Title: Cherrie Lawson v. William H. Moore, Jr., M.D., and Whittington, Moore & Kouri, P.C.
Citation: N/A
Docket Number: 1070634
State: Alabama
Issuer: Alabama Supreme Court
Date: December 31, 2008

REL: 12/31/2008
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, 2008-2009
____________________
1070634
____________________
Cherrie Lawson
v.
William H. Moore, Jr., M.D., and Whittington, Moore & Kouri,
P.C.
Appeal from Montgomery Circuit Court
(CV-05-3246)
SMITH, Justice.
Cherrie Lawson appeals from a judgment as a matter of law
entered against her in an action she filed against William H.
Moore, Jr., M.D., and Whittington, Moore & Kouri, P.C.
(collectively referred to as "the Moore defendants").  We
reverse and remand.
1070634
According to Dr. Moore's brief, 
1
"[in] an ectopic pregnancy, the developing embryo
does not implant on the endometrial wall, but
instead attaches to some other surface.  Ectopic
pregnancy allows the conceptus to implant and mature
outside the endometrial cavity, which ultimately
ends in death of the fetus.  Without timely
diagnosis and treatment, ectopic pregnancy can
become 
a 
life-threatening situation.  Ectopic
pregnancy 
currently 
is 
the 
leading 
cause 
of
pregnancy-related death during the first trimester
in the United States."
2
Facts and Procedural History
On December 27, 2003, Lawson went to the emergency room
of Baptist Medical Center South in Montgomery with complaints
of pain in her abdomen and pelvic area.  Dr. Henry Kurusz, an
emergency-room physician, examined Lawson and ordered that she
undergo several tests, including a pregnancy test and an
ultrasound.  The pregnancy test was positive, and the
ultrasound revealed the existence of a cyst on Lawson's left
ovary.  The ultrasound did not, however, definitely show the
existence an intrauterine pregnancy, and the hospital records
from Lawson's visit indicate that Lawson informed Dr. Kurusz
that she had previously experienced an ectopic pregnancy.1
Dr. Kurusz diagnosed Lawson as being at risk for a
miscarriage, and he discharged her with instructions to return
1070634
Dr. Moore's brief states: "Pseudo gestational sacs are
2
created as a result of hormones excreted by the body in
response to the developing ectopic pregnancy.  These sacs
typically develop in the central aspect of the endometrial
cavity, as opposed to being buried within the uterine wall as
common with healthy or viable gestational sacs."
3
to the hospital in 48 hours for additional examination. 
Lawson did not return to the hospital in accordance with
Dr. Kurusz's instructions.  However, on December 31, 2003, she
again went to the emergency room of the hospital with
complaints of abdominal pain.  A different emergency-room
physician, Dr. James Bradwell, examined Lawson and ordered a
repeat ultrasound, a quantitative pregnancy test, and a
urinalysis.  
At 3:30 a.m. on the morning of January 1, 2004, Dr.
Bradwell asked Dr. Moore, an obstetrician/gynecologist, to
examine Lawson, and Dr. Moore agreed to do so.  According to
Dr. Moore, Dr. Bradwell stated that Lawson had an ectopic
pregnancy and that the ultrasound revealed the presence of a
pseudo- or "false" gestational sac located in the endometrial
cavity.   After examining Lawson, Dr. Moore diagnosed her as
2
having an ectopic pregnancy.
Dr. Moore instructed Lawson that an ectopic pregnancy is
a serious, life-threatening condition and that she would be
1070634
According to Dr. Moore's brief, "[m]ethotrexate is an
3
antimetabolite drug used for treatment of ectopic pregnancies.
Methotrexate causes ectopic pregnancies to degenerate without
having to utilize surgical methods of removal."
Dr. Moore testified that Lawson informed him that she had
4
undergone a number of specific surgical procedures.  He
testified further that Lawson, in deciding to be treated by
the use of methotrexate, told him she "did not want to have
another surgery."  
4
monitored closely pending a follow-up laboratory analysis.  He
discussed giving her the drug methotrexate  to terminate her
3
pregnancy; he also told Lawson that she might need surgical
intervention.
On the morning of January 2, 2004, Dr. Moore again
evaluated Lawson.  Lawson continued to be in tremendous pain,
and Dr. Moore again discussed her treatment options.  He
provided her with medical literature discussing methotrexate
and its benefits and the risks of treatment with that drug.
That afternoon, Lawson informed Dr. Moore that she had decided
to undergo the methotrexate treatment.   Lawson received an
4
injection of methotrexate later that evening.
