Title: Mobile OB-GYN, P.C. v. Wendy Godwin Baggett
Citation: N/A
Docket Number: 1071020
State: Alabama
Issuer: Alabama Supreme Court
Date: June 12, 2009

REL: 06/12/2009 
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 
1071020 
Mobile OB-GYN, P.C. 
v. 
Wendy Godwin Baggett 
1071081 
Wendy Godwin Baggett 
v. 
Mobile OB-GYN, P.C. 
Appeals from Mobile C i r c u i t 
Court 
(CV-05-2615) 
1071020, 1071081 
STUART, 
J u s t i c e . 
Wendy Godwin 
B a g g e t t 
s u e d M o b i l e OB-GYN, P.C., i n 
t h e 
M o b i l e 
C i r c u i t C o u r t 
a l l e g i n g t h a t one o f i t s p h y s i c i a n s , D r . 
P h i l l i p M a d o n i a , c o m m i t t e d m e d i c a l m a l p r a c t i c e w h i l e 
t r e a t i n g 
h e r 
d u r i n g h e r p r e g n a n c y a n d t h a t t h e d e a t h 
o f h e r b a b y 
s h o r t l y 
a f t e r 
c h i l d b i r t h 
was t h e 
d i r e c t 
r e s u l t 
o f D r . 
M a d o n i a ' s m a l p r a c t i c e . 
F o l l o w i n g a t r i a l , 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 f a v o r o f B a g g e t t a n d a g a i n s t M o b i l e OB-GYN i n t h e 
amount o f $8 m i l l i o n . 
The t r i a l 
c o u r t s u b s e q u e n t l y 
o r d e r e d a 
r e m i t t i t u r o f $3 m i l l i o n , 
r e d u c i n g t h e damages a w a r d t o $5 
m i l l i o n . 
M o b i l e 
OB-GYN now 
a p p e a l s 
t h e j u d g m e n t 
e n t e r e d 
a g a i n s t 
i t , 
a n d B a g g e t t h a s c r o s s - a p p e a l e d , 
c h a l l e n g i n g t h e 
r e m i t t i t u r . 
We r e v e r s e t h e j u d g m e n t e n t e r e d 
a g a i n s t 
M o b i l e 
OB-GYN a n d remand t h e c a u s e f o r 
a new 
t r i a l ; 
a c c o r d i n g l y , 
B a g g e t t ' s 
c r o s s - a p p e a l i s d i s m i s s e d as moot. 
I . 
B a g g e t t 
became a p a t i e n t a t M o b i l e OB-GYN on M a r c h 1, 
2004, when D r . M a d o n i a 
b e g a n 
t r e a t i n g h e r f o r h i g h 
b l o o d 
p r e s s u r e a n d d e p r e s s i o n . 
A t t h a t 
v i s i t a n d a t 
s u c c e e d i n g 
v i s i t s 
o v e r 
t h e n e x t 
s e v e r a l 
m o n t h s , 
D r . M a d o n i a 
t r i e d 
p r e s c r i b i n g v a r i o u s m e d i c a t i o n s t o t r e a t B a g g e t t , 
e v e n t u a l l y 
2 
1071020, 1071081 
s e t t l i n g on B e n i c a r f o r h e r 
h i g h b l o o d p r e s s u r e a n d 
W e l l b u t r i n 
and 
P r o z a c f o r 
h e r d e p r e s s i o n . 
B a g g e t t 
t e s t i f i e d 
t h a t t h e 
m e d i c a t i o n s D r . M a d o n i a p r e s c r i b e d h a d a p o s i t i v e 
i m p a c t on 
how she f e l t . 
On O c t o b e r 25, 2004, B a g g e t t 
a g a i n v i s i t e d M o b i l e OB-GYN 
a f t e r a home p r e g n a n c y t e s t 
i n d i c a t e d t h a t she was 
p r e g n a n t . 
Dr. M a d o n i a c o n f i r m e d t h e r e s u l t s o f t h a t t e s t , e s t i m a t e d t h a t 
she was a p p r o x i m a t e l y 
s i x weeks p r e g n a n t b a s e d on a 
p e l v i c 
exam, a n d gave B a g g e t t a p r e s c r i p t i o n f o r 
p r e n a t a l v i t a m i n s . 
Dr. M a d o n i a 
t e s t i f i e d 
t h a t he a l s o s p o k e w i t h B a g g e t t 
a b o u t 
t h e 
m e d i c a t i o n s 
she was t a k i n g a n d t o l d h e r t h a t she c o u l d 
c o n t i n u e t a k i n g W e l l b u t r i n a n d P r o z a c b u t t h a t she s h o u l d 
s t o p 
t a k i n g 
B e n i c a r 
b e c a u s e 
t h e r e were 
s t r o n g w a r n i n g s 
a g a i n s t 
t a k i n g i t 
d u r i n g p r e g n a n c y . 
H o w e v e r , B a g g e t t 
t e s t i f i e d 
t h a t 
Dr. 
M a d o n i a 
t o l d h e r t h a t i t 
was f i n e f o r 
h e r t o c o n t i n u e 
t a k i n g a l l 
o f h e r c u r r e n t m e d i c a t i o n s , a n d she c o n t i n u e d t o 
do 
s o .
1 
B a g g e t t 
t e s t i f i e d 
t h a t on s e v e r a l s u c c e e d i n g 
v i s i t s t o 
Dr. 
M a d o n i a ' s 
o f f i c e 
she a s k e d 
a b o u t 
t h e s a f e t y o f t h e 
m e d i c a t i o n s she 
was t a k i n g d u r i n g a p r e g n a n c y , b u t n e i t h e r D r . 
M a d o n i a n o r h i s n u r s e , Amy C l o s s m a n , 
e v e r 
t o l d h e r t o s t o p 
1 B a g g e t t i n f a c t 
r e f i l l e d h e r p r e s c r i p t i o n f o r B e n i c a r on 
O c t o b e r 27, 2004, two d a y s a f t e r h e r v i s i t w i t h D r . M a d o n i a . 
3 
1071020, 1071081 
t a k i n g B e n i c a r ; b o t h D r . M a d o n i a a n d C l o s s m a n 
t e s t i f i e d 
t h a t 
B a g g e t t 
n e v e r a s k e d them w h e t h e r she s h o u l d c o n t i n u e t o t a k e 
B e n i c a r once she l e a r n e d she was p r e g n a n t a n d t h a t t h e y d i d 
n o t know t h a t she c o n t i n u e d t a k i n g i t 
d u r i n g h e r p r e g n a n c y . 
A l t h o u g h B a g g e t t ' s m e d i c a l r e c o r d s i n d i c a t e t h e d a t e on w h i c h 
B e n i c a r was p r e s c r i b e d t o h e r , none o f D r . M a d o n i a ' s n o t e s a n d 
n o t h i n g i n t h e m e d i c a l 
r e c o r d s m a i n t a i n e d b y M o b i l e OB-GYN 
i n d i c a t e t h a t she was e v e r t o l d t o d i s c o n t i n u e t a k i n g B e n i c a r 
a f t e r she became 
p r e g n a n t . 
B a g g e t t 
r e t u r n e d t o M o b i l e OB-GYN f o r 
m o n t h l y 
p r e g n a n c y 
c h e c k u p s 
i n November, 
December, a n d J a n u a r y . 
U l t r a s o u n d 
e x a m i n a t i o n s 
were 
c o n d u c t e d 
i n November a n d December, a n d 
t h o s e e x a m i n a t i o n s , a l o n g w i t h o t h e r t e s t i n g done d u r i n g t h o s e 
v i s i t s , 
i n d i c a t e d 
t h a t B a g g e t t ' s 
p r e g n a n c y 
was p r o g r e s s i n g 
n o r m a l l y . 
On F e b r u a r y 7, 2005, B a g g e t t r e t u r n e d t o M o b i l e OB-
GYN f o r 
h e r f i f t h p r e n a t a l v i s i t 
w i t h D r . M a d o n i a . 
A n o t h e r 
u l t r a s o u n d e x a m i n a t i o n was p e r f o r m e d on t h i s 
v i s i t , a n d 
t h e 
t e c h n i c i a n 
c o n d u c t i n g 
t h i s 
e x a m i n a t i o n d i d 
n o t i n d i c a t e any 
p r o b l e m s i n h e r summary o f t h e e x a m i n a t i o n ; i n f a c t , she 
s p e c i f i c a l l y 
n o t e d 
t h a t t h e l e v e l 
o f a m n i o t i c 
f l u i d 
was 
n o r m a l . 
H o w e v e r , D r . M a d o n i a 
s u b s e q u e n t l y 
t e s t i f i e d 
t h a t 
4 
1071020, 1071081 
B a g g e t t ' s a m n i o t i c - f l u i d 
l e v e l a t t h e t i m e o f t h a t u l t r a s o u n d 
e x a m i n a t i o n , 6.69 c e n t i m e t e r s , was l o w , 
b u t t h a t he d i d n o t 
r e a l i z e 
i t a t t h e t i m e 
b e c a u s e 
he h a d 
r e l i e d 
upon t h e 
t e c h n i c i a n ' s s u m m a t i o n o f t h e u l t r a s o u n d e x a m i n a t i o n 
i n s t e a d 
o f 
l o o k i n g a t t h e e n t i r e 
r e p o r t . 
Low a m n i o t i c 
f l u i d , o r 
o l i g o h y d r a m n i o s , 
i s a 
c o n d i t i o n 
a s s o c i a t e d w i t h 
B e n i c a r 
e x p o s u r e 
d u r i n g 
p r e g n a n c y . 
B a g g e t t ' s n e x t two p r e n a t a l v i s i t s t o M o b i l e OB-GYN t o o k 
p l a c e on M a r c h 7 a n d A p r i l 4, a n d n o t h i n g d u r i n g t h o s e 
v i s i t s 
i n d i c a t e d 
t h a t 
B a g g e t t ' s 
p r e g n a n c y 
was a n y t h i n g o t h e r 
t h a n 
n o r m a l .
2 
On A p r i l 2 5 , B a g g e t t r e t u r n e d f o r 
h e r n e x t s c h e d u l e d 
a p p o i n t m e n t . 
D u r i n g h e r v i s i t 
w i t h D r . M a d o n i a , 
B a g g e t t 
r e p o r t e d 
t h a t 
she h a d 
e x p e r i e n c e d 
some 
v a g i n a l 
mucous 
d i s c h a r g e . 
D r . M a d o n i a e x a m i n e d h e r c e r v i x , b u t d i d 
n o t 
s e e 
a n y t h i n g 
a b n o r m a l . 
To a s s u r e 
B a g g e t t 
t h a t 
e v e r y t h i n g was 
n o r m a l , 
h o w e v e r , 
D r . M a d o n i a 
o r d e r e d 
a n o t h e r 
u l t r a s o u n d 
e x a m i n a t i o n . 
When t h i s 
u l t r a s o u n d was p e r f o r m e d , i t showed 
t h a t 
B a g g e t t h a d v i r t u a l l y no a m n i o t i c 
f l u i d a n d t h a t t h e 
f e t u s was i n d i s t r e s s . 
D r . M a d o n i a i m m e d i a t e l y 
t r a n s f e r r e d 
B a g g e t t t o t h e h i g h - r i s k 
o b s t e t r i c s 
c l i n i c a t t h e U n i v e r s i t y 
2 I t 
a p p e a r s 
t h a t 
an 
u l t r a s o u n d 
e x a m i n a t i o n 
was n o t 
p e r f o r m e d 
d u r i n g e i t h e r o f t h o s e 
v i s i t s . 
5 
1071020, 1071081 
o f S o u t h A l a b a m a C h i l d r e n ' s 
and Women's H o s p i t a l , and 
s h o r t l y 
t h e r e a f t e r an e m e r g e n c y c a e s a r e a n s e c t i o n was 
p e r f o r m e d and 
a 
b a b y b o y 
was 
d e l i v e r e d . 
The 
b a b y ' s c o n d i t i o n , h o w e v e r , was 
n o t good, and, 
a f t e r 
an e x a m i n a t i o n , h i s p r i m a r y p h y s i c i a n , D r . R i c h a r d 
W h i t e h u r s t , 
i n d i c a t e d i n h i s n o t e s t h a t t h e b a b y s u f f e r e d f r o m h y p o t e n s i o n 
r e l a t e d t o m a t e r n a l B e n i c a r e x p o s u r e . 
I n a n o t h e r n o t e w r i t t e n 
t h e f o l l o w i n g day, 
a f t e r t h e b a b y was 
g i v e n a t r a n s f u s i o n , 
D r . 
