Opinion ID: 1697418
Heading Depth: 1
Heading Rank: 2

Heading: Pleading and Procedural Considerations

Text: In determining whether the summary judgment for Dr. Howorth was proper, we must consider the interplay of several applicable rules of pleading and procedure, some of which are peculiar to medical-malpractice actions. Under Rule 8, Ala. R. Civ. P., a complaint is sufficient if it puts the defendant on notice of the claims against him; however, the rule of generalized notice pleading may be qualified by rule or statute. Bethel v. Thorn, 757 So.2d 1154, 1158 (Ala.1999). Section 6-5-551, Code of Ala.1975, provides that in any medical-malpractice action, [t]he plaintiff shall include in the complaint filed in the action a detailed specification and factual description of each act and omission alleged by plaintiff to render the health care provider liable to plaintiff. The plaintiff is prohibited from introducing at trial evidence of any other act or omission. Substantial evidence is defined in the medical-malpractice context as that character of admissible evidence which would convince an unprejudiced thinking mind of the truth of the fact to which the evidence is directed. § 6-5-542(5). Rule 56, Ala. R. Civ. P., governing motions for summary judgment, must be read in conjunction with that definition of substantial evidence. Golden v. Stein, 670 So.2d 904, 907 (Ala.1995). This Court's review of a summary judgment in a medical-malpractice case, as in other cases, is guided by the proposition that this Court must review the record in a light most favorable to the nonmovant and must resolve all reasonable doubts against the movant. Hobson v. American Cast Iron Pipe Co., 690 So.2d 341, 344 (Ala.1997), quoted in Hauseman v. University of Alabama Health Servs. Found., 793 So.2d 730, 734 (Ala.2000). If the movant in a medical-malpractice case makes a prima facie showing that there is no genuine issue of material fact, then, as in other civil cases, the burden shifts to the nonmovant to present substantial evidence creating such an issue. Ex parte Elba Gen. Hosp. & Nursing Home, Inc., 828 So.2d 308, 311 (Ala.2001). 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.'  Lyons v. Walker Reg'l Med. Ctr., 791 So.2d 937, 942 (Ala.2000)(bracketed language original). [A] medical malpractice plaintiff must produce substantial evidence that `the alleged negligence probably caused the [complained of] injury,' in order to survive a summary judgment motion, if the defendant has made a prima facie showing that no genuine issue of material fact exists as to the issue of causation. Golden, 670 So.2d at 907. `To present a jury question, the plaintiff [in a medical-malpractice action] must adduce some evidence indicating that the alleged negligence (the breach of the appropriate standard of care) probably caused the injury. A mere possibility is insufficient. The evidence produced by the plaintiff must have selective application to one theory of causation.' Rivard v. University of Alabama Health Servs. Found., P.C., 835 So.2d 987, 988 (Ala.2002). In most medical-malpractice cases, the element of proximate cause, i.e., that the breach of the standard of care probably caused the ensuing injury, must be established by expert testimony. Golden, 670 So.2d at 907. However, as recently discussed by this Court in Ex parte HealthSouth Corp., 851 So.2d 33, 44 (Ala.2002), there exists an exception to that requirement where 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 without expert testimony to assist in that determination.