Title: Lyons v. Walker Regional Medical Center
Citation: 791 So. 2d 937
Docket Number: 1981178
State: Alabama
Issuer: Alabama Supreme Court
Date: December 8, 2000

791 So. 2d 937 (2000)
Margaret LYONS, as the administratrix of the Estate of Kenneth Cook, deceased
v.
WALKER REGIONAL MEDICAL CENTER and Laurie Hunter.
1981178.

Supreme Court of Alabama.
December 8, 2000.
Rehearing Denied February 23, 2001.
*938 Richard S. Jaffe, Stephen A. Strickland, and Cecilee R. Beasley of Jaffe, Strickland, Beasley &amp; Drennan, P.C., Birmingham, for appellant.
Jasper P. Juliano and Dorothy A. Powell of Parsons, Lee &amp; Juliano, P.C., Birmingham, for appellees.
ENGLAND, Justice.
Margaret Lyons, as administratrix of the estate of Kenneth Cook, filed a wrongful-death case against Walker Regional Medical Center and Laurie Hunter, a registered *939 nurse employed by Walker Regional. Walker Regional and Hunter moved for a summary judgment. Initially, the trialcourt denied their motion. Walker Regional and Hunter asked the court again to grant their motion, and the court did. Lyons moved to alter, amend, or vacate the summary judgment, but the court denied her motion. Lyons appealed from the defendants' summary judgment. We reverse and remand.
In order to enter a summary judgment, the trial court must determine (1) that there is no genuine issue of material fact and (2) that the moving party is entitled to a judgment as a matter of law. Rule 56, Ala.R.Civ.P. In order to defeat a defendant's properly supported motion for summary judgment, the plaintiff must present "substantial evidence," i.e., "evidence of such weight and quality that fairminded persons in the exercise of impartial judgment can reasonably infer the existence of the fact sought to be proved." West v. Founders Life Assurance Co. of Florida, 547 So. 2d 870, 871 (Ala.1989). In determining whether a summary judgment was properly entered, the reviewing court must view the evidence in a light most favorable to the nonmovant. Long v. Jefferson County, 623 So. 2d 1130, 1132 (Ala. 1993).
The trial court recited the following undisputed facts in its initial "Memorandum Opinion and Order" denying the defendants' motion for summary judgment:
To maintain a medical-malpractice action, the plaintiff ordinarily must present expert testimony from a "similarly situated health-care provider" as to (1) "the appropriate standard of care," (2) a "deviation from that standard [of care]," and (3) "a proximate causal connection between the [defendant's] act or omission constituting the breach and the injury sustained by the plaintiff." Pruitt v. Zeiger, 590 So. 2d 236, 238 (Ala.1991) (quoting Bradford v. McGee, 534 So. 2d 1076, 1079 (Ala.1988)). The reason for the rule that proximate causation must be established through expert testimony is that the issue of causation in a medical-malpractice case is ordinarily "beyond `the ken of the average layman.'" Golden v. Stein, 670 So. 2d 904, 907 (Ala.1995), quoting Charles W. Gamble, McElroy's Alabama Evidence, § 127.01(5)(c), p. 333 (4th ed.1991). The plaintiff must prove through expert testimony "that the alleged negligence `probably caused the injury.'" McAfee v. Baptist Med. Ctr., 641 So. 2d 265, 267 (Ala. 1994).
The trial court initially denied the defendants' motion for summary judgment, holding that the evidence created a genuine issue of fact as to the issue of causation. The defendants moved the court to "reconsider" that denial, arguing, as they do on appeal, that Shanes v. Kiser, 729 So. 2d 319 (Ala.1999), supports their theory that Lyons was required to present the testimony of an expert witness on the question whether the defendants' alleged breach of the standard of care had proximately caused Cook's death. The trial court held, on its reconsideration of the denial, that, based on our holding in Shanes, Lyons could not carry her burden of proving that the defendants' alleged breach had proximately caused Cook's death. We disagree.
The defendants' reliance on Shanes is misplaced. In Shanes, the plaintiff's decedent sought emergency treatment for pain in her chest and upper abdomen that radiated to her back. She reported that she did not have a history of heart disease and that she had experienced the symptoms some years earlier. The plaintiff alleged, among other things, that the doctor should have consulted a cardiologist and should have performed other tests that might have revealed the onset of a heart attack. We held that the doctor could not be found to have breached the standard of care, given the uncertainty as to what had caused the decedent's death. Although the medical expert testified, based on statistical probabilities and the decedent's medical history and symptoms, that the death was heart-related, both the medical expert and the doctor who had treated the decedent identified at least three conditions with overlapping symptoms that were not heart-related and that could have resulted in sudden death. Id. at 322.