W h i t e h u r s t 
s t a t e d 
h i s d i a g n o s i s 
as 
h y p o t e n s i o n , 
a n u r i a , 
and 
B e n i c a r e x p o s u r e . 
The b a b y d i e d on A p r i l 27, a p p r o x i m a t e l y 
36 
h o u r s a f t e r b i r t h . 
B a g g e t t t e s t i f i e d a t 
t r i a l t h a t , f o l l o w i n g 
t h e b a b y ' s d e a t h , D r . 
W h i t e h u r s t recommended t h a t 
an 
a u t o p s y 
be p e r f o r m e d b e c a u s e he b e l i e v e d t h a t B e n i c a r e x p o s u r e was 
t h e 
c a u s e o f t h e b a b y ' s p r o b l e m s . 
An 
a u t o p s y was 
p e r f o r m e d , 
and 
t h e 
p a t h o l o g i s t 
who 
p e r f o r m e d 
t h a t 
a u t o p s y , 
D r . 
E l i z a b e t h 
M a n c i - G a r d n e r , 
c o n c l u d e d 
t h a t 
" [ t ] h e 
most 
l i k e l y 
c a u s e 
o f 
d e a t h 
i n t h i s 
c a s e 
i s d e c r e a s e d u t e r o p l a c e n t a l 
b l o o d 
f l o w . " 
B a g g e t t i n t r o d u c e d e v i d e n c e a t t r i a l i n d i c a t i n g t h a t d e c r e a s e d 
u t e r o p l a c e n t a l b l o o d 
f l o w i n a m o t h e r , as w e l l as 
h y p o t e n s i o n 
and 
a n u r i a 
i n a b a b y , a r e c o n d i t i o n s 
a s s o c i a t e d w i t h 
e x p o s u r e 
t o B e n i c a r 
d u r i n g 
t h e 
p r e g n a n c y . 
6 
1071020, 1071081 
On 
J u l y 12, 2005, 
B a g g e t t 
f i l e d 
a 
m e d i c a l - m a l p r a c t i c e 
a c t i o n 
a g a i n s t 
M o b i l e 
OB-GYN i n t h e M o b i l e 
C i r c u i t 
C o u r t , 
a l l e g i n g t h a t i t s n e g l i g e n c e a n d / o r w a n t o n n e s s was r e s p o n s i b l e 
f o r 
t h e d e a t h o f h e r b a b y . 
The c a s e p r o c e e d e d t o t r i a l on 
November 5, 2007, a n d , a t t h e c l o s e o f a l l t h e e v i d e n c e , t h e 
t r i a l 
c o u r t c h a r g e d t h e j u r y on t h e f o l l o w i n g f i v e c o u n t s o f 
n e g l i g e n c e : 
"Now, Wendy B a g g e t t b r i n g s t h i s l a w s u i t a l l e g i n g 
t h e 
f o l l o w i n g : N e g l i g e n t l y 
p r e s c r i b [ e d ] t h e d r u g 
B e n i c a r t o Wendy G o d w i n 
B a g g e t t ; t w o , n e g l i g e n t l y 
f a i l e d t o a p p r o p r i a t e l y f o l l o w up w i t h Wendy B a g g e t t 
and 
m o n i t o r 
h e r c o n d i t i o n and t h a t o f h e r 
c h i l d ; 
t h r e e , n e g l i g e n t l y d i d 
n o t have i n 
p l a c e 
a p p r o p r i a t e 
p r o c e d u r e s , 
s a f e g u a r d s , and p r o t o c o l s t o p r e v e n t t h e 
d r u g 
B e n i c a r 
f r o m 
b e i n g 
p r e s c r i b e d 
t o 
p r e g n a n t 
p a t i e n t s ; f o u r , n e g l i g e n t l y f a i l e d t o a p p r e c i a t e t h e 
d e v e l o p i n g 
s i g n s o f t h e d e v e l o p i n g damage t h e d r u g 
B e n i c a r was c a u s i n g d u r i n g t h e p r e g n a n c y and f a i l e d 
t o 
i n s t i t u t e 
any 
r e m e d i a l 
m e a s u r e s ; 
and 
f i v e , 
n e g l i g e n t l y d i d n o t p r o p e r l y 
e v a l u a t e t h e r i s k o f 
a l l o w i n g a p r e g n a n t p a t i e n t t o r e m a i n on t h e d r u g 
B e n i c a r . " 
On November 9, 2007, t h e j u r y 
r e t u r n e d a g e n e r a l v e r d i c t i n 
f a v o r o f B a g g e t t a n d a g a i n s t M o b i l e OB-GYN i n 
t h e amount o f $8 
m i l l i o n . 
M o b i l e OB-GYN s u b s e q u e n t l y 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 , 
a new t r i a l , o r a r e m i t t i t u r , a n d , f o l l o w i n g 
a h e a r i n g on M o b i l e OB-GYN's m o t i o n , t h e t r i a l 
c o u r t 
e n t e r e d 
an 
o r d e r 
d e n y i n g 
t h e r e q u e s t s f o r 
a j u d g m e n t as a m a t t e r o f 
7 
1071020, 1071081 
l a w a n d a new t r i a l b u t o r d e r i n g a r e m i t t i t u r a n d r e d u c i n g 
t h e 
damages t o 
$5 m i l l i o n . 
On A p r i l 2 1 , 2008, M o b i l e OB-GYN 
f i l e d 
i t s 
n o t i c e o f a p p e a l t o t h i s 
C o u r t , a n d , on May 1, 2008, 
B a g g e t t 
f i l e d h e r 
c r o s s - a p p e a l . 
I I . 
"When r e v i e w i n g a r u l i n g on a m o t i o n f o r 
a JML 
[ j u d g m e n t as a m a t t e r o f l a w ] , t h i s C o u r t u s e s t h e 
same 
s t a n d a r d t h e t r i a l 
c o u r t 
u s e d 
i n i t i a l l y i n 
d e c i d i n g w h e t h e r t o g r a n t o r deny t h e m o t i o n f o r 
a 
JML. 
P a l m H a r b o r Homes, I n c . 
v . C r a w f o r d , 689 So. 
2d 3 ( A l a . 1 9 9 7 ) . 
R e g a r d i n g q u e s t i o n s o f f a c t , t h e 
u l t i m a t e 
q u e s t i o n i s w h e t h e r 
t h e nonmovant h a s 
p r e s e n t e d 
s u f f i c i e n t 
e v i d e n c e t o a l l o w t h e c a s e t o 
be s u b m i t t e d t o t h e j u r y f o r 
a f a c t u a l 
r e s o l u t i o n . 
C a r t e r v . H e n d e r s o n , 
598 So. 2d 1350 ( A l a . 1 9 9 2 ) . 
The 
nonmovant 
must 
h a v e 
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 o r d e r t o w i t h s t a n d a m o t i o n f o r 
a JML. 
See § 1 2 - 2 1 - 1 2 , A l a . 
Code 
1 
975; 
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 . 
1 9 8 9 ) . 
A 
r e v i e w i n g 
c o u r t must 
d e t e r m i n e 
w h e t h e r t h e p a r t y who b e a r s t h e b u r d e n o f p r o o f h a s 
p r o d u c e d 
s u b s t a n t i a l 
e v i d e n c e 
c r e a t i n g 
a 
f a c t u a l 
d i s p u t e 
r e q u i r i n g 
r e s o l u t i o n b y t h e j u r y . 
C a r t e r , 
598 
So. 2d a t 1 3 5 3 . 
I n r e v i e w i n g a r u l i n g on a 
m o t i o n f o r 
a JML, t h i s C o u r t v i e w s 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 t h e nonmovant a n d 
e n t e r t a i n s 
s u c h 
r e a s o n a b l e 
i n f e r e n c e s as t h e j u r y 
w o u l d 
h a v e 
b e e n 
f r e e 
t o draw. 
I d . R e g a r d i n g a 
q u e s t i o n o f l a w , h o w e v e r , 
t h i s 
C o u r t 
i n d u l g e s no 
p r e s u m p t i o n o f c o r r e c t n e s s as t o t h e t r i a l 
c o u r t ' s 
r u l i n g . 
R i c w i l , 
I n c . v . S.L. P a p p a s & Co., 599 So. 
2d 1126 ( A l a . 1 9 9 2 ) . " 
W a d d e l l & R e e d , I n c . 
v . U n i t e d I n v e s t o r s L i f e 
I n s . Co., 8 
7 
5 
So. 2d 1 1 4 3 , 1152 ( A l a . 2 0 0 3 ) . 
The p l a i n t i f f 
i n a m e d i c a l -
8 
1071020, 1071081 
m a l p r a c t i c e a c t i o n i s 
r e q u i r e d t o p r e s e n t 
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 
b o t h 
t h a t 
t h e d e f e n d a n t 
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 c o m p l y 
w i t h t h e s t a n d a r d 
o f c a r e a n d t h a t 
s u c h 
f a i l u r e p r o b a b l y 
c a u s e d t h e i n j u r y o r d e a t h i n q u e s t i o n . " 
§ 
6-5-549, A l a . Code 1 9 7 5 . 
I I I . 
M o b i l e OB-GYN a r g u e s t h a t i t 
i s e n t i t l e d t o a new 
t r i a l 
b e c a u s e , i t c l a i m s , t h e t r i a l c o u r t e r r e d by s u b m i t t i n g t o t h e 
j u r y , i n a d d i t i o n t o a c l a i m t h a t was s u p p o r t e d by s u b s t a n t i a l 
e v i d e n c e , 
c l a i m s 
t h a t 
were 
n o t s u p p o r t e d 
b y 
s u b s t a n t i a l 
e v i d e n c e , 
t h a t i s , " e v i d e n c e o f s u c h w e i g h t a n d 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 . " 
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 . 1 9 8 9 ) . 
M o b i l e OB-GYN a r g u e s t h a t , o f 
t h e 
f i v e c o u n t s s u b m i t t e d t o t h e j u r y i n t h i s c a s e , o n l y one 
was 
s u p p o r t e d b y s u b s t a n t i a l e v i d e n c e a n d , c i t i n g 
L o n g v . 
Wade, 
98 0 So. 2d 378, 385 
( A l a . 
2007 ), 
a r g u e s 
t h a t t h e 
j u d g m e n t e n t e r e d on t h e j u r y ' s g e n e r a l v e r d i c t must 
t h e r e f o r e 
be 
r e v e r s e d 
b e c a u s e b o t h a g o o d c o u n t a n d a b a d c o u n t w e r e 
9 
1071020, 1071081 
s u b m i t t e d t o t h e j u r y . 
I n L o n g , t h i s C o u r t s t a t e d t h a t , u n d e r 
t h e s o - c a l l e d g o o d - c o u n t / b a d - c o u n t 
r u l e , 
"'when t h e t r i a l c o u r t s u b m i t s t o t h e j u r y 
a "good c o u n t " -- one t h a t i s s u p p o r t e d by 
t h e e v i d e n c e -- a n d a " b a d c o u n t " -- one 
t h a t i s n o t s u p p o r t e d b y t h e e v i d e n c e -¬
and t h e j u r y 
r e t u r n s a g e n e r a l 
v e r d i c t , 
t h i s C o u r t c a n n o t p r e s u m e t h a t t h e v e r d i c t 
was 
r e t u r n e d on t h e g o o d c o u n t . 
I n s u c h a 
c a s e , a j u d g m e n t e n t e r e d upon t h e v e r d i c t 
must be r e v e r s e d . ' 
" L a r r i m o r e v . Dubose, 827 So. 2d 60, 63 ( A l a . 
2001) 
( q u o t i n g 
A l f a Mut. I n s . 
Co. v . R o u s h , 723 So. 2d 
1250, 1257 ( A l a . 1 9 9 8 ) ) 
( e m p h a s i s 
a d d e d ) . " 
980 
So. 2d a t 3 8 5 . 
A c c o r d i n g l y , i f any o f t h e c o u n t s 
s u b m i t t e d t o t h e j u r y i n t h i s 
c a s e 
were n o t s u p p o r t e d b y 
s u b s t a n t i a l e v i d e n c e , M o b i l e OB-GYN i s e n t i t l e d t o a j u d g m e n t 
as a m a t t e r o f l a w 
on t h o s e u n s u p p o r t e d "bad c o u n t s , " a n d 
t h e 
j u d g m e n t e n t e r e d on t h e j u r y ' s v e r d i c t i s 
due t o be r e v e r s e d 
and t h e c a u s e remanded f o r a new t r i a l on t h e r e m a i n i n g "good 
c o u n t s . " 
M o b i l e 
OB-GYN 
does 
n o t d i s p u t e 
t h a t 
t h e r e i s 
s u b s t a n t i a l e v i d e n c e s u p p o r t i n g t h e f i r s t 
c o u n t s u b m i t t e d t o 
t h e 
j u r y , 
i . e . , 
t h e 
c o u n t 
a l l e g i n g 
t h a t 
D r . 
