Title: Alpha Cobb v. Edward H. Fisher III et al
Citation: N/A
Docket Number: 1071501
State: Alabama
Issuer: Alabama Supreme Court
Date: April 3, 2009

REL: 04/03/2009
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
_________________________
1071501
_________________________
Alpha Cobb
v.
Edward H. Fisher III et al.
Appeal from Franklin Circuit Court
(CV-06-200)
PER CURIAM.
Alpha Cobb appeals from a summary judgment in favor of
Edward H. Fisher III, M.D. ("Dr. Fisher"), Edward H. Fisher
III, M.D., P.C. (hereinafter referred to collectively as
1071501
2
"Fisher"), and Russellville Hospital, LLC ("the hospital").
We affirm.
Cobb sued Fisher and the hospital on August 16, 2006,
stating claims alleging medical malpractice, breach of
fiduciary duty, and the tort of outrage and asserting claims
based on the doctrines of res ipsa loquitor and respondeat
superior.  She alleged that Dr. Fisher had performed a
bilateral knee replacement on her at the hospital on August
16, 2004.  Cobb asserted that she experienced pain in her left
knee and had difficulty walking after the surgery, and that in
December 2004 she discovered bone fragments and cement in her
left knee.  Cobb maintained that her pain was alleviated by
subsequent surgery that removed the bone fragments and some of
the cement.
Fisher and the hospital answered Cobb's complaint.  On
February 22, 2007, the trial court entered an order placing
the case on that court's "administrative docket" and stating
that the parties could move to have the case returned to the
"active docket" when the case was ready for trial.  Five weeks
later, on April 2, 2007, the trial court entered a scheduling
order.  The scheduling order stated, in part, as follows:
1071501
3
"(1) Plaintiffs 
to 
provide 
appropriate 
Rule 
26[,
Ala. R. Civ. P.,] information on or before May 15,
2007;
"(2) 
Plaintiffs 
will 
make 
their 
experts
available for deposition on or before June 15, 2007;
"(3) Defendants will identify their expert
witnesses 
and 
provide 
appropriate 
Rule 
26
information on or before August 1, 2007;
"(4) The Defendants will present their experts
for deposition on or before September 15, 2007;
"(5) Discovery will close on November 1, 2007;
"(6) All dispositive motions shall be filed on
or before December 1, 2007 ...."
The parties thereafter proceeded with discovery and
issued subpoenas to third parties.  On May 16, 2007, the
hospital filed a motion to compel discovery responses from
Cobb, and the following week the trial court ordered Cobb to
respond to the hospital's outstanding discovery requests.
However, neither Cobb nor Fisher and the hospital disclosed
information regarding their expert witnesses, and no expert
witnesses were deposed.  On November 9, 2007, the hospital
moved for a summary judgment.  To support its motion, the
hospital submitted the affidavit of Leah Hyde, a nurse who had
participated in Cobb's surgery. Hyde stated that she was
familiar with the standard of care applicable to nurses at the
1071501
4
time of Cobb's surgery, that the hospital's nursing staff
adhered to that standard, and that the standard was not
breached.  She also stated that cement is used during knee-
replacement surgery to hold the new joint in place.
Based on Hyde's affidavit, the hospital argued that it
had not breached the applicable standard of care and that the
burden therefore had shifted to Cobb to present substantial
evidence to support her claims.  The hospital argued that Cobb
had not done so.  Specifically, the hospital asserted that
Cobb had not presented expert testimony to support her claims
as required under § 6-5-548, Ala. Code 1975, a part of the
Alabama Medical Liability Act, § 6-5-540 et seq., Ala. Code
1975 ("the AMLA").
On November 13, 2007, Fisher moved for a summary
judgment, asserting substantially the same arguments stated in
the hospital's summary-judgment motion.  Fisher's motion was
supported by an affidavit of Dr. Fisher.  Dr. Fisher stated
that he was familiar with the standards of care applicable to
similarly situated health-care providers and to nurses at the
time of Cobb's surgery.  Dr. Fisher stated that neither he nor
the hospital's nursing staff had breached those standards of
care.  Dr. Fisher also stated that cement is used during a
1071501
5
knee-replacement procedure and that it remains inside the
patient to hold the new joint in place.