Lawson remained in the hospital under Dr. Moore's care
until January 4, 2004.  After her discharge from the hospital,
Lawson continued to receive treatment from Dr. Moore at his
office, including follow-up ultrasounds.  Ultimately, the
1070634
The Moore defendants did not move for a summary judgment
5
before the case was tried.
5
methotrexate injection terminated Lawson's pregnancy.  On
January 30, 2004, Dr. Moore performed a dilation-and-curettage
procedure to remove the remnants of the terminated pregnancy.
On December 23, 2005, Lawson sued the Moore defendants,
alleging that at the time she received the methotrexate
injection she had in fact had a viable intrauterine pregnancy
and that Dr. Moore acted negligently (1) in failing to
discover the alleged intrauterine pregnancy and (2) in
recommending and administering the methotrexate injection.
The Moore defendants answered the complaint, denying the
allegations. 
After the parties completed discovery, the cause was
tried before a jury.   The trial court denied the Moore
5
defendants' motions for a judgment as a matter of law ("JML")
made at the close of Lawson's case and at the close of all the
evidence.  
The jury was unable to reach a verdict.  The Moore
defendants moved for a mistrial and again moved for a judgment
as a matter of law.  In a written order, the trial court
granted the motion for a JML but did not explain in that order
1070634
6
its basis for doing so.  Lawson filed a motion to alter,
amend, or vacate the judgment.  The trial court held a hearing
on that motion, and the motion was denied by operation of law
under Rule 59.1, Ala. R. Civ. P.  This appeal followed.
Standard of Review
The standard of review applicable to a ruling on a motion
for a JML was stated in Mobile Infirmary Medical Center v.
Hodgen, 884 So. 2d 801, 808-09 (Ala. 2003):
"Our standard of review for a renewed motion for
a JML is well settled:
"'In reviewing the trial court's ruling on
a motion for a JML, an appellate court uses
the same standard the trial court used in
ruling on the motion initially.  Thus, "'we
review the evidence in a light most
favorable 
to 
the 
nonmovant, 
and 
we
determine whether the 
party 
with the 
burden
of proof has produced sufficient evidence
to 
require 
a 
jury 
determination.'"
Acceptance Ins. Co. v. Brown, 832 So. 2d 1,
12 
(Ala. 2001), 
quoting American Nat'l Fire
Ins. Co. v. Hughes, 624 So. 2d 1362,
1366-67 (Ala. 1993); see, also, Jim Walter
Homes, Inc. v. Kendrick, 810 So. 2d 645,
649-50 (Ala. 2001).'
"Hicks v. Dunn, 819 So. 2d 22, 23-24 (Ala. 2001).
Thus, in reviewing the evidence in this case, we are
required to construe the facts and any reasonable
inferences that the jury could have drawn from them
most favorably to [the nonmovant]."
Additionally, this Court noted in Liberty Life Insurance Co.
1070634
7
v. Daugherty, 840 So. 2d 152, 156 (Ala. 2002):
"'"A judgment as a matter of law is proper only
where there is a complete absence of proof on a
material issue or where there are no controverted
questions of fact on which reasonable people could
differ and the moving party is entitled to a
judgment as a matter of law."'  Southern Energy
Homes, Inc. v. Washington, 774 So. 2d 505, 510-11
(Ala. 2000), quoting Locklear Dodge City, Inc. v.
Kimbrell, 703 So. 2d 303, 304 (Ala. 1997).  In
reviewing the denial of a motion for a judgment as
a matter of law, this Court is required to view the
evidence in a light most favorable to the nonmovant.
Kmart Corp. v. Kyles, 723 So. 2d 572, 573 (Ala.
1998).  Therefore, where the evidence in the record
is disputed, we present it in a light most favorable
to [the nonmovant]." 
Discussion
The sole issue in this appeal, as argued by the Moore
defendants in their motion for a JML in the trial court and in
their materials to this Court, is whether Lawson offered
substantial evidence indicating that, when the methotrexate
was administered, there was a viable intrauterine pregnancy.
The Moore defendants contend:
"Based on the nature of Ms. Lawson's allegations,
she could recover damages against [Dr. Moore] if,
and only if, her intrauterine pregnancy was viable,
i.e., if the pregnancy probably would have survived
to 
term 
without 
Dr. 
Moore 
administering
methotrexate. 
 
If 
Ms. 