M a d o n i a 
n e g l i g e n t l y p r e s c r i b e d B e n i c a r t o B a g g e t t ; h o w e v e r , i t o b j e c t s 
t o 
a l l f o u r o t h e r c o u n t s . 
We t h e r e f o r e r e v i e w e a c h o f t h o s e 
10 
1071020, 1071081 
f o u r 
c o u n t s 
t o d e t e r m i n e 
w h e t h e r 
t h e y 
were 
s u p p o r t e d b y 
s u b s t a n t i a l e v i d e n c e a t 
t r i a l . 
The 
s e c o n d 
c o u n t , 
a l l e g i n g 
t h a t 
M o b i l e 
OB-GYN 
" n e g l i g e n t l y 
f a i l e d 
t o a p p r o p r i a t e l y 
f o l l o w up w i t h Wendy 
B a g g e t t a n d m o n i t o r h e r c o n d i t i o n a n d t h a t o f h e r c h i l d , " a n d 
t h e 
f o u r t h 
c o u n t , 
a l l e g i n g 
t h a t 
M o b i l e OB-GYN 
" n e g l i g e n t l y 
f a i l e d t o a p p r e c i a t e t h e d e v e l o p i n g s i g n s o f t h e d e v e l o p i n g 
damage t h e d r u g B e n i c a r was c a u s i n g d u r i n g t h e p r e g n a n c y a n d 
f a i l e d t o i n s t i t u t e any r e m e d i a l m e a s u r e s , " b o t h r e l a t e t o t h e 
u l t r a s o u n d e x a m i n a t i o n t h a t was p e r f o r m e d on F e b r u a r y 7, 2005, 
and 
a r e t h e r e f o r e 
t r e a t e d 
t o g e t h e r . 
The 
s e c o n d 
c o u n t 
s p e c i f i c a l l y 
c o n c e r n s D r . M a d o n i a ' s f a i l u r e t o r e c o g n i z e t h a t 
B a g g e t t ' s a m n i o t i c f l u i d was l o w , a n d 
t h e f o u r t h c o u n t 
r e l a t e s 
t o h i s f a i l u r e t o t a k e r e m e d i a l m e a s u r e s t o p r o t e c t t h e f e t u s , 
i n c l u d i n g 
t e l l i n g B a g g e t t t o c e a s e t a k i n g B e n i c a r , 
a f t e r t h e 
F e b r u a r y 7 u l t r a s o u n d e x a m i n a t i o n 
r e v e a l e d a l o w a m n i o t i c -
f l u i d 
l e v e l . 
A t 
t r i a l , 
B a g g e t t 
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 , a t t h e t i m e t h e F e b r u a r y 7, 2005, u l t r a s o u n d 
was 
p e r f o r m e d 
h e r a m n i o t i c - f l u i d 
l e v e l was l o w , t h a t 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 
r e q u i r e d 
D r . M a d o n i a t o t a k e 
11 
1071020, 1071081 
a c t i o n b a s e d on t h a t f a c t , and t h a t he 
f a i l e d t o do s o . 
T h a t 
e v i d e n c e 
i n c l u d e d t h e f o l l o w i n g t e s t i m o n y f r o m Dr. 
M a d o n i a ' s 
v i d e o t a p e d d e p o s i t i o n , w h i c h was 
shown a t 
t r i a l : 
"Q. 
A l l r i g h t . 
D o c t o r , 
i s n ' t 
t h e s t a n d a r d o f 
c a r e 
when you h a v e a l o w a m n i o t i c f l u i d r e a d i n g 
l i k e 
t h i s t o h o s p i t a l i z e 
t h e m o t h e r t o c o n s i d e r 
y o u r 
t r e a t m e n t 
o p t i o n s ? 
"A. 
Depends 
on 
-- 
you 
know, we 
p r o b a b l y 
w o u l d n ' t 
h o s p i t a l i z e 
h e r 
w i t h 
an 
a m n i o t i c 
f l u i d . 
We 
w o u l d 
r e p e a t 
t h i s 
a t some p o i n t . 
R e p e a t i t 
p r o b a b l y t h e n e x t 
day. 
"Q. 
B u t you d i d n ' t do t h a t i n t h i s c a s e ; d i d you? 
"A. 
No, 
I d i d n ' t . 
"Q. 
Okay. 
I n 
f a c t , 
u n t i l I showed you 
t h e 
a c t u a l 
u l t r a s o u n d 
r e a d i n g , 
w h i c h 
i s E x h i b i t 
1F, 
you 
d i d n ' t 
r e a l i z e 
t h a t t h i s m o t h e r had 
s u c h a 
l o w 
r e a d i n g ; d i d you? 
"A. 
No s i r . 
"Q. 
Okay. 
Thank y o u , 
D o c t o r . 
D o c t o r , 
i f you 
had 
s e e n t h a t u l t r a s o u n d r e a d i n g i n F e b r u a r y , 
w o u l d 
you have q u i z z e d Ms. 
B a g g e t t 
a b o u t w h e t h e r 
she 
was 
s t i l l 
on 
B e n i c a r ? 
"A. 
I t ' s p o s s i b l e . 
I'm 
n o t s u r e what I -- 
I w o u l d 
h a v e done s o m e t h i n g . 
I'm 
n o t s u r e what I w o u l d 
h a v e done. 
"Q. 
The 
n o r m a l p a r t o f what you w o u l d h a v e done a t 
t h a t p o i n t i s r e - c o v e r e d 
h e r 
m e d i c a t i o n s 
w i t h 
h e r ? 
"A. 
P r o b a b l y . 
12 
1071020, 1071081 
"Q. 
A l l r i g h t . 
A n d i f 
she h a d t o l d y o u ' I 
am 
s t i l l 
on 
B e n i c a r , ' 
y o u 
w o u l d 
have 
t o l d 
h e r on 
F e b r u a r y 7 t h 
t o s t o p t a k i n g i t ; 
w o u l d n ' t you? 
"A. Y e s . " 
B a g g e t t ' s 
e x p e r t w i t n e s s , D r . Mark T u r r e n t i n e , a l s o 
t e s t i f i e d 
on 
t h i s 
i s s u e : 
"Q. 
D o c t o r , 
b a s e d 
on 
y o u r 
e d u c a t i o n , 
t r a i n i n g , 
b a c k g r o u n d , t h e m a t e r i a l s y o u h a v e 
r e v i e w e d , 
t h e f a c t s y o u have become f a m i l i a r w i t h , do y o u 
h a v e 
an 
o p i n i o n 
t o a 
r e a s o n a b l e 
d e g r e e o f 
m e d i c a l 
c e r t a i n t y as t o w h e t h e r [ M o b i l e OB-GYN] 
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 ] 
by n o t 
t a k i n g 
a d d i t i o n a l 
a c t i o n 
a f t e r an 
u l t r a s o u n d 
r e a d i n g came b a c k s h o w i n g a m n i o t i c 
f l u i d 
l e v e l 
o f 
6.69, 
w h i c h 
D r . 
M a d o n i a 
h i m s e l f 
h a s 
t e s t i f i e d 
was 
l o w a n d 
r e q u i r e d 
a d d i t i o n a l 
a t t e n t i o n ? 
"A. Y e s . 
"Q. What i s y o u r 
o p i n i o n ? 
"A. 
T h a t t h e r e s h o u l d h a v e b e e n f u r t h e r e v a l u a t i o n 
f o l l o w i n g t h a t 
u l t r a s o u n d . 
"Q. So y o u r o p i n i o n i s [ M o b i l e OB-GYN] d i d d e v i a t e ? 
"A. 
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 , 
y e s . " 
A l t h o u g h 
M o b i l e OB-GYN a l s o p r o d u c e d some e v i d e n c e 
i n d i c a t i n g 
t h a t B a g g e t t ' s 
a m n i o t i c - f l u i d 
l e v e l on F e b r u a r y 7, 2005, 6.69 
c e n t i m e t e r s , 
i s n o t u n i v e r s a l l y 
c o n s i d e r e d 
t o be a l o w 
r e a d i n g , t h e e v i d e n c e 
s u b m i t t e d b y B a g g e t t was 
n e v e r t h e l e s s 
s u f f i c i e n t t o c o n s t i t u t e s u b s t a n t i a l e v i d e n c e 
t h a t D r . M a d o n i a 
13 
1071020, 1071081 
b r e a c h e d 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 . 
M o b i l e OB-GYN d o e s 
n o t 
d i s p u t e 
t h i s 
p o i n t , 
b u t 
i t a r g u e s 
t h a t 
B a g g e t t 
s u b s e q u e n t l y 
f a i l e d 
t o p u t 
f o r t h 
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 
D r . M a d o n i a ' s 
e r r o r 
c a u s e d 
t h e d e a t h o f 
B a g g e t t ' s b a b y , 
t h a t 
i s , t h a t t h e b a b y p r o b a b l y 
w o u l d 
h a v e 
l i v e d i f 
D r . M a d o n i a h a d r e c o g n i z e d 
t h a t B a g g e t t ' s 
a m n i o t i c -
f l u i d 
l e v e l was l o w a n d h a d t a k e n 
r e m e d i a l 
m e a s u r e s . 
S e e , 
e.g., 
§ 6-5-549, A l a . 
Code 
1975 ; DCH 
H e a l t h c a r e 
A u t h . v . 
D u c k w o r t h , 883 So. 2d 1214, 
1217 ( A l a . 2003) ("'There must be 
more t h a n t h e 
mere p o s s i b i l i t y t h a t t h e n e g l i g e n c e 
c o m p l a i n e d 
o f c a u s e d t h e i n j u r y ; 
r a t h e r t h e r e must be e v i d e n c e t h a t t h e 
n e g l i g e n c e 
c o m p l a i n e d 
o f 
p r o b a b l y 
c a u s e d 
t h e 
i n j u r y . ' " 
( q u o t i n g 
P a r k e r 
v . 
C o l l i n s , 
605 So. 2d 824, 826 
( A l a . 
1 9 9 2 ) ) ) .
3 
I n i t i a l l y , 
M o b i l e 
OB-GYN 
n o t e s 
t h a t 
when 
B a g g e t t ' s 
e x p e r t , 
D r . 
T u r r e n t i n e , 
was 
a s k e d 
s p e c i f i c a l l y 
a b o u t 
c a u s a t i o n , he was i n t e r r u p t e d by an o b j e c t i o n a n d , a f t e r 
t h a t 
o b j e c t i o n was r e s o l v e d , 
f a i l e d t o a n s w e r t h e q u e s t i o n : 
3 I n h e r b r i e f 
t o t h i s 
C o u r t , 
B a g g e t t 
e m p h a s i z e s 
t h a t 
" [ M o b i l e OB-GYN] d i d n o t o f f e r a s i n g l e w i t n e s s who 
t e s t i f i e d 
t h a t b a b y Andrew 
c o u l d n o t be s a l v a g e d 
as o f F e b r u a r y 7." 
B a g g e t t ' s 
b r i e f , 
p. 17. 
However, 
t h i s 
a r g u m e n t 
f a i l s t o 
r e c o g n i z e 
t h a t t h e b u r d e n was on B a g g e t t t o p r o v e 
c a u s a t i o n , 
n o t on M o b i l e OB-GYN t o d i s p r o v e i t . 
14 
1071020, 1071081 
"Q. Now, a s s u m i n g t h a t on F e b r u a r y 7 t h t h e d o c t o r s 
a t 
M o b i l e 
OB-GYN h a d a s k e d Wendy B a g g e t t a r e 
you -- what m e d i c a t i o n s you a r e t a k i n g , a n d 
she 
had 
t o l d them B e n i c a r , i f 
t h e B e n i c a r h a d b e e n 
d i s c o n t i n u e d t h e n , do you h a v e an o p i n i o n as t o 
w h e t h e r 
l i t t l e 
b a b y 
Andrew 
c o u l d 
h a v e 
b e e n 
s a l v a g e d , -¬
" [ M o b i l e OB-GYN's a t t o r n e y : ] 
Y o u r H o n o r , --
"Q. -- c o u l d have b e e n s a v e d ? 
" [ M o b i l e 
OB-GYN's 
a t t o r n e y : ] 
-- p a r d o n me. 
I 
o b j e c t . 