The trial court set the summary-judgment motions for a
hearing on January 3, 2008.  Three days before the hearing, on
December 31, 2007, Cobb responded to the summary-judgment
motions.  She based her response almost exclusively on the
affidavit of Steven R. Graboff, M.D., a licensed orthopedic
surgeon who practices in California.  Dr. Graboff stated that
he was familiar with the standard of care applicable to
similarly situated health-care providers in the same general
line of practice as Dr. Fisher in the national medical
community.  Dr. Graboff stated that he had reviewed Cobb's
medical records, and, based on the information in those
records, it was his opinion that Dr. Fisher and the hospital
staff had deviated from the applicable standards of care.
On the day of the hearing on the summary-judgment
motions, Fisher and the hospital moved to strike Dr. Graboff's
affidavit.  They stated that Cobb did not disclose Dr. Graboff
as an expert witness by May 15, 2007, pursuant to the April 2,
2007, scheduling order.  They argued, therefore, that Dr.
Graboff's affidavit was untimely and was thus due to be
stricken.  They also argued that Dr. Graboff's affidavit did
1071501
6
not adequately describe the applicable standards of care and
that, as to the hospital, Dr. Graboff was not a similarly
situated health-care provider.
Before the trial court ruled on the motion to strike and
the summary-judgment motions, Cobb filed a supplemental
response to the summary-judgment motions.  She argued, among
other things, that her claims fell within an exception to the
requirement in the AMLA for expert testimony because, she
said, 
the 
claims 
involved 
a 
foreign 
substance 
or
instrumentality, i.e., the cement in her knee.  Cobb also
moved to be relieved from the April 2, 2007, scheduling order.
In that motion, Cobb stated that, "because of staffing
issues," her counsel had not calendared the scheduling order.
Cobb contended that her failure to comply with the scheduling
order was an administrative oversight and that her attorney
had not failed to "participate in good faith."  See Rule
16(f), Ala. R. Civ. P.  She also filed a motion that refers to
a prior oral motion in which she argued that affidavits
submitted with Fisher's and the hospital's summary-judgment
motions included expert opinions and that Fisher and the
hospital had similarly failed to disclose their experts.
1071501
7
On February 13, 2008, the trial court entered an order
granting Fisher's and the hospital's motions to strike and for
a summary judgment and dismissing Cobb's action with
prejudice.  The trial court stated that its April 2, 2007,
scheduling order required Cobb to designate an expert by May
15, 2007, and to make the expert available for deposition by
June 15, 2007.  The trial court stated that Cobb had failed to
comply with that order, and it rejected her argument that
Fisher and the hospital would not be prejudiced by the entry
of a new scheduling order.  It noted that Fisher and the
hospital had filed their summary-judgment motions pursuant to
the April 2, 2007, scheduling order and that Cobb had "the
benefit of reviewing the motion[s] and seeing the arguments of
the defendants before [she] selected [her] expert."  Finally,
the trial court discussed the delay in discovery that would
result from a new scheduling order and stated: "The Court
would be more inclined to give leeway to [Cobb] if only a
month or two had lapsed from the deadline of the scheduling
order."
Cobb moved to alter, amend, or vacate the trial court's
judgment.  Her motion was denied by operation of law pursuant
to Rule 59.1, Ala. R. Civ. P., and she appealed.  On appeal,
1071501
8
Cobb contends that the trial court's summary judgment amounted
to a discovery sanction under Rule 16(f) and Rule 37(b), Ala.
R. Civ. P., and that in entering the judgment the trial court
had exceeded its discretion because, she says, the sanction is
so severe as to not be proportional to her violation of the
scheduling order.  In the alternative, Cobb contends that her
claims fall within an exception to the requirement in the AMLA
for expert testimony.  Fisher and the hospital contend that
the trial court's summary judgment was not a discovery
sanction but was based on Cobb's failure to present expert
testimony to support her claims, and they argue that the
judgment, therefore, should be affirmed.  Alternatively,
Fisher and the hospital contend that, if the judgment was in
the nature of a discovery sanction, it was appropriate.