Lawson's 
intrauterine
pregnancy was probably nonviable--and probably would
not have survived to term regardless of Dr. Moore's
treatment--then 
there 
would 
be 
no 
basis 
for
1070634
Dr. Blackwell testified specifically as follows:
6
"Q.  All right, sir. Now with regard to the
ultrasound on January 1, do you have an opinion as
to whether that ultrasound demonstrated a normal,
healthy, viable fetus, a fetus that had opportunity
to be born?
"A.  I don't believe this was a viable
pregnancy.  No matter how you dated the pregnancy,
you basically didn't see any of the markers that
should have been seen.
"....
"Q. ... Based on what you see on the ultrasound
report for January 1, what is your opinion with
regard to whether--whatever was defined had any
opportunity to develop into a live healthy baby?
"A.  I don't think this would have resulted in
a live birth.
8
attributing Ms. Lawson's alleged damages to Dr.
Moore.  Simply stated, if the intrauterine pregnancy
probably would have failed regardless of Dr. Moore's
treatment, he cannot be found to have caused Ms.
Lawson's injury."
The Moore defendants cite the testimony of their expert,
Dr. Richard Blackwell, who testified that, taking into account
the information Dr. Moore had at the time, Dr. Moore acted
appropriately in administering the methotrexate on January 2,
2004, because, Dr. Blackwell asserted, Lawson's pregnancy
would have failed regardless of the administration of the
methotrexate.   Additionally, the Moore defendants contend
6
1070634
"Q.  What in your judgment would have occurred
in time?
"A.  If you simply left it alone long enough,
you would have had an ultimate miscarriage hopefully
without having some of the complications that can
occur from a retained pregnancy.
"....
"Q.  ... In your judgment, did Dr. Moore provide
appropriate and good care to this patient?
"A.  Yes, he did.
"Q.  Did he do 
anything to destroy an
opportunity 
for 
an 
intrauterine 
pregnancy 
to
develop?
"A.  Absolutely not. And I think probably helped
preserve her fertility.
"Q.  And did he also potentially save her life
by treating the ectopic pregnancy?
"A. Yes, sir."
9
that the ultrasounds conducted on Lawson on January 1 and
January 3, 2004, demonstrate that no viable intrauterine
pregnancy was present.  In support of that assertion, the
Moore defendants cite Dr. Moore's testimony at trial as well
as the testimony of Dr. Berto Lopez, who testified as an
expert on Lawson's behalf.  
Lawson, however, contends that Dr. Lopez's testimony at
1070634
"The hormone human chorionic gonadotropin (better known
7
as hCG) is produced during pregnancy and can be used to
determine the viability of pregnancy."  Dr. Moore's brief, p.
18 n.6.
10
trial provided substantial evidence indicating that a viable
intrauterine pregnancy existed and that, based on the
information available to him on January 2, 2004, Dr. Moore
acted 
negligently 
in 
recommending 
and 
administering
methotrexate to Lawson.  Specifically, Dr. Lopez testified as
follows:
"A. .... On the basis of the information Dr.
Moore had on January 2, he had ultrasounds that
showed what you would expect a progression of a
normal pregnancy.  He had hormone numbers that
showed a normal progression of a pregnancy.  And
that's not the candidate that you give methotrexate
to if you suspect an ectopic pregnancy or other type
of pregnancy other than a normal pregnancy.  Because
once you give it you can't give it back.  And the
worse thing in the world is to administer something
you can't take back and the very next day you find
out that it was in fact a pregnancy inside of the
uterus.
"That 
baby 
is now doomed to suffer 
the
consequences of methotrexate.
"Q.  And that consequence is what?
"A.  Consequence is that baby will die and it is
substandard in the presence of his knowledge that
the beta HCG,
 the hormone numbers were rising.
[7]
The serum progesterone indicated that this is a baby
that was going to survive more likely than not.  And
that the ultrasounds were encouraging that there was
1070634
11
something inside of the uterus that looked like a
baby.
"He should not have used methotrexate.  And I'm
critical of his use of methotrexate knowing these
facts in advance of his administration on the 2nd of
January of 2004.
"Q.  Do you express that opinion to a medical--
to a reasonable degree of medical certainty?
"A.  Yes, to a reasonable degree of medical
certainty it was inappropriate for Dr. Moore to have
administered methotrexate to patient Lawson in light
of the fact that I mentioned before.
"Q.  And is this your opinion that there is a
cause and effect relationship between his breach of
the standard of care and the ultimate fetus, demise
of the fetus?