A g a i n , 
he h a s no 
q u a l i f i c a t i o n s t o 
g i v e t h a t t e s t i m o n y a t 
a l l . " 
Dr. 
T u r r e n t i n e d i d 
n o t t h e r e a f t e r e x p r e s s 
an o p i n i o n as t o 
w h e t h e r 
t h e b a b y 
c o u l d 
h a v e 
b e e n 
s a v e d h a d B e n i c a r 
b e e n 
d i s c o n t i n u e d on F e b r u a r y 7; i n s t e a d , he b e g a n 
d i s c u s s i n g a 
m e d i c a l - j o u r n a l 
a r t i c l e . 
D r . T u r r e n t i n e 
s u m m a r i z e d 
t h a t 
a r t i c l e , 
F e t a l 
T o x i c 
E f f e c t s o f A n g i o t e n s i n 
I I R e c e p t o r 
A n t a g o n i s t s : C a s e R e p o r t a n d F o l l o w - U p a f t e r B i r t h , 
p u b l i s h e d 
i n t h e J a n u a r y 2005 e d i t i o n o f The A n n a l s o f P h a r m a c o t h e r a p y , 
as f o l l o w s : 
"Q. And what i s t h a t p a r t i c u l a r 
a r t i c l e 
a b o u t ? 
"A. 
T h i s 
a r t i c l e i s -- h a s two c o m p o n e n t s . 
I t 
i s 
d e s c r i b e d as a c a s e r e p o r t o f an i n f a n t who was 
e x p o s e d t o one o f t h e s e ARB m e d i c a t i o n s
[ 4 ] 
d u r i n g 
4 B e n i c a r b e l o n g s t o a c l a s s o f d r u g s a l t e r n a t e l y r e f e r r e d 
t o 
a t 
t r i a l 
as 
a n g i o t e n s i n 
r e c e p t o r 
b l o c k e r s , 
o r "ARB 
m e d i c a t i o n s , " 
a n d as a n g i o t e n s i n I I r e c e p t o r 
a n t a g o n i s t s , o r 
"AT1 
a n t a g o n i s t s . " 
15 
1071020, 1071081 
p r e g n a n c y . 
And 
t h e n , 
i n 
a d d i t i o n , 
i t 
s u m m a r i z e s t h e a r t i c l e s a v a i l a b l e up u n t i l t h a t 
t i m e o f o t h e r c a s e r e p o r t s o f i n f a n t s t h a t h a v e 
b e e n 
e x p o s e d 
t o 
t h e 
ARB 
m e d i c a t i o n 
d u r i n g 
p r e g n a n c y . " 
Dr. 
T u r r e n t i n e a l s o was a s k e d what c o n c l u s i o n s were drawn i n 
t h i s 
a r t i c l e : 
"Q. 
D o c t o r , 
what 
c o n c l u s i o n s were r e a c h e d 
i n 
t h i s 
a r t i c l e 
a b o u t t h e 
s u r v i v a b i l i t y 
b y an 
i n f a n t 
who 
h a d b e e n on a m e d i c a t i o n 
s u c h as 
B e n i c a r 
and 
was 
t h e n 
t a k e n 
o f f o f 
t h e 
m e d i c a t i o n 
B e n i c a r 
up 
t o 
t h e 
2 8 t h 
week 
o f 
p r e g n a n c y , 
b e a r i n g i n m i n d t h a t 
l i t t l e A n d r e w ' s u l t r a s o u n d 
was 
when 
he 
was 
a p p r o x i m a t e l y 
22 
weeks 
g e s t a t i o n a l age? 
"A. 
The 
a r t i c l e 
h e r e 
b y 
[ M a r i e - A n d r e e ] 
B o s -
Thompson, t h e r e a r e t h r e e -- o f t h e t e n r e p o r t s 
t h a t a r e t h e r e , 
t h e r e a r e t h r e e o f them, a n d , 
a g a i n , 
t h e y 
w e r e 
-- 
t h e s e 
were 
A R B - l i k e 
m e d i c a t i o n s . 
They were -- none o f them were 
s p e c i f i c a l l y 
B e n i c a r . 
They 
a l l a c t 
v e r y 
s i m i l a r l y . 
" I n 
t h r e e 
o f 
t h e 
c a s e s 
where 
t h e 
m e d i c a t i o n s 
were d i s c o n t i n u e d , I t h i n k one was 
a t 24 w e e k s , one was a t 25 w e e k s , and one a t 28 
w e e k s . 
And a t t h e t i m e 
t h e m e d i c a t i o n s 
w e r e 
d i s c o n t i n u e d , 
t h e r e was 
v e r y 
m i n i m a l 
a m n i o t i c 
f l u i d 
a r o u n d 
t h e b a b y . 
And 
i n t h o s e 
t h r e e 
c a s e s , 
w i t h i n b e t w e e n two t o s i x w e e k s , t h e 
f l u i d 
l e v e l came b a c k t o a s u f f i c i e n t 
l e v e l . 
"Now one o f t h e s e c a s e s t h e f a m i l y o p t e d t o 
end t h e p r e g n a n c y a t 32 w e e k s . 
The o t h e r 
c a s e 
had -- t h e b a b y d i e d a t 33 w e e k s . 
B u t i n t h e 
t h i r d c a s e t h e b a b y was l i v e - b o r n . 
16 
1071020, 1071081 
"Q. A n d t h e b a b y 
t h a t 
was 
l i v e - b o r n , 
two 
y e a r s 
a f t e r i t was b o r n , how was i t d o i n g ? 
"A. 
From t h i s c a s e r e p o r t , a c t u a l l y i t h a d r e g a i n e d 
a l o t 
o f i t s r e n a l 
f u n c t i o n a n d h a d i m p r o v e d 
t r e m e n d o u s l y . " 
Thus, a t no p o i n t 
i n h i s t e s t i m o n y o r d i s c u s s i o n 
o f t h e 
m e d i c a l - j o u r n a l 
a r t i c l e d i d 
D r . T u r r e n t i n e e v e r s t a t e , as h i s 
e x p e r t 
o p i n i o n , 
t h a t 
B a g g e t t ' s 
b a b y 
p r o b a b l y 
w o u l d 
h a v e 
s u r v i v e d i f 
r e m e d i a l a c t i o n h a d b e e n t a k e n on F e b r u a r y 7.
5 
However, 
e v e n 
t h o u g h 
D r . T u r r e n t i n e d i d n o t g i v e an 
o p i n i o n 
on 
t h i s 
p o i n t , 
B a g g e t t 
a r g u e s 
t h a t 
t h e r e i s 
n e v e r t h e l e s s 
s u b s t a n t i a l 
e v i d e n c e i n t h e r e c o r d 
i n d i c a t i n g 
t h a t t h e b a b y w o u l d h a v e s u r v i v e d i f M o b i l e OB-GYN h a d t a k e n 
r e m e d i a l a c t i o n on F e b r u a r y 7. 
B a g g e t t 
f i r s t a r g u e s t h a t t h e 
5 I n i t s 
b r i e f t o t h i s C o u r t , M o b i l e OB-GYN a l s o 
e m p h a s i z e s 
t h a t 
o f t h e t h r e e 
c a s e s 
d i s c u s s e d b y Dr. T u r r e n t i n e i n 
s u m m a r i z i n g 
t h e m e d i c a l - j o u r n a l 
a r t i c l e , 
o n l y 
one 
b a b y 
s u r v i v e d : 
"The 
f a c t 
t h a t one b a b y s u r v i v e d o u t o f t h r e e 
r e p o r t e d 
c a s e s p r o v e s 
n o t h i n g . 
These t h r e e 
c a s e s 
a r e n o t shown t o p r e s e n t a s u f f i c i e n t 
s t a t i s t i c a l 
s a m p l e 
h a v i n g 
any 
a p p l i c a t i o n 
t o 
o t h e r 
b a b i e s 
e x p o s e d 
t o B e n i c a r . 
I n 
f a c t , 
i f t h e y 
s u g g e s t 
a n y t h i n g a t a l l , 
i t 
i s t h a t t h e B a g g e t t b a b y was 
l i k e l y 
t o d i e e v e n 
i f M r s . B a g g e t t 
h a d 
s t o p p e d 
t a k i n g B e n i c a r f o l l o w i n g t h e F e b r u a r y 7 
u l t r a s o u n d . " 
M o b i l e OB-GYN's b r i e f , p. 37. 
17 
1071020, 1071081 
a r t i c l e d i s c u s s e d by Dr. T u r r e n t i n e i s i t s e l f an e x p e r t 
s o u r c e 
e s t a b l i s h i n g 
c a u s a t i o n . 
However, 
an 
e x a m i n a t i o n 
o f 
t h a t 
a r t i c l e 
r e v e a l s 
t h a t 
i t d o e s 
n o t , 
i n 
f a c t , 
s u p p o r t 
t h a t 
p r o p o s i t i o n . 
I n d e e d , 
a f t e r 
s u m m a r i z i n g 
15 
c a s e s 
i n 
w h i c h 
f e t u s e s were e x p o s e d t o ARB 
m e d i c a t i o n s 
s i m i l a r 
t o 
B e n i c a r , 
w h i c h 
m e d i c a t i o n s 
a r e 
r e f e r r e d t o 
i n 
t h e 
a r t i c l e 
as 
"AT1 
a n t a g o n i s t s , " 
t h e 
a r t i c l e 
s t a t e s t h a t 
" [ b ] a s e d 
on 
t h e s e 
15 
c a s e r e p o r t s , i t i s n o t p o s s i b l e t o c o n c l u d e 
t h a t t h e 
r i s k 
i s 
r e a l l y 
r e d u c e d when t r e a t m e n t 
i s s t o p p e d 
e a r l y i n p r e g n a n c y . 
R a t h e r , 
i t 
does 
s u p p o r t 
a v o i d a n c e 
o f 
AT1 
a n t a g o n i s t s 
t h r o u g h o u t 
p r e g n a n c y . " 
M a r i e - A n d r e e 
Bos-Thompson 
e t a l . , 
F e t a l 
T o x i c 
E f f e c t s o f A n g i o t e n s i n 
I I R e c e p t o r 
A n t a g o n i s t s : 
C a s e 
R e p o r t 
and 
F o l l o w - U p 
a f t e r 
B i r t h , 
39 
The 
A n n a l s 
o f 
P h a r m a c o t h e r a p y 
157, 
160 
( J a n u a r y 
2 0 0 5 ) . 
The 
a r t i c l e 
c o n c l u d e s 
as f o l l o w s : 
"Our 
c a s e 
and 
r e v i e w 
o f 
o t h e r 
r e p o r t e d 
c a s e s 
s u p p o r t 
t h e r e c o m m e n d a t i o n t o a v o i d AT1 
a n t a g o n i s t s 
d u r i n g p r e g n a n c y . 
AT1 
a n t a g o n i s t s 
a r e 
r e s p o n s i b l e 
f o r 
s e v e r e 
o l i g o a m n i o s , 
w h i c h c a n 
l e a d t o 
n e o n a t a l 
r e n a l 
i n s u f f i c i e n c y 
and 
o t h e r 
a s s o c i a t e d 
a b n o r m a l i t i e s . 
I f a p r e g n a n t woman i s 
a c c i d e n t a l l y 
p r e s c r i b e d 
an 
AT1 
a n t a g o n i s t , 
t h e 
a g e n t 
s h o u l d 
be 
s t o p p e d 
as s o o n as p o s s i b l e . 
M o n i t o r i n g o f 
a m n i o t i c 
f l u i d v o l u m e and p 2 - m i c r o g l o b u l i n f e t a l b l o o d 
l e v e l s 
c a n 
be u s e d t o i n c r e a s e t h e 
l i k e l i h o o d 
o f 
p o s i t i v e 
f e t a l 
o u t c o m e s . " 
18 
1071020, 1071081 
I d . 
Thus, 
t h i s 
a r t i c l e a t b e s t 
s t a n d s f o r 
t h e p r o p o s i t i o n 
t h a t i f 
i t 
i s d i s c o v e r e d t h a t a p r e g n a n t woman i s t a k i n g an 
AT1 
a n t a g o n i s t s u c h as B e n i c a r , she s h o u l d c e a s e 
d o i n g so as 
s o o n as p o s s i b l e , a n d s t e p s c a n t h e n be t a k e n t o i n c r e a s e t h e 
p o s s i b i l i t y o f a p o s i t i v e o u t c o m e . 
However, a t no p o i n t i n 
t h e a r t i c l e i s 
i t s t a t e d , o r e v e n i m p l i e d , t h a t i f t h o s e 
s t e p s 
a r e t a k e n t h e r e i s 
a p r o b a b i l i t y o f a p o s i t i v e outcome t o 
t h e 
p r e g n a n c y . 
