Title: DCH Healthcare Authority v. Duckworth
Citation: 883 So. 2d 1214
Docket Number: 1020913
State: Alabama
Issuer: Alabama Supreme Court
Date: December 19, 2003

883 So. 2d 1214 (2003)
DCH HEALTHCARE AUTHORITY d/b/a DCH Regional Medical Center
v.
Mary K. DUCKWORTH, as personal representative of Dee Duckworth, deceased.
1020913.

Supreme Court of Alabama.
December 19, 2003.
*1216 James J. Jenkins and Terri Olive Tompkins of Phelps, Jenkins, Gibson &amp; Fowler, L.L.P., Tuscaloosa, for appellant.
Stephen D. Heninger of Heninger, Burge, Vargo &amp; Davis, LLP, Birmingham, for appellee.
WOODALL, Justice.
This appeal challenges a judgment entered on a jury verdict against DCH Healthcare Authority d/b/a DCH Regional Medical Center ("the Center") in favor of Mary K. Duckworth, as personal representative of her husband, Dee Duckworth, deceased, in Mrs. Duckworth's medical-malpractice action against the Center. We reverse and render a judgment for the Center.
According to the undisputed facts, 83-year-old Dee Duckworth went to the Center on October 9, 1999, to pick up Mary Duckworth, a patient at the Center, who was being discharged that day. After arriving at the Center, however, Mr. Duckworth fell on an escalator and struck his head. He was taken to the emergency department at 10:24 a.m. Mrs. Duckworth was notified of the accident and joined him at the emergency department.
At 10:59 a.m., Dr. Malcolm Nelson, the emergency-department physician, examined Mr. Duckworth and ordered an X-ray examination, which began at 12:36 p.m. For approximately 45 minutes preceding the X-ray examination, Mr. Duckworth waited in the hallway of the radiology department. While he was waiting, he developed a headache and nausea. He vomited during and after the X-ray examination.
At 1:17 p.m., Dr. Nelson ordered a computerized tomography scan ("CT scan"), which was performed at 1:54 p.m. At 2:00 p.m., the radiology department notified emergency-department personnel that Mr. Duckworth had a subdural hematoma. At approximately 2:15 p.m., Mr. Duckworth was relocated to the critical-care unit, and neurosurgeon Dr. Moses Jones was called to relieve the hemorrhage. Dr. Jones arrived at the Center at approximately 3:15 p.m. Surgery began at 4:40 p.m. and was completed at 6:00 p.m. Mr. Duckworth remained hospitalized until October 22, 1999, when he died as a result of the injuries he sustained in the fall on October 9.
Subsequently, Mrs. Duckworth sued the Center, alleging that Dr. Nelson and the other emergency-department personnel "caused or negligently allowed [Mr. Duckworth] to go without proper and timely evaluation, monitoring, care, and treatment for a potential closed-head injury, and failed to timely and properly address, observe and report changes in his condition." The complaint further alleged that as a consequence of the alleged negligence, Mr. Duckworth "was caused to worsen with a cerebral bleed and he was so injured that he died."
During the trial of the case, the Center moved for a judgment as a matter of law *1217 ("JML") at the close of Mrs. Duckworth's evidence, and, again, at the close of all the evidence. As a ground for the motions, the Center asserted that Mrs. Duckworth failed to present substantial evidence of causation by expert testimony. The trial court denied the motions, and a jury awarded Mrs. Duckworth $350,000. The Center filed a postverdict motion for a JML. That motion was overruled by operation of law, pursuant to Ala. R. Civ. P. 59.1, and the Center appealed.
The standard of review of a motion for a JML is well established:
Delchamps, Inc. v. Bryant, 738 So. 2d 824, 830-31 (Ala.1999).
Mrs. Duckworth's theory of the case is that the Center's diagnosis of her husband's condition and its treatment was dilatory. More specifically, she complains of the failure of emergency-department personnel to respond timely and appropriately to her husband's visibly deteriorating condition "over a three (3) hour period." Mrs. Duckworth's brief, at 23. She contends that "this inferior care ... adversely affected [his] condition," namely, the subdural hematoma, from which he subsequently died.
"To prove liability in a medical malpractice case, the plaintiff is required to show 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." Parker v. Collins, 605 So. 2d 824, 826 (Ala.1992). "There must be more than the mere possibility that the negligence complained of caused the injury; rather, there must be evidence that the negligence complained of probably caused the injury." Id.
As to causation in a dilatory-diagnosis-and-treatment case such as this one, "an action `may properly be submitted to the jury where there is evidence that prompt diagnosis and treatment would have placed the patient in a better position than she was in as a result of inferior medical care.'" Shanes v. Kiser, 729 So. 2d 319, 320-21 (Ala.1999) (quoting Parker, 605 So.2d at 827) (emphasis added). "It is not necessary to establish that prompt care could have prevented the injury or death of the patient; rather, the plaintiff must produce evidence to show that her condition was adversely affected by the alleged negligence." Parker, 605 So. 2d  at 827 (emphasis added). Unless "the cause and effect relationship between the breach of the standard of care and the subsequent complication or injury is so readily understood that a layperson can reliably determine the issue of causation," causation in a medical-malpractice case must be established through expert testimony. *1218 Cain v. Howorth, 877 So. 2d 566, 576 (Ala.2003); see also Bradley v. Miller, 878 So. 2d 262 (Ala.2003); Rivard v. University of Alabama Health Servs. Found., P.C., 835 So. 2d 987 (Ala.2002).
