Title: Sarah Mosley v. Brookwood health Services, Inc., d/b/a Brookwood Medical Center
Citation: N/A
Docket Number: 1071533
State: Alabama
Issuer: Alabama Supreme Court
Date: May 22, 2009

Rel 05/22/2009
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, 2008-2009
_________________________
1071533
_________________________
Sarah Mosley
v.
Brookwood Health Services, Inc., d/b/a 
Brookwood Medical Center
Appeal from Jefferson Circuit Court
(CV-05-1648)
COBB, Chief Justice.
Sarah Mosley appeals from a summary judgment entered by
the Jefferson Circuit Court in favor of Brookwood Health
Services, Inc., d/b/a Brookwood Medical Center ("Brookwood").
We affirm.
1071533
2
Facts
On 
March 
19, 
2003, 
Mosley 
was 
admitted 
to 
the
intermediate-care unit 2 ("IMCU-2 unit") of the psychiatric
department at the Brookwood Medical Center to be treated for
depression.
While Mosley was in the IMCU-2 unit, another patient
("patient A") was also receiving treatment there.  Patient A
had been admitted to the IMCU-2 unit for treatment of
schizophrenia, agitation, violent behavior, and paranoia.
Patient A's medical records indicate that she was admitted to
the hospital in part because she had been "picking fights with
almost everyone around her."  The staff at Brookwood Medical
Center was under instructions to monitor and observe the
patients in the IMCU-2 unit at 15-minute intervals and to note
their observations.  At 9:15 a.m. and again at 9:30 a.m. on
March 20, 2003, patient A was at the nurses' station, and she
was agitated and combative.  Patient A hit, kicked, cursed,
and shoved staff members, including Brenda Freeman, a mental-
health technician.  Patient A was then placed in "time out"
(i.e., she was sent to her room to be separate from the other
patients for 15 minutes; the door to patient A's room was
1071533
3
unlocked).  During the staff's 15-minute observations of
patient A from 9:45 to 11:45 a.m., patient A remained quiet,
staying either in her room or at the nurses' station.  Then,
at some time between the staff's observation of patient A at
12:00 p.m. and the next scheduled observation of her at 12:15
p.m. on March 20, 2003, patient A attacked Mosley in Mosley's
room.  Mosley cried out, and patients and staff went to her
assistance.  Mosley reported that patient A had pulled her
hair and smashed her head on the floor.  Patient A was
subsequently transferred to a different psychiatric unit at
Brookwood Medical Center.
Freeman testified in deposition that the procedures in
the IMCU-2 unit required the staff to place combative patients
in "time out" for 15 minutes.  If the patient remained
combative after the 15-minute "time out," the staff was to
contact the patient's doctor and, if the doctor so ordered, to
seclude the patient by placing the patient in a locked room
used for that purpose.
Procedural History
1071533
March 20, 2005, was a Sunday.
1
4
On March 21, 2005, Mosley filed the instant medical-
malpractice action against Brookwood.   On March 27, 2007,
1
Brookwood filed a motion for a summary judgment.  The trial
court withheld ruling on Brookwood's summary-judgment motion
to allow Mosley further time for discovery.  On June 23, 2008,
after further proceedings and a hearing on the summary-
judgment motion, the trial court entered a summary judgment in
favor of Brookwood.  Mosley appealed. 
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 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."
1071533
5
Dow v. Alabama Democratic Party, 897 So. 2d 1035, 1038-39
(Ala. 2004).
Analysis
This medical-malpractice action is governed by the
Alabama Medical Liability Act, § 6-5-480 et seq. and § 6-5-541
et seq., Ala. Code 1975 ("the AMLA"). See Mock v. Allen, 783
So. 2d 828, 832 (Ala. 2000) (noting that the AMLA "applies
'[i]n any action for injury or damages or wrongful death,
whether in contract or in tort, against a health care provider
for breach of the standard of care.'" (quoting § 6-5-548(a),
Ala. Code 1975)). "To prevail on a medical-malpractice claim,
a plaintiff must prove '"1) the appropriate standard of care,
2) the [health-care provider's] deviation from that standard,
and 3) a proximate causal connection between the [health-care
provider's] act or omission constituting the breach and the
injury sustained by the plaintiff."'"  Giles v. Brookwood
Health Servs., Inc., [Ms. 1060883, June 27, 2008] __ So. 3d
__, __ (Ala. 2008) (quoting Pruitt v. Zeiger, 590 So. 2d 236,
238 (Ala. 1991), quoting in turn Bradford v. McGee, 534 So. 2d
1076, 1079 (Ala. 1988)). 