T h i s same p r o b l e m 
a l s o 
e x i s t s 
f o r B a g g e t t i n 
r e g a r d t o t h e f o l l o w i n g t e s t i m o n y g i v e n b y Dr. M a d o n i a , 
w h i c h 
she a l s o c i t e s as e v i d e n c e o f c a u s a t i o n : 
"Q. 
A c c o r d i n g t o t h i s 
a r t i c l e a t l e a s t , 
t h e r e a r e 
t h i n g s you c a n a t t e m p t 
t o do t o r e v e r s e t h e 
e f f e c t o f d r u g s s u c h as B e n i c a r ; c o r r e c t ? 
"A. Y e s . " 
However, one c a n n o t 
r e a s o n a b l y i n f e r f r o m t h i s t e s t i m o n y t h a t 
m e r e l y b e c a u s e a p h y s i c i a n c a n a t t e m p t t o r e v e r s e t h e e f f e c t s 
o f B e n i c a r on a f e t u s , t h e p r o b a b l e 
r e s u l t o f s u c h an a t t e m p t 
i s a p o s i t i v e outcome t o t h e p r e g n a n c y . 
B a g g e t t 
a l s o c i t e s t h e t e s t i m o n y o f M o b i l e OB-GYN's two 
e x p e r t w i t n e s s e s as f u r t h e r e v i d e n c e o f c a u s a t i o n . Dr. D w i g h t 
Rouse a n d D r . Max R o g e r s b o t h 
t e s t i f i e d on b e h a l f o f M o b i l e 
OB-GYN, a n d t h e i r e x p e r t o p i n i o n was t h a t B a g g e t t ' s 
a m n i o t i c -
19 
1071020, 1071081 
f l u i d 
l e v e l on F e b r u a r y 7 was n o t l o w . 
They 
t e s t i f i e d 
t h a t 
h e r 
f l u i d 
l e v e l 
was 
n o r m a l 
b e c a u s e i t was 
above t h e 
f i v e -
c e n t i m e t e r 
mark, 
w h i c h , 
t h e y 
c l a i m e d , 
i s t h e 
g e n e r a l l y 
r e c o g n i z e d 
c u t o f f 
p o i n t 
f o r o l i g o h y d r a m n i o s . 
Dr. 
Rouse 
s p e c i f i c a l l y t e s t i f i e d t h a t " t h e r e was no i n d i c a t i o n , b a s e d on 
t h e i m p r e s s i o n o f t h e e x p e r i e n c e d s o n o g r a p h e r , 
t h a t t h e r e was 
a n y t h i n g w r o n g on t h i s u l t r a s o u n d , " and Dr. R o g e r s a g r e e d 
t h a t 
B a g g e t t ' s 
a m n i o t i c - f l u i d 
l e v e l 
on F e b r u a r y 
7 was 
" n o r m a l " ; 
b o t h w i t n e s s e s s t a t e d t h a t no f u r t h e r 
a c t i o n was 
r e q u i r e d by 
Dr. 
M a d o n i a 
b a s e d 
on t h e F e b r u a r y 
7 u l t r a s o u n d . 
B a g g e t t 
a r g u e s 
t h a t 
t h e s e two w i t n e s s e s w e r e , i n e f f e c t , 
d e c l a r i n g 
t h a t t h e b a b y was 
" p e r f e c t l y n o r m a l " on F e b r u a r y 7 and w o u l d 
t h e r e f o r e have b e e n f i n e h a d B a g g e t t c e a s e d t a k i n g B e n i c a r as 
o f t h a t 
d a t e . 
However, B a g g e t t ' s a r g u m e n t m i s c h a r a c t e r i z e s 
Dr. R o u s e ' s 
and Dr. R o g e r s ' s t e s t i m o n y . 
N e i t h e r w i t n e s s e v e r e x p r e s s e d an 
o p i n i o n 
as t o t h e h e a l t h 
o f B a g g e t t ' s b a b y on F e b r u a r y 
7; 
r a t h e r , t h e y e x p r e s s e d t h e i r o p i n i o n s r e g a r d i n g t h e u l t r a s o u n d 
r e p o r t , s p e c i f i c a l l y as i t 
r e l a t e d t o B a g g e t t ' s 
a m n i o t i c - f l u i d 
l e v e l . 
N e i t h e r Dr. R o u s e ' s 
s t a t e m e n t 
t h a t 
" t h e r e was 
no 
i n d i c a t i o n 
... 
t h a t 
t h e r e 
was 
a n y t h i n g 
w r o n g 
on 
t h i s 
20 
1071020, 1071081 
u l t r a s o u n d " n o r Dr. R o g e r s ' s t e s t i m o n y t h a t t h e a m n i o t i c - f l u i d 
l e v e l was " n o r m a l " 
n e c e s s a r i l y 
l e a d s t o t h e c o n c l u s i o n t h a t 
t h e b a b y was " p e r f e c t l y n o r m a l " on F e b r u a r y 7.
6 
I t 
was 
u n d i s p u t e d 
a t 
t r i a l 
t h a t 
t h e u s e 
o f 
AT1 
a n t a g o n i s t s 
s u c h 
as 
B e n i c a r 
d u r i n g t h e s e c o n d 
and 
t h i r d 
t r i m e s t e r s 
o f p r e g n a n c y 
c a n c a u s e 
i n j u r y 
o r d e a t h 
t o t h e 
f e t u s . 
I t was 
a l s o 
u n d i s p u t e d 
t h a t 
B a g g e t t 
was 
a l r e a d y 
a p p r o x i m a t e l y h a l f w a y t h r o u g h h e r s e c o n d 
t r i m e s t e r when t h e 
F e b r u a r y 7 u l t r a s o u n d was c o n d u c t e d . 
No e x p e r t t e s t i f i e d 
t h a t 
B a g g e t t ' s b a b y p r o b a b l y w o u l d h a v e b e e n s a v e d i f 
B a g g e t t h a d 
s t o p p e d t a k i n g B e n i c a r on F e b r u a r y 7 a n d , e v e n when l o o k i n g a t 
t h e e n t i r e t y o f 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 
B a g g e t t , as we must, W a d d e l l & Reed, I n c . , 
875 So. 2d a t 1152, 
i t i s i m p o s s i b l e t o c o n c l u d e t h a t a f a i r - m i n d e d p e r s o n 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 o u l d r e a s o n a b l y 
i n f e r 
t h a t 
B a g g e t t ' s b a b y p r o b a b l y w o u l d h a v e b e e n s a v e d i f 
B a g g e t t h a d 
s t o p p e d t a k i n g B e n i c a r on F e b r u a r y 7. 
A t m o s t , t h e e v i d e n c e 
6The e v i d e n c e i n t h e r e c o r d t h a t d o e s s p e a k t o t h i s p o i n t 
-- t h e p a c k a g e i n s e r t i n c l u d e d w i t h B e n i c a r -- w o u l d 
a c t u a l l y 
seem t o r e b u t B a g g e t t ' s 
a r g u m e n t . 
T h a t 
i n s e r t 
s t a t e s 
t h a t 
" [ p ] a t i e n t s 
and p h y s i c i a n s s h o u l d be a w a r e , h o w e v e r , 
t h a t 
o l i g o h y d r a m n i o s may n o t a p p e a r 
u n t i l 
a f t e r 
t h e f e t u s h a s 
s u s t a i n e d 
i r r e v e r s i b l e 
i n j u r y , " t h u s 
i n d i c a t i n g t h a t B e n i c a r 
may h a v e 
a l r e a d y c a u s e d 
i r r e v e r s i b l e 
i n j u r i e s 
e v e n i f 
t h e 
a m n i o t i c - f l u i d 
l e v e l a p p e a r s 
n o r m a l . 
21 
1071020, 1071081 
i n d i c a t e d o n l y t h a t t h e b a b y p o s s i b l y c o u l d have b e e n s a v e d i f 
B a g g e t t 
had 
s t o p p e d 
t a k i n g 
B e n i c a r 
on 
F e b r u a r y 
7. 
A mere 
p o s s i b i l i t y 
i s an 
i n s u f f i c i e n t b a s i s upon w h i c h t o s u p p o r t 
a 
j u r y v e r d i c t i n a m e d i c a l - m a l p r a c t i c e 
a c t i o n . 
See 
§ 6-5-549, 
A l a . Code 1975. 
A c c o r d i n g l y , t h e s e c o n d and f o u r t h c o u n t s 
a r e 
b a d 
c o u n t s t h a t s h o u l d 
n o t have b e e n s u b m i t t e d 
t o t h e j u r y .
7 
I V . 
7The 
C h i e f 
J u s t i c e ' s s p e c i a l w r i t i n g , 
q u o t i n g 
f r o m 
t h e 
a u t o p s y r e p o r t 
d e s c r i b i n g an 
a u t o p s y t h a t 
o c c u r r e d 
11 weeks 
a f t e r t h e F e b r u a r y 7, 2005, u l t r a s o u n d , 
s t a t e s : " ' [ T ] h e most 
l i k e l y c a u s e o f d e a t h i n t h i s c a s e i s d e c r e a s e d u t e r o p l a c e n t a l 
b l o o d 
f l o w , w h i c h a p p e a r s t o h a v e b e e n 
r e l a t i v e l y 
r e c e n t 
i n 
o n s e t b e c a u s e t h e f e t a l 
... w e i g h t s ' were w i t h i n n o r m a l r a n g e s 
f o r 
a 
3 3 - w e e k - o l d 
f e t u s . " 
So. 
3d 
a t 
(Cobb, 
C . J . , 
c o n c u r r i n g 
i n 
p a r t 
and 
d i s s e n t i n g 
i n 
p a r t ) . 
The 
C h i e f 
J u s t i c e ' s s p e c i a l w r i t i n g , 
r e l y i n g h e a v i l y on t h e e v i d e n c e 
as 
t o d e c r e a s e d b l o o d 
f l o w b e i n g 
" r e l a t i v e l y r e c e n t " 
c o n c l u d e s : 
" [ 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 
t h a t 
B e n i c a r 
l o w e r e d 
B a g g e t t ' s 
b l o o d 
p r e s s u r e 
and 
d e c r e a s e d 
b l o o d 
f l o w 
t o 
t h e 
u t e r u s 
a f t e r t h e F e b r u a r y 7 u l t r a s o u n d , 
t h e r e b y 
p r o b a b l y 
and 
p r o x i m a t e l y 
c a u s i n g 
t h e 
d e c r e a s e 
i n 
a m n i o t i c - f l u i d 
l e v e l s 
a f t e r 
t h e 
F e b r u a r y 
7 
u l t r a s o u n d , 
w h i c h 
i n 
t u r n 
c a u s e d 
d e v e l o p m e n t a l d e f e c t s i n t h e f e t u s and, 
as a r e s u l t , t h e d e a t h 
o f t h e 
c h i l d . " 
So. 
3d a t 
. 
Of 
c o u r s e , 
t h e d o c t o r 
who 
p r e p a r e d 
t h e a u t o p s y r e p o r t was 
n o t 
q u a l i f i e d as an e x p e r t 
on 
t h e e f f e c t s o f B e n i c a r 
and 
o f f e r e d no 
o p i n i o n on t h e 
r o l e 
o f 
B e n i c a r 
i n c a u s a t i o n . 
F u r t h e r m o r e , 
as 
n o t e d 
i n 
t h i s 
m a i n 
o p i n i o n , 
no 
e x p e r t 
o p i n i o n 
t e s t i m o n y 
s u p p o r t s 
t h e v i e w 
t h a t 
e v e n t s p r e c e d i n g 
t h e F e b r u a r y 7 u l t r a s o u n d e x a m i n a t i o n 
can 
be 
d i s r e g a r d e d 
so 
as 
t o 
w a r r a n t 
t h e 
c o n c l u s i o n 
t h a t 
l a c k 
o f 
f u r t h e r 
e v a l u a t i o n by 
Dr. 
M a d o n i a 
f o l l o w i n g t h e 
F e b r u a r y 
7 
u l t r a s o u n d p r o b a b l y 
c a u s e d t h e b a b y ' s d e a t h . 
C o n s e q u e n t l y , a 
j u r y 
v e r d i c t 
r e a c h i n g 
t h e 
c o n c l u s i o n 
drawn 
i n 
t h e 
C h i e f 
J u s t i c e ' s s p e c i a l w r i t i n g w o u l d be b a s e d on s p e c u l a t i o n as 
t o 
m a t t e r s w e l l b e y o n d t h e e x p e r t i s e o f a 
l a y p e r s o n . 
