Title: Ex parte Brookwood Medical Center. PETITION FOR WRIT OF MANDAMUS: CIVIL (In re: James L. Sallas, by and through his wife and next friend Sara Sallas, et al. v. Brookwood Medical Center et al.)
Citation: N/A
Docket Number: 1061307
State: Alabama
Issuer: Alabama Supreme Court
Date: May 23, 2008

REL: 05/23/2008
Notice: This opinion is subject to formal revision before publication in the advance
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Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-
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the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
OCTOBER TERM, 2007-2008
____________________
1061307
____________________
Ex parte Brookwood Medical Center
PETITION FOR WRIT OF MANDAMUS
(In re: James L. Sallas, by and through his
wife and next friend Sara Sallas, et al.
v.
Brookwood Medical Center et al.)
(Jefferson Circuit Court, CV-05-3181)
MURDOCK, Justice.
Brookwood Medical Center ("Brookwood") seeks a writ of
mandamus directing the Jefferson Circuit Court to enter an
1061307
2
order granting separate trials in a civil action filed against
Brookwood and several fictitiously named defendants by
James L. Sallas ("Mr. Sallas"), an alleged incompetent person
suing through his wife and next friend Sara Sallas, by Sara,
individually, and by Belinda J. Helms, individually and as
executrix 
of 
the 
estate 
of 
her 
deceased 
husband,
James Earl Helms.  We grant the writ.
Facts and Procedural History
   
In June 2005, Sara, individually and as wife and next
friend of Mr. Sallas, and Belinda, individually and as
executrix of the estate of her deceased husband, filed a
single complaint in the Jefferson Circuit Court.  The
complaint, as subsequently amended, alleged:
"4.  On or about June 24, 2004 an adult male
referred 
to 
[as 
T.B.] 
was 
admitted 
to 
the
[Brookwood] psychiatric unit with a number of
significant 
diseases, 
including 
Intermittent-
Explosive Disorder (IED).  IED is an impulse control
disorder characterized by specific episodes of
violent and aggressive behavior that may involve
harm to others. ...
"5.  Between June 24, 2004 and July 22, 2004
[T.B.] engaged in a number of violent acts.  For
example, on a number of occasions the nursing staff
found [T.B.] beating his head on the floor or wall.
After one such outburst, [T.B.] was taken to the
[Brookwood] emergency room where he was diagnosed
with a broken nose.  Not only did [T.B.] injure
1061307
3
himself, but on a number of occasions, including,
but not limited to July 14, 2004, July 20, 2004, and
July 22, 2004, [T.B.] assaulted and battered
Brookwood staff members.  Indeed, the situation
became so dangerous that on July 22, 2004, a
Petition was filed requesting that the Probate Court
of Jefferson County order the aggressor to be
committed to a state mental hospital.
"6.  On or about June 16, 2004, James Earl Helms
was admitted to the geriatric floor at [Brookwood]
for 
treatment 
of cerebral bleeding, seizures,
vascular dementia, and depression.  While on the
geriatric 
floor, 
Mr. 
Helm's 
physician 
became
concerned that because of Mr. Helm's strength and
his 
'friendliness' 
towards 
other 
patients,
Mr. Helms, in his interaction with other patients,
might injure the other patients.  Mr. Helms's
physician was also concerned that another patient
might take offense at Mr. Helms's 'friendliness' and
respond by injuring Mr. Helms.  Mr. Helm's physician
told Mrs. Helms that her husband needed to be
admitted to the psychiatric unit for his own
protection and that he would receive one-on-one
supervision and care.  Mr. Helms was admitted to the
[Brookwood] psychiatric unit ... on June 23, 2004.
"7.  Sometime between June 23, 2004 and July 24,
2004, the staff at the [psychiatric] unit assigned
Mr. Helms and [T.B.] to reside in the same room.  At
no time prior to July 24, 2004, did the staff inform
any family member of Mr.  Helms that [T.B.] had
assaulted and battered staff members in the unit.
"8.  On or about July 24, 2004, and possibly on
at least one prior occasion, [T.B.] assaulted
Mr. Helms.  As a result of the assault, Mr. Helms's
left elbow, right shoulder, face, head and buttocks
were injured.  [The Brookwood psychiatric-unit]
staff did not examine Mr. Helms nor did they order
any diagnostic tests to see what injuries he
suffered as a result of the assault.  The staff
1061307
4
merely informed Mrs. Helms that her husband had a
slight cut on his arm that resulted from a 'little
altercation.'  On July 25, 2004 Mrs. Helms visited
her husband and found that he had two black eyes.