Our standard of review of a summary judgment is well
settled:
"'The standard of review applicable to a summary
judgment is the same as the standard for granting
the motion....' McClendon v. Mountain Top Indoor
Flea Market, Inc., 601 So. 2d 957, 958 (Ala. 1992).
"'A summary judgment is proper when
there is no genuine issue of material fact
and the moving party is entitled to a
judgment as a matter of law. Rule 56(c)(3),
Ala. R. Civ. P. The burden is on the moving
1071501
9
party to make a prima facie showing that
there is no genuine issue of material fact
and that it is entitled to a judgment as a
matter of law. In determining whether the
movant has carried that burden, the court
is to view the evidence in a light most
favorable to the nonmoving party and to
draw all reasonable inferences in favor of
that party. To defeat a properly supported
summary judgment motion, the nonmoving
party must present "substantial evidence"
creating a genuine issue of material fact--
"evidence of such weight and quality that
fair-minded persons in the exercise of
impartial judgment can reasonably infer the
existence of the fact sought to be proved."
Ala. Code 1975, § 12-21-12; West v.
Founders Life Assurance Co. of Florida, 547
So. 2d 870, 871 (Ala. 1989).'
"Capital Alliance Ins. Co. v. Thorough-Clean, Inc.,
639 So. 2d 1349, 1350 (Ala. 1994).  Questions of law
are reviewed de novo.  Alabama Republican Party v.
McGinley, 893 So. 2d 337, 342 (Ala. 2004)."
Pritchett v. ICN Med. Alliance, Inc., 938 So. 2d 933, 935
(Ala. 2006).  We note that "[t]he decision concerning the
appropriate sanction for failure to comply with a pretrial
order, including whether to exclude the testimony of the
noncomplying witness, is within the trial court's discretion,"
and we review such decisions to determine whether the trial
court exceeded its discretion.   Vesta Fire Ins. Corp. v.
Milam & Co. Constr., Inc., 901 So. 2d 84, 105 (Ala. 2004)
(citing Truck Rentals of Alabama, Inc. v. M.O. Carroll-Newton
1071501
10
Co., 623 So. 2d 1106, 1112 (Ala. 1993), and Mitchell v. Moore,
406 So. 2d 347, 350 (Ala. 1981)).
The AMLA, at § 6-5-548(a), Ala. Code 1975, provides, in
relevant part: 
"In any action for injury ... against a health care
provider for breach of the standard of care, the
plaintiff shall have the burden of proving by
substantial evidence that the health care provider
failed to exercise such reasonable care, skill, and
diligence as other similarly situated health care
providers in the same general line of practice
ordinarily have and exercise in a like case."
This Court has stated: "[i]n a medical-malpractice action, the
plaintiff ordinarily is required to present expert testimony
as to the relevant standard of care."  Martin v. Dyas, 896 So.
2d 
436, 
441 
 
(Ala. 
2004). 
 
"A 
plaintiff 
in 
a
medical-malpractice action must also present expert testimony
establishing a causal connection between the defendant's act
or omission constituting the alleged breach and the injury
suffered by the plaintiff."  Sorrell v. King, 946 So. 2d 854,
862 (Ala. 2006) (citing Pruitt v. Zeiger, 590 So. 2d 236, 238
(Ala. 1991)).
"However, '[a]n exception to this rule [requiring
expert testimony] exists "in a case where want of
skill or lack of care is so apparent ... as to be
understood by a layman, and requires only common
knowledge 
and 
experience 
to 
understand 
it."'
1071501
11
[Tuscaloosa Orthopedic Appliance Co. v.] Wyatt, 460
So. 2d [156,] 161 [(Ala. 1984)] (quoting Dimoff v.
