h a t 
i n d i c a t e d h i s 
d e c i s i o n t o remove t h e mass was a p p r o p r i a t e , Dr. 
V o e l l e r 
t e s t i f i e d 
c l e a r l y t h a t Dr. B l a c k ' s d e c i s i o n t o remove 
t h e mass d e v i a t e d f r o m t h e a p p l i c a b l e o b j e c t i v e s t a n d a r d o f 
c a r e . 
Thus, Comer p r e s e n t e d 
s u b s t a n t i a l e v i d e n c e 
i n d i c a t i n g 
t h a t Dr. B l a c k ' s d e c i s i o n t o remove t h e mass was n o t , i n t h e 
l a n g u a g e o f t h e w r i t t e n c o n s e n t , 
an " a d d i t i o n a l 
o p e r a t i o n [ ] 
[ o r ] 
p r o c e d u r e [ ] " 
t h a t 
was 
" c o n s i d e r e d 
t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e 
i n t h e 
e x e r c i s e 
o f p r o f e s s i o n a l 
j u d g m e n t . " 
I n o t h e r w o r d s , by d e m o n s t r a t i n g 
t h a t Dr. B l a c k ' s 
d e c i s i o n t o remove t h e mass 
d e v i a t e d 
f r o m t h e s t a n d a r d o f 
c a r e , Comer p r e s e n t e d s u b s t a n t i a l 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 
r e m o v a l o f t h e mass was n o t " t h e r a p e u t i c a l l y 
n e c e s s a r y 
o r 
a d v i s a b l e i n t h e e x e r c i s e o f p r o f e s s i o n a l j u d g m e n t " and t h a t 
Dr. B l a c k t h e r e f o r e e x c e e d e d t h e s c o p e o f t h e w r i t t e n c o n s e n t . 
A c c o r d i n g l y , 
Dr. B l a c k 
was n o t 
e n t i t l e d 
t o a J M L on t h e 
c o n s e n t 
c l a i m . 
23 
1070652 
Dr. 
B l a c k 
n e x t 
c o n t e n d s 
t h a t 
" [ t ] h e 
e v i d e n c e 
[ w a s ] 
i n s u f f i c i e n t t o w a r r a n t c o m p e n s a t o r y damages i n t h e amount o f 
$ 3 5 0 , 0 0 0 , and a r e m i t t i t u r i s r e q u i r e d . " 
Dr. B l a c k ' s 
b r i e f , 
p. 32. 
I n D a n i e l s v . E a s t A l a b a m a P a v i n g , I n c . , 740 So. 2d 
1033, 
1044 
( A l a . 1 9 9 9 ) , 
t h i s 
C o u r t 
s t a t e d t h e 
f o l l o w i n g 
r e g a r d i n g 
o u r 
r e v i e w 
f o r e x c e s s i v e n e s s 
o f 
an 
a w a r d 
o f 
c o m p e n s a t o r y damages f o r m e n t a l 
a n g u i s h : 
"We 
r e c e n t l y , i n Kmart C o r p . v . K y l e s , 723 So. 
2d 572 
( A l a . 
1 9 9 8 ) , 
m o d i f i e d t h e r e v i e w 
p r o c e d u r e 
e s t a b l i s h e d i n Hammond [ v . C i t y o f G a d s d e n , 493 So. 
2d 
1374 
( A l a . 
1 
98 6 ) ] , 
t o add an 
a d d i t i o n a l 
b a s i s 
upon w h i c h a j u r y v e r d i c t may be f l a w e d . 
We h e l d i n 
K m a r t t h a t damages a w a r d e d f o r m e n t a l 
a n g u i s h were 
s u b j e c t t o s t r i c t 
s c r u t i n y i f 
t h e p l a i n t i f f h a d n o t 
s u f f e r e d any p h y s i c a l 
i n j u r y and o f f e r e d l i t t l e o r 
no d i r e c t 
e v i d e n c e 
c o n c e r n i n g t h e d e g r e e o f 
m e n t a l 
s u f f e r i n g he o r she h a d e x p e r i e n c e d . 
T h a t 
p r i n c i p l e 
e s t a b l i s h e d i n K m a r t does n o t a p p l y i n t h i s 
c a s e , 
b e c a u s e 
t h e 
D a n i e l s e s 
e a c h 
s u f f e r e d 
p h y s i c a l 
i n j u r i e s and e x p e r i e n c e d v a r y i n g d e g r e e s o f p a i n and 
s u f f e r i n g . 