The staff members were not able to give Mrs. Helms
an explanation.
"9.  Since 1998, James Sallas suffered from
vascular Dementia and Bipolar Affective Disorder.
On or about July 21, 2004, Dr. Ed Logue, at
Mr. Sallas's request, admitted Mr. Sallas to the
psychiatric unit at Brookwood because Mr. Sallas had
homicidal 
ideations. 
 
After 
[T.B.] 
assaulted
Mr. Helms, on July 24, 2004, the [psychiatric-unit]
staff inexplicably assigned Mr. Sallas to [T.B.]'s
room.
"10.  On or about July 25, 2004, and possibly on
prior occasions, [T.B.] also assaulted Mr. Sallas
and knocked him unconscious.  As a result of the
assault, Mr. Sallas suffered numerous injuries,
including a skull fracture, a left frontal subdural
hematoma, subarachnoid hemorrhaging and a fractured
toe.  The [psychiatric-unit] staff neither took
immediate 
steps 
to 
determine 
what 
injuries
Mr. Sallas suffered in the attack nor did they
contact Mrs. Sallas to inform her of the assault
until after Mrs. Sallas had received a call from her
husband's physician notifying her of the assault.
"11.  On or about July 27, 2004 Brookwood
discharged Mr. Helms to the Pleasant Grove Nursing
Home. 
 
After 
getting 
Mr. 
Helms 
registered,
Mrs. Helms went to her husband's room where the
nursing home staff was helping Mr. Helms change his
clothes.  As the staff attempted to undress
Mr. Helms they found that in addition to the black
eyes and elbow laceration, Mr. Helms had bruises
over his entire body.  The bruising was so extensive
that the Director of Nursing at Pleasant Grove
Nursing Home refused to accept Mr. Helms for fear
that they, at a later date, might be blamed for
1061307
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inflicting the injuries to Mr. Helms.  After calling
the 
emergency 
room 
at 
Brookwood 
and 
making
arrangements for Mr. Helms to be returned to
Brookwood, the Director of Nursing told Mrs. Helms
that she was to take her husband back to the
emergency room for evaluation.
"12.  After being examined in the emergency
room, Mr. Helms was found to have a wrist fracture
and bleeding in the brain.  Mr. Helms was admitted
to the geriatric floor at Brookwood where his
condition 
continued 
to 
decline 
until 
he 
was
discharged to [hospice at Brookwood] and thereafter
died on August 7, 2004." 
The complaint continues by stating claims alleging that
Brookwood (1) "negligently and/or wantonly provided medical
services to Mr. Sallas and Mr. Helms and negligently and/or
wantonly breached [the] acceptable standard of practice in
providing 
such 
medical 
services," 
(2) 
fraudulently 
"suppressed
from the families of Messrs. Sallas and Helms the truth
concerning 
[T.B.] 
and 
his 
violent 
tendencies," 
and
(3) committed the tort of outrage based on the manner in which
Brookwood conducted itself with respect to Mr. Sallas and
Mr. Helms and their families.
On July 6, 2005, Brookwood filed a "Motion to Sever
Claims," pursuant to which Brookwood sought the severance of
the Sallas claims from the Helms claims, such that there would
be "two separate actions, each case with its own civil action
1061307
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docket number."  Brookwood argued that allowing the case "to
proceed as a single action, rather than two separate actions,
will only confuse the jury and greatly prejudice [Brookwood]"
and that allowing the case "to move forward as a single action
... [would frustrate] the very purpose and intent of the
Legislature in enacting Alabama Code [1975,] § 6-5-551," which
is part of the Alabama Medical Liability Act, Ala. Code 1975,
§ 6-5-540 et seq. ("the AMLA").  The trial court conducted a
hearing on Brookwood's motion, and on July 26, 2005, it
entered an order, which states:  "[Brookwood]'s pending Motion
to Sever is ... denied, but the Court defers consideration of
whether separate trials may be warranted in this case."