22 
1071020, 1071081 
M o b i l e 
OB-GYN 
a l s o 
a r g u e s 
t h a t 
b o t h 
t h e t h i r d 
c o u n t 
s u b m i t t e d t o t h e j u r y -- t h a t i t 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 e c a u s e i t " n e g l i g e n t l y d i d n o t have i n p l a c e 
a p p r o p r i a t e 
p r o c e d u r e s , 
s a f e g u a r d s , 
a n d p r o t o c o l s t o p r e v e n t 
t h e d r u g 
B e n i c a r f r o m b e i n g p r e s c r i b e d t o p r e g n a n t 
p a t i e n t s " -- a n d t h e 
f i f t h 
c o u n t 
s u b m i t t e d t o t h e j u r y -- t h a t i t 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 e c a u s e i t " n e g l i g e n t l y d i d n o t p r o p e r l y 
e v a l u a t e t h e r i s k o f a l l o w i n g a p r e g n a n t 
p a t i e n t t o r e m a i n on 
t h e 
d r u g 
B e n i c a r " -- a r e n o t s u p p o r t e d 
b y t h e e v i d e n c e . 
S p e c i f i c a l l y , 
M o b i l e OB-GYN a r g u e s 
t h a t t h e r e was no e x p e r t 
t e s t i m o n y 
e s t a b l i s h i n g t h e s t a n d a r d o f c a r e a p p l i c a b l e as t o 
e i t h e r 
c o u n t , 
e s t a b l i s h i n g 
t h a t t h e r e was a b r e a c h o f t h a t 
s t a n d a r d , o r e s t a b l i s h i n g 
t h a t t h a t 
a l l e g e d 
b r e a c h was t h e 
p r o x i m a t e 
c a u s e o f t h e b a b y ' s d e a t h . 
F o r t h e r e a s o n s 
t h a t 
f o l l o w , we d i s a g r e e . 
I n 
r e g a r d t o t h e t h i r d c o u n t , 
B a g g e t t ' s 
e x p e r t 
w i t n e s s , 
Dr. T u r r e n t i n e , gave t h e f o l l o w i n g t e s t i m o n y e s t a b l i s h i n g t h e 
s t a n d a r d o f c a r e h e a l t h - c a r e p r o v i d e r s s h o u l d u s e i n 
c h a r t i n g 
p a t i e n t s ' 
m e d i c a t i o n s a n d c o n c l u d i n g t h a t M o b i l e OB-GYN 
d i d 
n o t meet t h a t 
s t a n d a r d : 
"Q. 
D o c t o r , 
b a s e d on y o u r 
e d u c a t i o n , 
t r a i n i n g a n d 
b a c k g r o u n d , i s i t t h e s t a n d a r d o f c a r e t h a t t h e 
23 
1071020, 1071081 
d o c u m e n t i n g o f t h e c o n t i n u a n c e , d i s c o n t i n u a n c e , 
p r e s c r i p t i o n o f m e d i c a t i o n s i s t o be c h a r t e d ? 
"A. 
The s t a n d a r d o f c a r e i s t h a t m e d i c a t i o n s , when 
t h e y 
a r e 
s t a r t e d 
and 
s t o p p e d , 
s h o u l d 
be 
d o c u m e n t e d . 
f i 
"Q. 
D o c t o r , 
b a s e d 
on 
y o u r 
e d u c a t i o n , 
t r a i n i n g , 
b a c k g r o u n d , 
t h e m a t e r i a l s you 
r e v i e w e d , 
t h e 
f a c t s 
you h a v e become 
f a m i l i a r 
w i t h i n 
t h i s 
c a s e , do you h a v e an o p i n i o n t o a 
r e a s o n a b l e 
d e g r e e 
o f 
m e d i c a l 
c e r t a i n t y 
as 
t o 
w h e t h e r 
[ M o b i l e OB-GYN] v i o l a t e d t h e s t a n d a r d o f c a r e 
by n o t c h a r t i n g 
m e d i c a t i o n s 
a p p r o p r i a t e l y i n 
t h e i r c h a r t s ? 
"A. Y e s , 
t h e y 
d i d n o t 
c h a r t 
d i s c o n t i n u i n g 
t h e 
B e n i c a r . " 
Dr. 
Rouse 
and Dr. R o g e r s 
s u b s e q u e n t l y 
t e s t i f i e d 
t h a t Dr. 
M a d o n i a ' s c h a r t i n g 
p r a c t i c e s d i d n o t b r e a c h 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. 
T u r r e n t i n e ' s 
t e s t i m o n y 
n e v e r t h e l e s s 
c o n s t i t u t e s 
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 s t a n d a r d o f c a r e 
r e q u i r e d Dr. M a d o n i a t o c h a r t when m e d i c a t i o n s a r e s t a r t e d and 
s t o p p e d and t h a t he 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 
f a i l i n g 
t o do s o . 
I n r e g a r d t o t h e f i f t h c o u n t , t h e u n a n i m o u s t e s t i m o n y o f 
e v e r y e x p e r t who 
t e s t i f i e d a t t r i a l was t h a t when a p a t i e n t 
t a k i n g B e n i c a r becomes p r e g n a n t , B e n i c a r s h o u l d be i m m e d i a t e l y 
d i s c o n t i n u e d . 
I n d e e d , 
t h e 
t e s t i m o n y 
o f 
t h o s e 
e x p e r t s 
24 
1071020, 1071081 
i n d i c a t e d t h a t i t 
was a v i o l a t i o n o f t h e s t a n d a r d o f c a r e n o t 
t o 
d i s c o n t i n u e t h e u s e o f B e n i c a r . 
T h i s 
t e s t i m o n y i s 
t a n t a m o u n t t o s t a t i n g 
t h a t a p r o p e r 
e v a l u a t i o n o f t h e r i s k s 
a s s o c i a t e d 
w i t h 
l e a v i n g a p r e g n a n t p a t i e n t on B e n i c a r 
w i l l 
a l w a y s 
l e a d t h e e v a l u a t i n g p h y s i c i a n t o c o n c l u d e 
t h a t t h e 
r i s k s a r e u n a c c e p t a b l e a n d t h a t B e n i c a r s h o u l d t h e r e f o r e be 
d i s c o n t i n u e d ; b y e x t e n s i o n , any e v a l u a t i o n ( o r 
t h e f a i l u r e t o 
c o n d u c t an e v a l u a t i o n ) t h a t r e s u l t s i n 
t h e p a t i e n t b e i n g 
l e f t 
on B e n i c a r h a s n e c e s s a r i l y b e e n n e g l i g e n t a n d t h e e v a l u a t i n g 
p h y s i c i a n who d o e s n o t d i s c o n t i n u e B e n i c a r h a s 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 . 
Thus, 
t h e r e 
was 
e x p e r t 
t e s t i m o n y 
e s t a b l i s h i n g 
t h e 
s t a n d a r d s o f c a r e a p p l i c a b l e t o t h e t h i r d a n d f i f t h c o u n t s as 
w e l l as e v i d e n c e 
i n d i c a t i n g t h a t M o b i l e OB-GYN f a i l e d t o meet 
t h o s e s t a n d a r d s . 
However, t h e r e 
s t i l l must be some 
e v i d e n c e 
f r o m w h i c h a j u r y c o u l d r e a s o n a b l y 
c o n c l u d e 
t h a t M o b i l e OB-
GYN's b r e a c h o f t h o s e s t a n d a r d s p r o x i m a t e l y c a u s e d t h e d e a t h 
o f 
B a g g e t t ' s b a b y b e f o r e t h o s e c o u n t s may be c o n s i d e r e d g o o d 
c o u n t s . 
M o b i l e OB-GYN e m p h a s i z e s t h a t t h e r e was no e x p e r t 
t e s t i m o n y 
e s t a b l i s h i n g 
p r o x i m a t e 
c a u s a t i o n ; 
h o w e v e r , t h e 
g e n e r a l 
f a c t s 
u n d e r l y i n g 
t h e s e 
c o u n t s , 
a l o n g 
w i t h t h e 
25 
1071020, 1071081 
u n d i s p u t e d 
e x p e r t t e s t i m o n y 
e s t a b l i s h i n g t h a t women who become 
p r e g n a n t 
s h o u l d 
i m m e d i a t e l y 
d i s c o n t i n u e t h e u s e o f B e n i c a r , 
c o n s t i t u t e 
s u b s t a n t i a l e v i d e n c e o f p r o x i m a t e 
c a u s a t i o n . 
I f 
M o b i l e OB-GYN h a d m a i n t a i n e d 
i t s p a t i e n t s ' m e d i c a l 
r e c o r d s i n 
a manner c o n s i s t e n t w i t h t h e s t a n d a r d o f c a r e as e s t a b l i s h e d 
by 
D r . T u r r e n t i n e , 
D r . M a d o n i a 
w o u l d 
h a v e h a d a 
r e c o r d 
i n d i c a t i n g t h a t B a g g e t t h a d b e e n p r e s c r i b e d B e n i c a r , a n d , upon 
r e v i e w i n g 
t h a t r e c o r d , he w o u l d have a l s o s e e n t h a t t h e r e c o r d 
i n d i c a t e d t h a t B a g g e t t h a d n e v e r s t o p p e d t a k i n g B e n i c a r . 
The 
u n d i s p u t e d 
e v i d e n c e 
i n d i c a t e s 
t h a t 
D r . M a d o n i a 
knew 
t h a t 
B e n i c a r 
s h o u l d 
n o t be t a k e n b y p r e g n a n t women; 
t h u s , h i s 
e v a l u a t i o n 
o f t h e s i t u a t i o n 
a f t e r 
r e v i e w i n g 
h e r 
m e d i c a l 
r e c o r d s 
a n d 
l e a r n i n g 
t h e s e 
f a c t s 
w o u l d 
h a v e 
n e c e s s a r i l y 
r e s u l t e d 
i n h i s i n s t r u c t i n g 
B a g g e t t 
t o i m m e d i a t e l y 
c e a s e 
t a k i n g 
B e n i c a r . 
A j u r y c o u l d 
t h e r e f o r e 
r e a s o n a b l y 
c o n c l u d e 
t h a t 
M o b i l e 
OB-GYN's 
f a i l u r e 
t o p r o p e r l y 
c h a r t 
B a g g e t t ' s 
B e n i c a r 
u s e l e d t o t h e n e g l i g e n t 
f a i l u r e t o e v a l u a t e 
t h a t 
r e s u l t e d i n h e r c o n t i n u e d 
u s e o f B e n i c a r 
a n d t h e u l t i m a t e 
d e a t h 
o f h e r b a b y . 
The 
t h i r d 
a n d 
f i f t h 
c o u n t s 
were 
a c c o r d i n g l y good c o u n t s 
t h a t were p r o p e r l y 
s u b m i t t e d 
t o 
t h e 
j u r y . 
26 
1071020, 
1071081 
V. 
A f t e r a l l 
t h e e v i d e n c e was p r e s e n t e d , t h e j u r y i n t h i s 
c a s e was g i v e n a c h a r g e 
a l l e g i n g 
f i v e 
c o u n t s o f n e g l i g e n c e . 
I t s u b s e q u e n t l y r e t u r n e d a g e n e r a l v e r d i c t i n 
f a v o r o f B a g g e t t 
and 
a g a i n s t M o b i l e OB-GYN, a n d t h e 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 b a s e d on t h a t v e r d i c t . 
However, b e c a u s e two o f 
t h e 
f i v e 
c o u n t s t h e j u r y was c h a r g e d on were n o t s u p p o r t e d b y 
s u b s t a n t i a l e v i d e n c e , M o b i l e OB-GYN was e n t i t l e d t o 
a j u d g m e n t 
as a m a t t e r o f l a w on t h o s e two c o u n t s , a n d t h o s e 
c o u n t s 
s h o u l d n o t 
have b e e n s u b m i t t e d t o t h e j u r y . 
B e c a u s e we c a n n o t 
presume 
t h a t t h e j u r y ' s 
v e r d i c t 
was b a s e d on t h e t h r e e 
r e m a i n i n g g o o d c o u n t s , we must t h e r e f o r e r e v e r s e t h e j u d g m e n t 
e n t e r e d on t h a t v e r d i c t . 
L o n g , 980 So. 2d a t 3 8 5 . A l l o t h e r 
i s s u e s 
r a i s e d b y M o b i l e OB-GYN i n i t s 
a p p e a l a n d t h e i s s u e 
r e g a r d i n g t h e r e m i t t i t u r r a i s e d b y B a g g e t t i n 
h e r c r o s s - a p p e a l 
a r e 
t h e r e f o r e moot, a n d t h e c a u s e i s remanded t o t h e 
t r i a l 
c o u r t f o r 
a new t r i a l on t h e r e m a i n i n g good 
c o u n t s . 