Maitre, 432 So. 2d 1225, 1226-27 (Ala. 1983)). This
Court has recognized the following situations as
falling within this exception:
"'"1) where a foreign instrumentality is
found in the plaintiff's body following
surgery; 2) where the injury complained of
is in no way connected to the condition for
which the plaintiff sought treatment; 3)
where the plaintiff employs a recognized
standard or authoritative medical text or
treatise to prove what is or is not proper
practice; and 4) where the plaintiff is
himself 
or 
herself 
a 
medical 
expert
qualified 
to 
evaluate 
the 
doctor's
allegedly negligent conduct."'
"Allred [v. Shirley], 598 So. 2d [1347,] 1350 [(Ala.
1992)] (quoting Holt v. Godsil, 447 So. 2d 191,
192-93 (Ala. 1984) (citations omitted in Allred))."
Anderson v. Alabama Reference Labs., 778 So. 2d 806, 811 (Ala.
2000); see also Sorrell v. King, 946 So. 2d at 861-62; Ex
parte HealthSouth Corp., 851 So. 2d 33, 37 (Ala. 2002).
In her principal brief seeking reversal of the trial
court's summary judgment, Cobb makes two arguments.  She
contends that the circumstances surrounding the discovery of
a foreign substance in her following the surgery--the cement--
entitle her to an exception from the requirement of the AMLA
that she submit expert testimony.  See Anderson v. Alabama
Reference Labs., supra.  She further contends that even if she
1071501
12
was required to submit expert testimony, the trial court's
dismissal of her action constituted an excessive discovery
sanction.  She does not assert in her principal brief, as she
did in the trial court, that Fisher and the hospital also
violated the discovery deadline and therefore that the trial
court did not deal evenhandedly with the failure of all
parties to comply with its discovery order.  She raises this
argument on appeal for the first time in her reply brief.
"[T]his Court does not address issues raised for the first
time in a reply brief." Byrd v. Lamar, 846 So. 2d 334, 341
(Ala. 2002).  Another argument, possibly related to the
contention of lack of evenhandedness, is the extent to which
expert testimony from the defendant is necessary to establish
a suitable basis for the conclusion of unavailability of the
"foreign instrumentality" exception to the AMLA requirement of
expert testimony as to the standard of care.  We address only
the arguments for reversal presented in Cobb's principal
brief.
Cobb contends that the cement found in her knee following
the surgery was a foreign instrumentality and that Dr.
Fisher's and the hospital staff's "want of skill or lack of
1071501
13
care is so apparent ... as to be understood by a layman, and
requires only common knowledge and experience to understand
it."  Anderson, 778 So. 2d at 811.  However, it is undisputed
that cement remains in a patient's knee to hold the new joint
in place after correctly performed knee-replacement surgery.
Therefore, the cement in Cobb's knee was not akin to an
instrumentality that should have been removed by the surgeon
but that was negligently left in the patient's body.  See,
e.g., Houserman v. Garrett, 902 So. 2d 670 (Ala. 2004)
(surgical pad left in patient's body after surgery); Sellers
v. Noah, 209 Ala. 103, 95 So. 167 (1923) (needle left in
patient's body after surgery).  Instead, the cement that
remains in Cobb's body is a part of the knee-replacement
procedure.  The question, therefore, is not whether Dr. Fisher
and the hospital staff acted negligently in leaving the cement
in Cobb's knee; rather, the question is whether the placement
or use of the cement breached the standard of care.
Accordingly, the discovery of bone fragments and cement in
Cobb's knee four months after the surgery is not indicative of
a breach of the standard of care "so apparent ... as to be
understood by a layman."  Anderson, 778 So. 2d at 811.
1071501
14
Therefore, Cobb's claims do not fall within the exception to
the general rule requiring expert testimony in medical-
malpractice actions.  Accordingly, it was incumbent upon Cobb
to present expert testimony to support her claims.  See, e.g.,
Martin, supra, and Sorrell, supra.  It is undisputed that the
April 2, 2007, scheduling order, at the very least, required
Cobb to present her expert for deposition on or before June
15, 2007.  Cobb did not do so.  