Brookwood has not sought relief in this Court from the trial
court's denial of its motion to sever; therefore, we do not
have before us any question regarding the propriety of the
joinder of the various claims in a single action. 
In February 2007, Brookwood filed a "Motion for Separate
Trials," requesting, pursuant to Rule 42(b), Ala. R. Civ. P.,
that the trial court conduct separate trials as to the Sallas
claims and the Helms claims.  Brookwood asserted that the
failure to conduct separate trials would frustrate the purpose
1061307
Whether the claims asserted by the Sallases and Belinda
1
Helms are governed by the AMLA is not an issue presented by
the petition; all parties take the position in their briefs to
this Court that they are.
7
and intent of the last sentence of § 6-5-551.  Section 6-5-551
provides, in part:
"In any action for injury, damages, or wrongful
death, whether in contract or in tort, against a
health care provider for breach of the standard of
care, whether resulting from acts or omissions in
providing health care, or the hiring, training,
supervision, retention, or termination of care
givers, the [AMLA] shall govern the parameters of
discovery and all aspects of the action. ...  Any
party shall be prohibited from conducting discovery
with regard to any other act or omission or from
introducing at trial evidence of any other act or
omission."
(Emphasis added.)   Brookwood also argued:
1
"Additionally, 
while 
the 
claims 
asserted 
by 
both
sets of plaintiffs are governed by the AMLA, Mr. and
Mrs. Sallas have made allegations of negligence and
wantonness, which will involve compensatory and
punitive damages, and Ms. Helms asserts a claim of
wrongful death, which will be strictly punitive in
nature.  In seeking punitive damages, Mr. and
Mrs. Sallas will have to prove wantonness by clear
and convincing evidence whereas Ms. Helms will have
to prove the wrongful death claim by substantial
evidence.  Thus, the plaintiffs will have different
burdens of proof.  To allow Mr. and Mrs. Sallas'
claims 
against 
Brookwood 
for 
negligence 
and
wantonness to be tried with Ms. Helms' claim against
Brookwood for wrongful death will only confuse the
jury and will greatly prejudice this defendant."
1061307
8
The Sallases and Belinda Helms filed a response to
Brookwood's motion for separate trials, arguing, in part,
that, rather than ordering separate trials, the trial court
could give limiting instructions to the jury concerning the
proper consideration of the evidence for each plaintiff's
claims.  Brookwood replied to the plaintiffs' limiting-
instruction argument by arguing that the use of limiting
instructions would neither "resolve any non-compliance" with
§ 6-5-551 nor "rectify the prejudice that will result to
Brookwood from allowing evidence of the incident between
Mr. Sallas and [T.B.] to be admitted during the trial of
Ms. Helms' claims."  Brookwood further noted that 
"[h]ad the claims by each set of plaintiffs in fact
been filed as separate lawsuits, then without
question, during the trial of Ms. Helms' claims,
evidence of the incident between Mr. Sallas and
[T.B.] would not be admissible pursuant to Alabama
Code [1975,] § 6-5-551, as it is an 'other act or
omission.'  By filing the instant lawsuit in behalf
of two separate sets of plaintiffs for alleged
breaches in the standard of care occurring on two
different days against a single defendant, the
plaintiffs are seeking to circumvent the express
language of Alabama Code [1975,] § 6-5-551."   
In May 2007, the trial court entered an order denying
Brookwood's motion for separate trials.  Among other things,
the trial court expressed its intention, in lieu of ordering
1061307
9
separate trials, to give "limiting instructions" to the jury
in relation to evidence that would not be relevant to both
sets of claims.
Brookwood then filed this petition for a writ of
mandamus.  This Court stayed the trial of the case pending its
decision on Brookwood's petition.
Standard of Review
Mandamus is an extraordinary writ by which "a party seeks
emergency and immediate appellate review of an order that is
otherwise interlocutory and not appealable."  Rule 21(e)(4),
Ala. R. App. P.  Mandamus is appropriate 
"'where there is (1) a clear legal right in the
petitioner to the order sought; (2) an imperative
duty upon the respondent to perform, accompanied by
a refusal to do so; (3) the lack of another adequate
remedy; and (4) properly invoked jurisdiction of the
court.'"  
Ex parte Perfection Siding, Inc., 882 So. 2d 307, 309-10 (Ala.