1071020 -- REVERSED AND REMANDED. 
L y o n s , 
W o o d a l l , 
S m i t h , 
B o l i n , 
P a r k e r , a n d Shaw, J J . , 
c o n c u r . 
Cobb, C . J . , 
c o n c u r s i n p a r t a n d d i s s e n t s i n p a r t . 
M u r d o c k , J . , 
c o n c u r s i n t h e r e s u l t i n p a r t a n d d i s s e n t s 
i n 
p a r t . 
27 
1071020, 1071081 
1071081 -- 
DISMISSED. 
L y o n s , W o o d a l l , S m i t h , B o l i n , P a r k e r , M u r d o c k , and Shaw, 
J J . , 
c o n c u r . 
Cobb, C . J . , d i s s e n t s . 
28 
1071020, 1071081 
COBB, C h i e f J u s t i c e ( c o n c u r r i n g i n 
p a r t a n d d i s s e n t i n g i n p a r t 
i n 
c a s e no. 1 0 7 1 0 2 0 ) . 
I c o n c u r w i t h t h e m a j o r i t y ' s 
c o n c l u s i o n 
t h a t t h e 
f i r s t , 
t h i r d , a n d f i f t h 
n e g l i g e n c e 
c o u n t s were p r o p e r l y s u b m i t t e d t o 
t h e j u r y . As t o t h e m a j o r i t y ' s c o n c l u s i o n t h a t t h e t r i a l 
c o u r t 
e r r e d i n s u b m i t t i n g t h e s e c o n d a n d f o u r t h n e g l i g e n c e 
c o u n t s t o 
t h e 
j u r y , I r e s p e c t f u l l y d i s s e n t . 
The 
j o u r n a l 
a r t i c l e 
r e f e r e n c e d 
i n t h e m a j o r i t y 
o p i n i o n 
and 
d i s c u s s e d i n t h e r e c o r d d o e s n o t s u p p o r t Wendy B a g g e t t ' s 
c o n t e n t i o n 
t h a t t h e e f f e c t s o f B e n i c a r c a n be r e v e r s e d i f t h e 
m o t h e r s t o p s 
t a k i n g t h e d r u g . 
However, t h e r e c o r d 
c o n t a i n s 
o t h e r 
e v i d e n c e 
f r o m w h i c h a j u r y 
c o u l d 
r e a s o n a b l y 
c o n c l u d e 
t h a t B a g g e t ' s e x p o s u r e t o B e n i c a r 
a f t e r t h e F e b r u a r y 7, 2005, 
u l t r a s o u n d 
p r o b a b l y 
a n d p r o x i m a t e l y 
c a u s e d t h e d e a t h o f t h e 
i n f a n t . 
See, e . g . , A l a . Code 1975, 
§ 6-5-549 ("In 
t h e c a s e o f 
a j u r y 
t r i a l , t h e j u r y 
s h a l l be i n s t r u c t e d t h a t i n o r d e r t o 
r e t u r n a v e r d i c 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 , 
t h e j u r y 
s h a l l be r e a s o n a b l y 
s a t i s f i e d b y 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 c o m p l y w i t h t h e s t a n d a r d o f 
c a r e a n d t h a t s u c h f a i l u r e p r o b a b l y 
c a u s e d t h e i n j u r y o r d e a t h 
i n 
q u e s t i o n . " ) ; 
c f . C r u t c h e r 
v . 
W i l l i a m s , 
[Ms. 1 0 5 0 8 9 3 , 
J a n u a r y 9, 2 0 0 9 ] , 
So. 3d 
, 
( A l a . 2 
0 
0 
8 ) ( o p i n i o n on 
29 
1071020, 1071081 
r e t u r n 
t o 
s e c o n d 
remand) 
("[T]o 
p r e v a i l 
on 
a 
m e d i c a l - m a l p r a c t i c e c l a i m ... t h e p l a i n t i f f must p r o v e t h a t a 
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 ... p r o x i m a t e l y a n d p r o b a b l y 
c a u s e d a c t u a l i n j u r y t o t h e p l a i n t i f f . " ) ; 
G i l e s v . B r o o k w o o d 
H e a l t h 
S e r v s . , I n c . , 
5 So. 3d 533 ( A l a . 2008) 
( u p h o l d i n g a 
summary j u d g m e n t f o r 
t h e d e f e n d a n t i n a m e d i c a l - m a l p r a c t i c e 
c a s e 
b e c a u s e 
t h e 
p l a i n t i f f 
d i d n o t p r e s e n t 
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 
d e f e n d a n t p h y s i c i a n ' s n e g l i g e n c e p r o x i m a t e l y 
and p r o b a b l y c a u s e d i n j u r y t o t h e p l a i n t i f f ) . 
M o b i l e OB-GYN's own e v i d e n c e a t t r i a l d e m o n s t r a t e d 
t h a t 
B e n i c a r w o r k s b y l o w e r i n g t h e p a t i e n t ' s b l o o d p r e s s u r e , a n d 
t h a t i n d o i n g so i t 
d e c r e a s e s t h e f l o w o f b l o o d t o t h e u t e r u s 
and, 
u l t i m a t e l y , t o t h e f e t u s . 
I n s u f f i c i e n t b l o o d f l o w t o 
t h e 
u t e r u s 
i s known as u t e r o p l a c e n t a l i n s u f f i c i e n c y . 
B a g g e t t 
i n t r o d u c e d e v i d e n c e 
i n d i c a t i n g t h a t B e n i c a r l o w e r e d h e r b l o o d 
p r e s s u r e a n d c a u s e d t h e b l o o d f l o w t o t h e u t e r u s t o d e c r e a s e . 
The 
e v i d e n c e , 
i n c l u d i n g 
M o b i l e OB-GYN's own e v i d e n c e , 
a l s o 
d e m o n s t r a t e d t h a t t h e d e c r e a s e d 
f l o w o f b l o o d t o t h e u t e r u s 
c a u s e d a d e c r e a s e i n 
t h e 
amount o f a m n i o t i c 
f l u i d a n d t h a t t h e 
d e c r e a s e i n 
t h e amount o f a m n i o t i c 
f l u i d , i n t u r n , c a u s e d t h e 
b a b y i n t h i s c a s e t o d e v e l o p a b n o r m a l l y a n d u l t i m a t e l y t o d i e . 
30 
1071020, 1071081 
S u b s t a n t i a l 
e v i d e n c e 
a l s o 
e x i s t s 
t o 
show 
t h a t 
t h e 
c r i t i c a l 
d e c r e a s e 
i n t h e 
l e v e l 
o f a m n i o t i c 
f l u i d , 
c a u s e d 
by 
t a k i n g 
a 
m e d i c a t i o n 
one 
o f 
t h e 
e f f e c t s 
o f 
w h i c h 
i s 
t o 
d e c r e a s e b l o o d f l o w t o t h e u t e r u s , o c c u r r e d a f t e r t h e 
F e b r u a r y 
7, 
2005, 
u l t r a s o u n d . 
As 
t h e 
m a j o r i t y n o t e s , 
a c c o r d i n g 
t o 
M o b i l e OB-GYN's e x p e r t w i t n e s s e s , t h e a m n i o t i c - f l u i d 
l e v e l 
a t 
t h e t i m e 
o f t h e F e b r u a r y 
7 u l t r a s o u n d was 
w i t h i n t h e 
n o r m a l 
r a n g e . 
However, t h e u n d i s p u t e d 
e v i d e n c e 
showed t h a t , a t 
t h e 
t i m e o f t h e 
c h i l d ' s 
b i r t h a l m o s t 
11 weeks 
( a l m o s t t h e 
l e n g t h 
o f 
a 
t r i m e s t e r ) 
l a t e r , 
B a g g e t t 
had 
v i r t u a l l y 
no 
a m n i o t i c 
f l u i d . 
M o r e o v e r , Dr. E l i z a b e t h M a n c i - G a r d n e r , who 
p e r f o r m e d 
t h e a u t o p s y , 
c o n c l u d e d 
t h a t " [ t ] h e most l i k e l y c a u s e o f 
d e a t h 
i n 
t h i s 
c a s e 
i s d e c r e a s e d 
u t e r o p l a c e n t a l b l o o d 
f l o w , 
w h i c h 
a p p e a r s t o have b e e n 
r e l a t i v e l y 
r e c e n t 
i n o n s e t b e c a u s e 
t h e 
f e t a l ... w e i g h t s " were w i t h i n n o r m a l r a n g e s f o r a 3 3 - w e e k - o l d 
f e t u s . 
Thus, a l t h o u g h 
t h e r e was 
no p r o o f 
a t 
t r i a l 
t h a t 
c e a s i n g 
t h e 
a d m i n i s t r a t i o n o f 
B e n i c a r 
c a n 
r e v e r s e damage 
t h a t 
has 
a l r e a d y b e e n done, 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 t h a t B e n i c a r 
l o w e r e d B a g g e t ' s b l o o d p r e s s u r e 
and 
d e c r e a s e d 
t h e b l o o d 
f l o w 
t o 
t h e 
u t e r u s 
a f t e r 
t h e 
F e b r u a r y 
7 
u l t r a s o u n d , 
t h e r e b y 
p r o b a b l y 
and 
p r o x i m a t e l y 
c a u s i n g 
t h e 
d e c r e a s e 
i n 
a m n i o t i c -
31 
1071020, 1071081 
f l u i d 
l e v e l s 
a f t e r 
t h e F e b r u a r y 7 u l t r a s o u n d , w h i c h 
i n t u r n 
c a u s e d 
d e v e l o p m e n t a l 
d e f e c t s i n t h e 
f e t u s and, 
as a 
r e s u l t , 
t h e d e a t h o f t h e 
c h i l d . 
The 
m a j o r i t y s t a t e s 
t h a t 
"no 
e x p e r t 
o p i n i o n t e s t i m o n y 
s u p p o r t s 
t h e 
v i e w 
t h a t 
e v e n t s 
p r e c e d i n g 
t h e 
F e b r u a r y 
7 
u l t r a s o u n d e x a m i n a t i o n c a n be d i s r e g a r d e d so as t o w a r r a n t t h e 
c o n c l u s i o n 
t h a t 
l a c k 
o f 
f u r t h e r 
e v a l u a t i o n 
by 
Dr. 
M a d o n i a 
f o l l o w i n g t h e F e b r u a r y 7 u l t r a s o u n d p r o b a b l y c a u s e d t h e b a b y ' s 
d e a t h . " 
So. 
3d 
a t 
n.7. 
On 
t h i s 
r e c o r d , one 
c o u l d 
n e v e r t h e l e s s r e a s o n a b l y c o n c l u d e t h a t t h e B e n i c a r t a k e n 
a f t e r 
t h e F e b r u a r y 7 u l t r a s o u n d p r o b a b l y c a n n o t be d i s r e g a r d e d as a 
p r o x i m a t e 
c a u s e 
o f t h e b a b y ' s d e a t h . 
The 
s e c o n d 
and 
f o u r t h 
c o u n t s were s u p p o r t e d by s u f f i c i e n t e v i d e n c e o f p r o x i m a t e 
and 
p r o b a b l e c a u s a t i o n and were p r o p e r l y s u b m i t t e d t o t h e 
j u r y . 
As a f i n a l n o t e , I r e m a i n c o n v i n c e d o f t h e c o r r e c t n e s s o f 
J u s t i c e M u r d o c k ' s s p e c i a l w r i t i n g c o n c u r r i n g i n t h e r e s u l t i n 
L o n g v. Wade, 980 
So. 
2d 
378, 
387 
( A l a . 2 0 0 7 ) , 
i n w h i c h 
I 
c o n c u r r e d . 
I t i s c l e a r f r o m t h e r e c o r d t h a t b o t h c o u n s e l and 
t h e 
t r i a l 
j u d g e 
a t t e m p t e d 
t o a d h e r e 
t o L o n g , w h i c h had 
j u s t 
b e e n r e l e a s e d a t t h e t i m e o f t h e t r i a l i n t h i s c a s e . 
However, 
I n o t e t h a t 
t h i s c a s e 
i l l u s t r a t e s t h e c o m p l i c a t i o n s t h a t 
c a n 
a r i s e u n d e r L o n g when a j u r y r e n d e r s a g e n e r a l v e r d i c t 
a f t e r 
32 
1071020, 1071081 
c o n s i d e r i n g 
a l l e g a t i o n s 
t h a t 
t h e d e f e n d a n t c o m m i t t e d 
s e v e r a l 
t o r t i o u s 
a c t s 
o r o m i s s i o n s , 
any 
one 
o f w h i c h 
c o u l d 
f o r m 
an 
i n d e p e n d e n t b a s i s f o r h o l d i n g t h e d e f e n d a n t l i a b l e . 