1071533
Freeman, a mental-health technician, is not a licensed
2
nurse.  Brookwood argues that Freeman's testimony cannot be
used to establish the standard of care for licensed nurses and
the IMCU-2 unit as a whole because, according to Brookwood,
Freeman is not a "similarly situated" health-care provider as
required under § 6-5-548, Ala. Code 1975.  Mosley argues to
the contrary.  Mosley further argues that, in any event,
Freeman may at least testify as to the standard of care
governing the mental-health technicians, including Freeman,
who Mosley alleges negligently allowed the attack to occur.
We need not address these arguments, however, because, as we
explain in this opinion, even using the standard of care
described by Freeman, Mosley did not produce substantial
evidence indicating that any of the staff of Brookwood Medical
Center breached that standard of care.
6
Mosley alleges that Brookwood negligently failed to
seclude patient A by placing her in a locked room used for
that purpose after patient A's combative behavior around 9:15
a.m. and negligently failed to contact a doctor for
authorization to so seclude patient A.  In support of this
argument, Mosley relies on Freeman's deposition testimony to
establish the standard of care.    Freeman testified that the
2
standard of care required staff members in the IMCU-2 unit to
place combative patients in "time out" for 15 minutes.
According to Freeman, if the patient remained combative after
the "time-out" period, the standard of care would have
required the staff to contact a doctor to obtain further
orders.  If the doctor so ordered, the staff was then to
1071533
7
seclude the combative patient in a locked room.  Mosley
produced no evidence indicating that Freeman or any other
member of the staff of Brookwood Medical Center failed to
follow these procedures.  The undisputed evidence demonstrates
that the staff placed patient A in "time out" when patient A
was combative around 9:15 a.m. and again at 9:30 a.m., that
patient A was not combative at the expiration of the "time-
out" period, that patient A was monitored and observed at 15-
minute intervals, and that patient A remained calm and
noncombative until she attacked Mosley between 12:00 and 12:15
p.m.  Thus, according to the standard of care as testified to
by Freeman, from the time patient A became calm after the
"time out" until she attacked Mosley, the staff had no duty to
take further steps to isolate patient A from the other
patients or to contact a doctor for authorization to seclude
patient A in a locked room.  Because the undisputed evidence
demonstrates that Brookwood acted in accordance with the
standard of care in isolating patient A, the trial court's
judgment is not due to be reversed on the issue of the
standard of care.   See Giles,__ So. 3d at ___ (holding that
summary judgment was proper when the plaintiff did not present
1071533
8
evidence indicating that a physician failed to act in
accordance with the applicable standard of care). 
Mosley also alleges that Brookwood failed to properly
monitor Mosley.  Freeman testified that the general practice
in the IMCU-2 unit was to monitor the patients every 15
minutes.  Mosley accepts this practice as being within the
standard of care.  The evidence demonstrates that Freeman
monitored Mosley at 15-minute intervals on March 20, 2003,
including at 12:00 p.m. and 12:15 p.m.  Relying on what she
perceives as discrepancies in Brookwood's records, Mosley
seems to question whether this evidence was fabricated after
the fact and whether the staff indeed monitored Mosley at
those times.  However, Mosley presents no evidence to
demonstrate that monitoring her at 15-minute intervals could
have prevented the attack, which it is undisputed occurred
between 12:00 and 12:15.  Accordingly, with regard to
Brookwood's alleged negligence in monitoring Mosley, the trial
court did not err in entering the summary judgment.
See Crutcher v. Williams [Ms. 1050893, January 9, 2009] __ So.
3d __, __ (Ala. 2008)(opinion on return to second remand)
("[T]o prevail on a medical-malpractice claim ... the
1071533
9
plaintiff must prove that a breach of the standard of care ...
proximately and probably caused actual injury to the
plaintiff.").
Mosley also alleges that Brookwood breached the standard
of care by not responding promptly to the attack.  However,
Mosley cites no evidence as to the standard of care for
responding to such an attack, and no evidence that any alleged
delay in coming to Mosley's assistance caused or contributed
to her injuries.  Therefore, with regard to Brookwood's
alleged negligence in responding to the attack, the trial
court did not err in entering the summary judgment.  See
Giles, __ So. 3d at __ ("To prevail on her medical-malpractice
claim ... [the plaintiff] must prove, among other things, that
[the 
medical-services 
provider] 
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."'" (quoting Pruitt, 590 So. 2d at 238, quoting in
turn Ala. Code 1975, § 6-5-484(a))); cf. McAfee ex rel. McAfee
v. Family Med., P.C., 641 So. 2d 265 (Ala. 1994) (holding
that, absent proof of actual injury caused by alleged delay in
1071533
10
the diagnosis and treatment of disease, plaintiffs could not
recover 
on 
their 
AMLA claims against medical-services
providers).
Conclusion
 No genuine issue of material fact exists, and Brookwood
is entitled to judgment as a matter of law.  Therefore, we
affirm the summary judgment for Brookwood.  See Rule 56(c),
Ala. R. Civ. P.
AFFIRMED.
Lyons, Stuart, Bolin, and Murdock, JJ., concur.