"A.  Yes.  To a reasonable degree of medical
certainty the reason this baby died is because of
the administration of methotrexate.
"Q.  Do you still or do you maintain or advocate
that opinion in light of what you know and what you
have reviewed from Mrs. Lawson's presentment at the
emergency room and on December 27 and/or December
31, 2003?
"A.  Yes.  Because again she has progression of
her beta HCGs.  Her ultrasounds showed progression
of the things, the landmarks that you would expect
in a normal pregnancy.  And the possibility that
this was a pregnancy inside of the uterus had to be
respected above all else.
"Now if he had concerns that it was an ectopic
pregnancy, he had other options for treating an
ectopic pregnancy.  He could have taken her to the
operating room and either cut her stomach open and
1070634
Dr. Lopez 
also 
testified 
that 
ultrasounds 
performed 
after
8
January 2, 2004, confirmed that Lawson had a viable
intrauterine pregnancy.  Specifically, Dr. Lopez testified
that one of the ultrasounds showed the fetus as having a
heartbeat of 88 beats per minute, which he testified was
"slower than normal" but consistent with what he would expect
given that "this baby [had] been exposed to [a] lethal dose of
methotrexate."  Dr. Moore testified, however, that the normal
heartbeat range for a fetus in the first trimester is between
12
looked around for an ectopic pregnancy or gone in
through her belly button and looked for ectopic
pregnancy.  And those two things would not have
harmed the pregnancy that was inside of her uterus.
It would not have been, you know, something that
could not be taken back, shall we say.  In other
words, it was not a course of action for which there
was no recourse.
"If you do surgery on a patient and they turn
out not to have an ectopic pregnancy, most of the
time the pregnancy progresses normally to whatever
destiny it is going to have otherwise.  So there
were other options that were available to him with
the information he had.  The one he chose was the
one that was probably the worse for the baby and
certainly the one that you couldn't take back.  And
that was a mistake."
(Emphasis added.)
We agree with Lawson that Dr. Lopez's testimony in that
regard is substantial evidence indicating that a viable
intrauterine pregnancy existed and that, based on the
information available to him on January 2, 2004, Dr. Moore
acted 
negligently 
in 
recommending 
and 
administering
methotrexate to Lawson.  
8
1070634
120 and 160 beats per minute and that such a fetus, if viable,
could not have a heartbeat rate of 88 beats per minute.
13
At the hearing on Lawson's postjudgment motion, the trial
court stated "that there was absolutely no credible evidence,
none, I mean, not a shred of credible evidence to support a
finding for [Lawson]" and that "the overwhelming evidence, the
substantial evidence, was for a defense verdict."  In ruling
on a motion for a JML, however, a court is to determine
whether there is substantial evidence to support each element
of the nonmovant's claim.   Mobile Infirmary Med. Ctr., 884
So. 2d at 808-09; Liberty Life Ins. Co., 840 So. 2d at 156.
In this case, Lawson presented substantial evidence through
Dr. Lopez's testimony indicating that Dr. Moore acted
negligently and that his alleged negligence terminated a
viable intrauterine pregnancy.  Although Dr. Lopez's testimony
in that regard is in conflict with Dr. Moore's testimony and
the testimony of the Moore defendants' expert, Dr. Blackwell,
"[a] motion for a judgment as a matter of law 'is properly
denied where there exists any conflict in the evidence for
consideration by the jury.'"  Williams v. BIC Corp., 771 So.
2d 441, 446 (Ala. 2000) (quoting Cloverleaf Plaza, Inc. v.
Cooper & Co., 565 So. 2d 1147, 1149 (Ala. 1990)).  See also
1070634
14
Liberty Life Ins. Co., 840 So. 2d at 156 ("'"A judgment as a
matter of law is proper only where there is a complete absence
of proof on a material issue or where there are no
controverted questions of fact on which reasonable people
could differ and the moving party is entitled to a judgment as
a matter of law."'" (quoting  Southern Energy Homes, Inc. v.
Washington, 774 So. 2d 505, 510-11 (Ala. 2000), quoting in
turn Locklear Dodge City, Inc. v. Kimbrell, 703 So. 2d 303,
304 (Ala. 1997))).  Consequently, the trial court erred in
granting the Moore defendants' motion for a JML.
Conclusion
The judgment is reversed, and the cause is remanded.
REVERSED AND REMANDED.
See, Woodall, Bolin, and Parker, JJ., concur.  
Cobb, C.J., recuses herself.