Cobb also contends that the summary judgment entered for
Fisher and the hospital was a discovery sanction for her
failure to comply with the trial court's scheduling order.  As
discussed above, the AMLA and this Court's prior decisions
require a plaintiff to present expert testimony to support his
or her claims, and, absent the application of an exception,
the failure of the plaintiff to do so is usually fatal to his
or her claim.  Accordingly, the striking of a plaintiff's
expert testimony is, in effect, fatal to the action. 
The trial court was authorized, pursuant to Rules 16(f)
and 37(b)(2)(C), Ala. R. Civ. P., to impose sanctions on a
party for failure to comply with the April 2, 2007, scheduling
order.  Rule 16(f) provides, in relevant part:
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15
"If a party or party's attorney fails to obey a
scheduling or pretrial order, or if no appearance is
made on behalf of a party at a scheduling or
pretrial conference, or if a party or party's
attorney is substantially unprepared to participate
in the conference, or if a party or party's attorney
fails to participate in good faith, the judge, upon
motion or the judge's own initiative, may make such
orders with regard thereto as are just, and among
others 
any 
of 
the 
orders 
provided 
in 
Rule
37(b)(2)(B), (C), (D)."
The orders provided for in Rule 37(b)(2), Ala. R. Civ. P.,
include:
"(B) An order refusing to allow the disobedient
party to support or oppose designated claims or
defenses, or prohibiting that party from introducing
designated matters in evidence; 
"(C) An order striking out pleadings or parts
thereof, or staying further proceedings until the
order is obeyed, or dismissing the action or
proceeding or any part thereof, or rendering a
judgment by default against the disobedient party;
[and]
"(D) ... [A]n order treating as a contempt of
court the failure to obey any orders except an order
to submit to a physical or mental examination."
Fisher and the hospital argue that the trial court did
not enter a summary judgment against Cobb as a sanction under
Rule 16 for missing a mandatory discovery deadline.  Instead,
they argue that the trial court merely struck Cobb's proffered
expert's affidavit as a means of enforcing its order
1071501
16
specifying a deadline by which her expert, if there was to be
one, must have been identified.  We agree.  This is not a
situation where the plaintiff missed a deadline imposed by the
court and is sanctioned for doing so with the entry of a
summary judgment, such as where a party fails or refuses to
meet a court-ordered deadline for responding to discovery
requests by the other side.  Here, in contrast, the deadline
was for an optional disclosure: If Cobb was going to introduce
expert testimony, then she was required to identify the expert
by a certain date.  Thus, Cobb's failure to identify an expert
by that date was not in and of itself a sanctionable offense.
Accordingly, it was not a direct ground for entering a summary
judgment against her under Rule 16; i.e., it was not a
"fail[ure] to obey" a scheduling or pretrial order as
contemplated by Rule 16(f).  Therefore, we conclude that in
entering the summary judgment the trial court was not
sanctioning Cobb for violating an order of the court.
Cases dealing with the inappropriateness of dismissal as
a sanction for violating an order unless the conduct is
willful or contumacious are not on point.  Here, Cobb would be
entitled to relief from the trial court if she satisfied the
1071501
17
requirements of Rule 6(b), Ala. R. Civ. P.  Under that rule,
enlarging the time in which an act is to be perform is allowed
"where the failure to act was the result of excusable
neglect."  Discovery was ongoing during the times in question
in this action, even though the case had been placed on the
trial court's "administrative docket."  In fact, during the
weeks leading to the discovery deadline, the parties exchanged
correspondence regarding discovery responses and a motion to
compel those responses.  Under the circumstances, Cobb's
inattention to the requirements of the scheduling order from
May 15, 2007, through as late as December 31, 2007, is
difficult to characterize as excusable neglect.  
Under the circumstances described above and given the
issues presented, we cannot say that the trial court exceeded
its discretion in striking the affidavit of Cobb's expert and
entering a summary judgment for Fisher and the hospital. 
AFFIRMED.
Cobb, C.J., and Lyons, Woodall, Stuart, Smith, Bolin,
Parker, and Murdock, JJ., concur.
Shaw, J., concurs in the result.