M o r e o v e r , 
e a c h 
p l a i n t i f f 
p r e s e n t e d 
e x t e n s i v e 
d i r e c t 
e v i d e n c e 
r e g a r d i n g t h e d e g r e e o f 
m e n t a l 
a n g u i s h 
he o r she h a d e x p e r i e n c e d , 
e i t h e r 
t h r o u g h 
h i s o r h e r own 
t e s t i m o n y 
o r t h r o u g h 
t h e 
t e s t i m o n y o f p h y s i c i a n s and o t h e r s who h a d k n o w l e d g e 
o f 
t h e i r 
s u f f e r i n g and a n g u i s h . 
"Under 
n o r m a l 
c i r c u m s t a n c e s , 
when 
a 
c o u r t 
d e t e r m i n e s 
t h a t a p a r t i c u l a r 
v e r d i c t i s e x c e s s i v e , 
t h e 
c o u r t 
n e c e s s a r i l y 
c o n c l u d e s 
t h a t t h e 
v e r d i c t 
r e s u l t e d 
f r o m 
some 
b i a s , 
p r e j u d i c e , 
p a s s i o n , 
c o r r u p t i o n , o r i m p r o p e r 
m o t i v e 
on t h e p a r t o f t h e 
j u r y . 
The 
c o u r t 
i s t h e n 
f a c e d 
w i t h 
o r d e r i n g 
a 
r e m i t t i t u r , 
and t h e q u e s t i o n becomes 
'How 
much?' 
T h e r e 
i s no 
y a r d s t i c k 
f o r m e a s u r i n g 
t h e 
p r o p e r 
24 
1070652 
r e d u c t i o n . 
I n t h i s 
s i t u a t i o n , t h e c o u r t o f t e n t u r n s 
t o 
a c o m p a r i s o n 
o f j u r y 
v e r d i c t s 
i n s i m i l a r 
c a s e s 
f o r some 
g u i d a n c e . 
" I n 
t h e a b s e n c e o f a f l a w e d v e r d i c t , h o w e v e r , a 
c o m p a r i s o n o f j u r y v e r d i c t s i n s i m i l a r c a s e s 
i s n o t 
t h e s t a n d a r d f o r d e t e r m i n i n g w h e t h e r a j u r y 
v e r d i c t 
s h o u l d 
be 
r e d u c e d . 
The 
t r i a l 
c o u r t 
must 
f i r s t 
d e t e r m i n e 
t h a t 
t h e 
v e r d i c t 
was 
f l a w e d . 
As 
t h i s 
C o u r t 
s t a t e d i n P i t t 
v. C e n t u r y 
I I , I n c . , 
[631 
So. 
2d 
235, 
239 
( A l a . 
1 
9 9 3 ) ] , 
'a 
r e v i e w 
o f 
a 
j u r y 
v e r d i c t 
f o r c o m p e n s a t o r y damages on 
t h e 
g r o u n d 
o f 
e x c e s s i v e n e s s 
must 
f o c u s 
on 
t h e 
p l a i n t i f f 
(as 
v i c t i m ) and 
a s k what t h e e v i d e n c e 
s u p p o r t s 
i n t e r m s 
o f 
damages 
s u f f e r e d 
by 
t h e 
p l a i n t i f f . ' 
I n 
t h e 
a b s e n c e o f a f l a w e d v e r d i c t , 
' t h e r e i s no s t a t u t o r y 
a u t h o r i t y 
t o 
i n v a d e 
t h e 
p r o v i n c e 
o f 
t h e 
j u r y 
i n 
a w a r d i n g c o m p e n s a t o r y damages.' 
I d . a t 
240. 
" T h i s C o u r t 
has 
l o n g h e l d t h a t 
' [ t ] h e r e i s 
no 
f i x e d 
s t a n d a r d 
f o r 
a s c e r t a i n m e n t 
o f 
c o m p e n s a t o r y 
damages r e c o v e r a b l e ... 
f o r p h y s i c a l p a i n and m e n t a l 
s u f f e r i n g ' 
and 
t h a t 
' t h e amount o f s u c h 
[an] 
a w a r d 
i s 
l e f t t o t h e s o u n d d i s c r e t i o n o f t h e j u r y , 
s u b j e c t 
o n l y t o c o r r e c t i o n by 
t h e c o u r t f o r c l e a r a b u s e 
o r 
p a s s i o n a t e 
e x e r c i s e o f 
t h a t 
d i s c r e t i o n . ' 
A l a b a m a 
Power Co. 
v. M o s l e y , 294 
A l a . 394, 
401, 
318 
So. 
2d 
260, 
266 
( 1 9 7 5 ) . 
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 
a 
t r i a l 
c o u r t 
c a n n o t 
i n t e r f e r e 
w i t h 
a 
j u r y 
v e r d i c t m e r e l y b e c a u s e i t b e l i e v e s t h e j u r y gave t o o 
l i t t l e 
o r t o o much. 
W i l l i s t o n 
v. A r d , 
611 
So. 