2003) (quoting  Ex parte Integon Corp., 672 So. 2d 497, 499
(Ala. 1995)).  In part, this Court may issue a writ of
mandamus "to prevent an abuse of discretion, or to correct an
arbitrary action outside of the exercise of a reasonable
discretion."  Foshee v. State, 210 Ala. 155, 157, 97 So. 565,
566 (1923).  A petition for a writ of mandamus is an
1061307
10
appropriate means for challenging a trial court's ruling on a
motion for separate trials.  See Ex parte Skelton, 459 So. 2d
825 (Ala. 1984). 
Discussion
Rule 42(b), Ala. R. Civ. P., states that the trial court
may order separate trials "in furtherance of convenience or to
avoid prejudice, or when separate trials will be conducive to
expedition and economy."  As it did in the trial court,
Brookwood in its petition relies upon Rule 42(b) and § 6-5-551
to argue that the trial court exceeded its discretion when it
denied Brookwood's motion for separate trials. 
 
In their response to Brookwood's petition, the Sallases
and Belinda Helms correctly note that the AMLA does not speak
per se to the issue of separate trials.  It also is true, as
they point out, that the trial court generally has significant
discretion in deciding whether separate trials are necessary
in order to achieve the objectives expressed in Rule 42 or
whether limiting instructions to the jury would be appropriate
or sufficient.  See, e.g., Ex parte R.B. Etheridge & Assocs.,
Inc., 494 So. 2d 54, 57-58 (Ala. 1986).  
1061307
11
Brookwood specifically argues, however, that, as applied
to the particular claims presented in this case, § 6-5-551
necessarily removes from the trial court any discretion to
allow the introduction, in the trial of the Helms claims, of
any evidence of Brookwood's alleged wrongful acts and
omissions as to Mr. Sallas, whether with or without limiting
instructions.  This argument is well-taken.  If both sets of
plaintiffs are allowed to prosecute their claims in the same
trial, a violation of § 6-5-551 is unavoidable.  In entering
the May 2007 order denying Brookwood's motion for separate
trials, the trial court therefore exceeded its discretion.
Accordingly, Brookwood's petition for the writ of
mandamus is granted.  The trial court is directed to vacate
its May 2007 order and to enter an order providing for
separate trials.
PETITION GRANTED; WRIT ISSUED.
Woodall, Stuart, and Bolin, JJ., concur.
Lyons, J., concurs specially.
1061307
12
LYONS, Justice (concurring specially).
I concur fully in the main opinion.
The complaint filed on behalf of Mr. Helms, the first
patient alleged to suffer from being placed in proximity to
T.B., must comply with § 6-5-551, Ala. Code 1975, which
requires that "[t]he plaintiff shall include in the complaint
filed in the action a detailed specification and factual
description of each act and omission alleged by plaintiff to
render the health care provider liable to plaintiff and shall
include when feasible and ascertainable the date, time, and
place of the act or acts."  Obviously, the subsequent conduct
of T.B. allegedly directed toward Mr. Sallas would not be
appropriate for inclusion in Belinda Helms's complaint, which
is limited by § 6-5-551 to "each act and omission alleged by
plaintiff to render the health care provider liable to
plaintiff."  
Section 6-5-551 concludes with the following statement:
"Any party shall be prohibited from conducting discovery with
regard to any other act or omission or from introducing at
trial evidence of any other act or omission."  (Emphasis
added.)  "Other" obviously refers to an act or omission other
1061307
13
than those acts or omissions alleged in the complaint.  See Ex
parte Anderson, 789 So. 2d 190, 198 (Ala. 2000) ("Discovery of
any incidents of malpractice other than those specifically
alleged in the complaint is precluded.").  Consequently, under
§ 6-5-551, evidence as to Mr. Sallas would not be admissible
in the trial of Belinda Helms's claim.
The trial court concluded that the portion of § 6-5-551
precluding introduction of evidence of Mr. Sallas's injury in
the trial of Belinda Helms's claim could be honored in a trial
involving both plaintiffs by the use of limiting instructions
to the jury.  However, § 6-5-551 condemns introduction of
extraneous evidence at trial.  The breadth of this prohibition
is ill-suited to avoid its violation by a limiting instruction
given after introduction of the condemned evidence in a trial
involving both plaintiffs.