The Center contends that Mrs. Duckworth failed to present substantial evidence  by the requisite expert testimony  that the outcome of this case would have been different had the acts or omissions of which she complains not occurred. We agree.
Mrs. Duckworth's only expert medical testimony on the element of proximate cause was the videotaped deposition of Dr. Jones, who performed the surgery on Mr. Duckworth. His testimony as to proximate cause included the following:
(Emphasis added.)
Mrs. Duckworth refers to other portions of Dr. Jones's testimony in support of her argument that a more expeditious "diagnosis and treatment" would have placed her husband in a "better position than [he] was in as a result," Shanes, 729 So. 2d  at 321, of the two- or three-hour diagnostic period of which she complains. Specifically, she states:
Mrs. Duckworth's brief, at 23 (citations to the record omitted). Dr. Jones's actual testimony in that connection is as follows:
(Emphasis added.)
Conspicuously absent from this testimony is any opinion as to how  or whether  the two- or three-hour diagnostic, or pre-operative, period of which Mrs. Duckworth complains probably affected the outcome of this case. On the contrary, Dr. Jones testified that there was an optimum period of eight hours between diagnosis and surgery. The hematoma was discovered at 2:00 p.m. and removed by 6:00 p.m. Even computing the time from 10:24 a.m., when Duckworth arrived at the emergency room, until the hematoma was evacuated, only 7½ hours occurred before the surgery  within the optimum treatment period Dr. Jones described. Although Dr. Jones conceded that the hematoma "could possibly [have been] smaller two hours earlier," he did not explain how an increase in size would have adversely affected Mr. Duckworth's ultimate condition. He agreed with the general proposition that a "delay in diagnosis [could] adversely affect a person's condition," not that it did so in this case.[1]
Indeed, Dr. Jones's testimony is functionally identical to the testimony held to be insufficient in McAfee v. Baptist Medical Center, 641 So. 2d 265 (Ala.1994). McAfee involved the consolidated appeals of two medical-malpractice plaintiffs. One plaintiff was Martin McAfee, a child who "developed bacterial meningitis and suffered permanent brain damage and vision impairment" as a result of the alleged malpractice. 641 So. 2d  at 266. The other plaintiff was Brenda Roberts, who developed breast cancer, which she alleged the defendants failed to discover. Id. McAfee alleged that Baptist Medical Center and others (collectively referred to as "Baptist Medical") "failed to recognize, appreciate, and treat [his] bacterial infection in a timely manner, ... [resulting] in a worsening of [his] condition." Id. Similarly, Roberts alleged that Life Diagnostic Radiology and others "fail[ed] to properly evaluate [a] lump . . . found in [her] right breast ... [resulting] in a one-year delay of treatment and ... an unnecessary worsening of her condition." Id. In each case, the trial court granted the defendants' summary-judgment motions. This Court affirmed the summary judgments, explaining:
641 So. 2d  at 267-68 (emphasis added).
The general statements proffered by McAfee and Roberts  that "time [was] of the essence," and that "the sooner the onset of treatment, the better the expected result"  essentially mirror the statements made by Dr. Jones  as soon as possible is "always the ideal," and "any delay in diagnosis can adversely affect a person's condition." Like the testimony in McAfee, Dr. Jones's opinion does not constitute substantial evidence that the two- or three-hour delay of which Mrs. Duckworth complains probably adversely affected Mr. Duckworth's response to treatment.
The expert testimony presented in the cases cited by Mrs. Duckworth is clearly distinguishable. Travis v. Scott, 667 So. 2d 674, 678 (Ala.1995) (plaintiff's expert testified that if surgery had been performed on the decedent two days after she was admitted to the hospital, rather than eight days after admission, she "probably would have survived"); University of Alabama Health Servs. Found., P.C. v. Bush, 638 So. 2d 794, 803 (Ala.1994) (plaintiff's expert testified that the challenged delay in treating the plaintiff's meningitis infection "caus[ed]" or "contributed to the neurological damage that occurred"); Parker v. Collins, 605 So. 2d  at 826 (breast-cancer patient's experts were "80% certain" that cancer invaded the lymph nodes, necessitating a "mastectomy and [a] course of chemotherapy and radiation treatments," because of the defendant-doctor's failure timely to diagnose a lump in the plaintiff's breast).
Because Mrs. Duckworth failed to present substantial evidence of medical causation, the trial court erred in denying the Center's motion for a JML. The judgment in favor of Mrs. Duckworth is, therefore, reversed, and a judgment is rendered in favor of the Center.
REVERSED AND JUDGMENT RENDERED.
HOUSTON, LYONS, BROWN, and JOHNSTONE, JJ., concur.
[1]  Dr. Jones also stated that "[a] person over 70 years of age with an acute subdural hematoma probably has an 80 percent morality rate," and that the "risk" of death "in the elderly" in such cases was "very, very high."