See 
L o n g , 
980 
So. 
2d 
a t 386-87 
("[The 
p l a i n t i f f ] 
may 
n o t , m e r e l y 
by 
i n c l u d i n g a l l a l l e g e d b a s e s o f r e c o v e r y i n a s i n g l e c o u n t o f 
t h e i r c o m p l a i n t , a v o i d t h e g o o d - c o u n t / b a d - c o u n t 
r u l e .... 
[The 
p l a i n t i f f ' s c l a i m s ] a r e n o t m e r e l y d i f f e r e n t t h e o r i e s on w h i c h 
t o 
r e c o v e r 
f o r t h e same 
a c t s 
o r 
o m i s s i o n s , 
b u t 
c o n s t i t u t e 
e n t i r e l y s e p a r a t e a c t s 
o r o m i s s i o n s , w h i c h f o r m d i s c r e t e 
and 
i n d e p e n d e n t b a s e s f o r p o t e n t i a l r e c o v e r y . ... Upon 
s u f f i c i e n t 
p r o o f , e a c h one 
c a r r i e s t h e p o t e n t i a l f o r l i a b i l i t y . " ) . 
I n 
l i g h t 
o f L o n g , 
t h e p l e a d i n g r e q u i r e m e n t s o f § 6-5-551, A l a . 
Code 1975, 
a p a r t 
o f t h e A l a b a m a M e d i c a l 
L i a b i l i t y A c t , 
and 
t h e m a j o r i t y ' s 
h o l d i n g t o d a y , i t a p p e a r s t h a t s p e c i a l 
v e r d i c t s 
o r 
g e n e r a l 
v e r d i c t s 
a c c o m p a n i e d 
by 
i n t e r r o g a t o r i e s 
may 
be 
a 
n e c e s s i t y 
i n many m e d i c a l - m a l p r a c t i c e c a s e s . 
See R u l e 
4 9 ( b ) 
and 
( c ) , A l a . R. 
C i v . P. 
( r e g a r d i n g 
s p e c i a l 
v e r d i c t s 
and 
g e n e r a l v e r d i c t s 
a c c o m p a n i e d 
by a n s w e r s 
t o 
i n t e r r o g a t o r i e s ) . 
33 
1071020, 1071081 
MURDOCK, 
J u s t i c e 
( c o n c u r r i n g i n t h e r e s u l t 
i n p a r t a n d 
d i s s e n t i n g i n p a r t i n c a s e no. 1 0 7 1 0 2 0 ) . 
W i t h r e s p e c t t o t h e a p p e a l i n c a s e no. 1071020, I c o n c u r 
i n t h e r e s u l t 
r e a c h e d b y t h e m a i n o p i n i o n e x c e p t as t o 
t h e 
f i f t h 
c o u n t 
o f Wendy B a g g e t t ' s 
c o m p l a i n t , as t o w h i c h 
I 
r e s p e c t f u l l y d i s s e n t . 
I w r i t e s e p a r a t e l y t o a d d r e s s t h e t h i r d 
and 
f i f t h 
c o u n t s o f t h e c o m p l a i n t . 
The 
T h i r d C o u n t 
I n 
t h e f i r s t 
t r i a l 
o f t h i s 
c a s e , t h e t h i r d 
c o u n t o f 
B a g g e t t ' s 
c o m p l a i n t 
a l l e g e d 
t h a t M o b i l e OB-GYN h a d 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 e c a u s e i t 
" n e g l i g e n t l y d i d 
n o t have i n 
p l a c e 
a p p r o p r i a t e p r o c e d u r e s , 
s a f e g u a r d s , a n d p r o t o c o l s t o 
p r e v e n t t h e d r u g 
B e n i c a r f r o m 
b e i n g p r e s c r i b e d t o p r e g n a n t 
p a t i e n t s . " 
B a g g e t t 
a d d u c e d e v i d e n c e 
d u r i n g 
t r i a l 
t h a t , i f 
b e l i e v e d by t h e j u r y , 
i n d i c a t e d t h a t D r . M a d o n i a ' s n u r s e d i d 
n o t know what B e n i c a r was b e f o r e B a g g e t t ' s b a b y was d e l i v e r e d ; 
t h a t t h e s t a f f o f M o b i l e OB-GYN d i d 
n o t a s k p a t i e n t s , 
d u r i n g 
e v e r y p r e n a t a l v i s i t , what m e d i c a t i o n s t h e y were t a k i n g ; t h a t 
some M o b i l e OB-GYN s t a f f e r r o n e o u s l y b e l i e v e d t h a t D r . M a d o n i a 
a u t o m a t i c a l l y 
d i s c o n t i n u e d a l l m e d i c a t i o n s 
when a 
p a t i e n t 
became p r e g n a n t ; 
a n d t h a t D r . M a d o n i a d i d n o t i n d i c a t e on 
B a g g e t t ' s 
m e d i c a l 
c h a r t t h a t he h a d a l l e g e d l y d i s c o n t i n u e d 
34 
1071020, 1071081 
B e n i c a r . 
F u r t h e r , 
a l t h o u g h d i s p u t e d , 
t h e r e was e v i d e n c e f r o m 
w h i c h t h e j u r y r e a s o n a b l y c o u l d 
f i n d t h a t D r . M a d o n i a 
h i m s e l f 
d i d n o t a s k B a g g e t t on p r e n a t a l 
v i s i t s what m e d i c a t i o n s she 
was 
t a k i n g a n d , 
as d i s c u s s e d i n 
t h e 
m a i n o p i n i o n , t h a t 
n e i t h e r 
Dr. 
M a d o n i a n o r h i s s t a f f 
f o l l o w e d 
c h a r t i n g 
p r a c t i c e s 
t h a t 
w o u l d r e v e a l 
t h i s 
i n f o r m a t i o n .
8 
The 
e x t r e m e n a t u r e o f t h e r i s k t o p r e g n a n t p a t i e n t s o f 
t a k i n g B e n i c a r was n o t o n l y 
t e s t i f i e d t o b y e x p e r t s , i t 
was 
u n d i s p u t e d . 
A c c o r d i n g l y , 
i f p r o v e n , t h e f a c t 
t h a t 
M o b i l e 
OB-GYN d i d n o t 
h a v e i n 
p l a c e n e c e s s a r y p r o c e d u r e s o r p r a c t i c e s 
f o r l e a r n i n g w h e t h e r a p r e g n a n t p a t i e n t was t a k i n g a d r u g as 
d a n g e r o u s 
t o a 
f e t u s 
as 
B e n i c a r 
-- 
a n d 
e s p e c i a l l y an 
a p p r o p r i a t e 
p r o c e d u r e 
o r p r a c t i c e t o d e t e r m i n e 
o r 
r e v e a l 
w h e t h e r a p r e g n a n t p a t i e n t was 
s t i l l 
t a k i n g a d r u g 
r e c e n t l y 
p r e s c r i b e d by D r . M a d o n i a h i m s e l f 
t h a t w o u l d be d a n g e r o u s t o 
a d e v e l o p i n g 
f e t u s -- w o u l d e n t a i l a " ' " l a c k o f c a r e 
[ t h a t ] i s 
so 
a p p a r e n t ... as t o be u n d e r s t o o d b y a l a y m a n , a n d 
[ t o ] 
8 C o n s i s t e n t 
w i t h 
e x p e r t 
t e s t i m o n y 
i n t r o d u c e d b y B a g g e t t 
a t 
t r i a l , n o t t o m e n t i o n 
i t s a b i l i t y t o u s e i t s own common 
s e n s e a n d e x p e r i e n c e , 
t h e j u r y 
c o u l d 
have 
f o u n d 
t h a t 
s u c h 
c h a r t i n g p r a c t i c e s w o u l d i n c l u d e a p r a c t i c e o f a l w a y s c h a r t i n g 
b o t h t h e 
p r e s c r i p t i o n o f a n d 
t h e 
d i s c o n t i n u a t i o n o f d r u g s 
t h a t 
p o s e d a d a n g e r t o p r e g n a n t women a n d a p r a c t i c e o f 
c h e c k i n g 
f o r b o t h t y p e s o f e n t r i e s w i t h r e s p e c t t o p a t i e n t s who become 
p r e g n a n t . 
35 
1071020, 1071081 
r e q u i r e [ ] 
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 t o u n d e r s t a n d 
i t . " ' " 
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, 39 ( A l a . 
2002) 
( q u o t i n g T u s c a l o o s a 
O r t h o p e d i c 
A p p l i a n c e Co. v. W y a t t , 
460 
So. 2d 156, 161 ( A l a . 1 9 8 4 ) , 
q u o t i n g i n t u r n D i m o f f v . 
M a i t r e , 432 So. 2d 1 2 2 5 , 1226-27 
( A l a . 1 9 8 3 ) ) . 
L i k e w i s e , as 
t o 
t h e i s s u e o f c a u s a t i o n , i t 
i s w e l l w i t h i n t h e ken o f a 
l a y p e r s o n 
t o be 
a b l e 
t o 
i n f e r 
how 
a p p r o p r i a t e 
c h a r t i n g 
p r a c t i c e s w o u l d h a v e made i t a p p a r e n t i n 
a t i m e l y manner t h a t 
B a g g e t t r e m a i n e d on B e n i c a r 
a f t e r she became p r e g n a n t . 
The 
F i f t h C o u n t 
I d i s a g r e e , h o w e v e r , w i t h t h e 
m a i n o p i n i o n ' s t r e a t m e n t o f 
c o u n t 
f i v e o f t h e c o m p l a i n t . 
B a g g e t t a l l e g e s i n c o u n t 
f i v e 
t h a t D r . M a d o n i a 
" n e g l i g e n t l y d i d 
n o t p r o p e r l y e v a l u a t e t h e 
r i s k o f a l l o w i n g a p r e g n a n t 
p a t i e n t t o r e m a i n on t h e d r u g 
B e n i c a r . " 
The r e c o r d , h o w e v e r , a t l e a s t as i t 
d e v e l o p e d a t 
t h e 
f i r s t 
t r i a l 
o f 
t h i s 
c a s e , 
d i d n o t s u p p o r t 
s u c h an 
a l l e g a t i o n . 
I n p o i n t o f f a c t , 
t h e r e was no d i s p u t e a t 
t h e 
f i r s t 
t r i a l b u t t h a t D r . M a d o n i a 
a c t u a l l y d i d 
know a n d 
d i d 
a p p r e c i a t e , a t t h e t i m e he was 
t r e a t i n g 
B a g g e t t , 
t h e r i s k 
B e n i c a r 
p o s e d 
t o f e t u s e s . 
The 
d i s p u t e 
was n o t w h e t h e r 
Dr. M a d o n i a h a d t h i s k n o w l e d g e , b u t r a t h e r w h e t h e r he 
a c t e d 
upon i t 
-- e i t h e r b y i m p l e m e n t i n g 
a p p r o p r i a t e 
p r o c e d u r e s t o 
36 
1071020, 
1071081 
p r e v e n t p a t i e n t s 
l i k e B a g g e t t f r o m r e m a i n i n g on s u c h a d r u g o r 
by a c t u a l l y i n f o r m i n g B a g g e t t t h a t she s h o u l d s t o p t a k i n g t h e 
d r u g . 
These a r e t h e i s s u e s t o w h i c h t h e e v i d e n c e a t t h e 
f i r s t 
t r i a l 
was 
d i r e c t e d -- and t h e s e 
i s s u e s a r e subsumed by t h e 
f i r s t 
and 
t h i r d 
c o u n t s o f t h e c o m p l a i n t . 
A c c o r d i n g l y , 
t h e 
c h a r g i n g o f t h e j u r y as t o t h e f i f t h c o u n t i n t h e f i r s t 
t r i a l 
o f 
t h i s 
c a s e 
was 
a t 
b e s t 
p o t e n t i a l l y 
d u p l i c a t i v e 
and 
c o n f u s i n g , s e e , e . g . , A m e r i c a n C a s t I r o n P i p e Co. v . W i l l i a m s , 
591 So. 2d 854, 856 
( A l a . 1 9 9 1 ) , 
and 75A Am. 
J u r . 2d 
T r i a l 
§ 991 ( 2 0 0 7 ) , and was a t w o r s t t h e c h a r g i n g o f a "bad c o u n t . " 
37