In this present case, Dr. Joseph Embry, a medical examiner with the Alabama Department of Forensic Sciences, stated in his affidavit that it is his professional opinion, within a degree of medical certainty, that Cook died of ketoacidosis due to diabetes mellitus. He also concluded, based upon the autopsy he did on Cook's body, that "no other injuries or natural disease processes caused or contributed to cause his death." Thus, unlike the Shanes case, this case presents little, if any, uncertainty in the record regarding the cause of death.
Lyons presented substantial evidence supporting her claim against Walker Regional and Hunter: (1) She offered expert testimony from a similarly situated health-care *943 provider regarding the appropriate standard of care, (2) she presented evidence indicating that the defendants had deviated from that standard of care; and (3) she demonstrated a proximate causal connection between Cook's death and the defendants' omission constituting the breach.
Lyons offered the expert testimony of Deborah Calhoun and Susan Atkinson to establish negligence. Calhoun and Atkinson are both registered nurses and work in an emergency room. Calhoun and Atkinson both testified that Walker Regional and Hunter had failed to provide Cook with the professional medical services, care, and treatment that similar medical providers within the medical community possessing and exercising ordinary and reasonable medical knowledge and skills would have provided. Cook's laboratory results stated "PANIC VALUES EXCEEDED." Atkinson testified that Hunter's failure to follow up on, and to report, the panic values was a breach of the standard of care.
Dr. Marshall Boone, Jr., the doctor on call at Walker Regional the night Cook died, testified in his deposition that he had treated similar cases of ketoacidosis. He testified that if Cook had been at the hospital (when they discovered that he had ketoacidosis), then he, Dr. Boone, would have placed Cook on IVs to try to get his blood sugars to normal levels. He testified that he would have stabilized Cook's condition and would have put him on a regimen to control his blood sugar. Dr. Boone also testified that, within a reasonable degree of medical certainty, he thought Cook would have survived if he (Dr. Boone) had treated him. Dr. Boone further testified in his deposition:
(R. 484-93.)
The record suggests that the hospital did not follow its procedures when the results of the electrolytes test were not recorded on the front of Kenneth Cook's chart. Dr. Boone's testimony suggests that the results of the electrolytes test were critical in assessing Cook's ailment. According to Dr. Boone, the results of the electrolytes test could have been used to save Cook's life. Whether Cook would have acquiesced to the treatment that would have been necessary to save his life is pure speculation and, more important, is immaterial to the question whether the defendants' alleged breach of the standard of care proximately caused Cook's death.
The defendants also argue that even if they were negligent, they are still not liable because Cook, they say, was contributorily negligent. We do not agree. "In order to prove contributory negligence, the defendant must show that the party charged: (1) had knowledge of the condition; (2) had an appreciation of the danger under the surrounding circumstances; and (3) failed to exercise reasonable care, by placing himself in the way of danger." Brown v. Piggly-Wiggly Stores, 454 So. 2d 1370, 1372 (Ala.1984) (citing Hatton v. Chem-Haulers, Inc., 393 So. 2d 950 (Ala. 1980); and Baptist Med. Ctr. v. Byars, 289 Ala. 713, 271 So. 2d 847 (1972)). The record shows that Cook was never informed of his life-threatening condition. It is questionable whether a blanket statement that "you could die" would have been enough to make him appreciate the danger of his condition, which even the defendants were unaware of until the laboratory results came back. Furthermore, Cook's cellmate testified by affidavit, in part, as follows:
His cellmate testified further that Cook tried to return to the hospital after the initial visit. Thus, the record does not support a summary judgment based on a contributory-negligence defense.
The burden was on the defendants to make a prima facie showing, by substantial evidence, that no genuine issue of material fact existed. They did not carry their *945 burden. Consequently, we reverse the summary judgment entered in favor of Walker Regional and Hunter and remand this case for proceedings consistent with this opinion.
REVERSED AND REMANDED.
HOOPER, C.J., and MADDOX, HOUSTON, BROWN, and JOHNSTONE, JJ., concur.