2d 
274 
( A l a . 1 9 9 2 ) ; O l y m p i a Spa v. J o h n s o n , 547 
So. 
2d 
80 
( A l a . 1 9 8 9 ) ; and V e s t v. Gay, 
275 
A l a . 286, 
154 
So. 
2d 297 
( A l a . 1 9 6 3 ) . " 
I n 
t h i s 
c a s e , 
t h e r e i s e v i d e n c e 
o f b o t h p h y s i c a l i n j u r y 
and 
m e n t a l 
a n g u i s h . 
Thus, 
i n r e v i e w i n g 
t h e 
c o m p e n s a t o r y -
damages 
a w a r d 
i n 
t h e 
p r e s e n t 
c a s e , 
we 
do 
n o t 
a p p l y 
t h e 
h e i g h t e n e d 
s c r u t i n y s e t f o r t h i n K m a r t C o r p . v. K y l e s , 723 
So. 
25 
1070652 
2d 572 
( A l a . 1 9 9 8 ) , 
as d i s c u s s e d i n D a n i e l s , s u p r a . 
R a t h e r , 
we r e v i e w t h e a w a r d i n t h i s c a s e t o d e t e r m i n e 
o n l y w h e t h e r i n 
d e t e r m i n i n g t h e amount o f damages t h e j u r y c l e a r l y a b u s e d i t s 
d i s c r e t i o n . 
D a n i e l s , 
740 
So. 
2d 
a t 
1044. 
See 
a l s o 
D e l c h a m p s , 
I n c . v. 
B r y a n t , 
738 
So. 
2d 
824, 
837 
( A l a . 
1999) 
("There i s no 
f i x e d 
s t a n d a r d 
f o r d e t e r m i n i n g 
t h e amount 
o f 
c o m p e n s a t o r y damages a j u r y may a w a r d f o r m e n t a l a n g u i s h . 
The 
amount 
o f 
t h e 
damages 
a w a r d 
i s 
l e f t 
t o 
t h e 
j u r y ' s 
s o u n d 
d i s c r e t i o n , 
s u b j e c t t o r e v i e w by t h e c o u r t f o r a c l e a r a b u s e 
o f t h a t 
d i s c r e t i o n . " ) . 
Comer's p h y s i c a l 
i n j u r i e s 
i n c l u d e t h e p e r m a n e n t l o s s 
o f 
h i s k i d n e y . 
He p r e s e n t e d e v i d e n c e 
o f h i s p a i n and 
s u f f e r i n g 
and 
t h e m e n t a l 
a n g u i s h 
c a u s e d 
by 
Dr. 
B l a c k ' s r e m o v a l 
o f h i s 
k i d n e y . 
A f t e r 
t h e 
r e m o v a l 
o f 
h i s k i d n e y , 
Comer s u f f e r e d 
i n t e r n a l 
b l e e d i n g 
f r o m 
two 
a r t e r i e s 
i n t h e 
a r e a where 
h i s 
k i d n e y 
had b e e n r e m o v e d . 
Comer 
t e s t i f i e d 
t h a t , 
b e f o r e 
t h e 
e m e r g e n c y 
s u r g e r y 
t o 
s t o p 
t h e 
b l e e d i n g , 
he 
s u f f e r e d 
" i n c r e d i b l e 
p a i n " and 
had 
t r o u b l e b r e a t h i n g and 
he 
t h o u g h t 
" t h a t 
[he] 
was 
gone, 
[ t h a t he] 
was 
g o i n g 
t o d i e . " 
He 
a l s o 
i n c u r r e d m e d i c a l e x p e n s e s o f $ 1 0 , 4 6 5 . 6 5 . 
26 
1070652 
Dr. Comer c i t e s 
s e v e r a l c a s e s i n s u p p o r t o f h i s a r g u m e n t 
t h a t 
t h e c o m p e n s a t o r y - d a m a g e s 
a w a r d was 
e x c e s s i v e . 
Those 
c a s e s a r e i n a p p o s i t e , h o w e v e r , b e c a u s e none o f them 
i n v o l v e d 
t h e r e v i e w o f a c o m p e n s a t o r y - d a m a g e s a w a r d f o r m e n t a l 
a n g u i s h 
i n w h i c h t h e p l a i n t i f f 
a l s o s u f f e r e d a p h y s i c a l 
i n j u r y . 
U n d e r t h e c i r c u m s t a n c e s o f t h i s c a s e , t h e c o m p e n s a t o r y -
damages a w a r d was n o t 
e x c e s s i v e . 
C o n c l u s i o n 
The j u d g m e n t i s a f f i r m e d . 
AFFIRMED. 
Cobb, C . J . , and W o o d a l l , P a r k e r , and Shaw, J J . , c o n c u r . 
27