Opinion ID: 1853969
Heading Depth: 1
Heading Rank: 2

Heading: jml

Text: In reviewing a ruling on a motion for a JML, this Court views the evidence in the light most favorable to the nonmovant and entertains such reasonable inferences from that evidence as the jury would have been free to draw. Daniels v. East Alabama Paving, Inc., 740 So.2d 1033, 1037 (Ala.1999). The denial of a defendant's motion for a JML is proper only when the plaintiff has presented substantial evidence to support each element of the plaintiff's claim. Kmart Corp. v. Bassett, 769 So.2d 282, 284 (Ala.2000). `Substantial evidence' is `evidence of such weight and quality that fair-minded persons in the exercise of impartial judgment can reasonably infer the existence of the fact sought to be proved.' Id. (quoting West v. Founders Life Assurance Co. of Florida, 547 So.2d 870, 871 (Ala.1989)). [T]he opinions of an expert witness may not rest on `mere speculation and conjecture.' . . . However, a theory of causation is not mere conjecture, when it is deducible as a reasonable inference from `known facts or conditions.' Dixon v. Board of Water & Sewer Comm'rs of Mobile, 865 So.2d 1161, 1166 (Ala.2003). `[I]f there is evidence which points to any one theory of causation, indicating a logical sequence of cause and effect, then there is a judicial basis for such a determination, notwithstanding the existence of other plausible theories with or without support in the evidence.' Id. (quoting Griffin Lumber Co. v. Harper, 247 Ala. 616, 621, 25 So.2d 505, 509 (1946), quoting in turn Southern Ry. v. Dickson, 211 Ala. 481, 486, 100 So. 665, 669 (1924)). As articulated by Mobile Central, the Wades' theory of causation is that excessive force was placed upon Daniel during the external-version attempts, resulting in direct head trauma [and a primary] subarachnoid hemorrhage (PSH). According to this theory, the PSH caused, or contributed to, massive brain damage, eventually leading to the cerebral palsy and to Daniel's consequent death. Although both Mobile Central and the Hospital challenge the sufficiency of evidence of causation, the Hospital concedes that the testimony of Dr. Paul Maertens, one of the Wades' experts, created an otherwise missing causal link between the version attempts and [the] brain injury, the Hospital's brief, at 82, and effectively connected the versions to the injury. Id. at 18. In that connection, Dr. Maertens testified as follows: Q. [By the Wades' counsel:] Doctor, what are the causes of a subarachnoid hemorrhageprimary subarachnoid hemorrhage? A. [By Dr. Maertens:] A subarachnoid hemorrhage basically [is] caused by any rupture of the bridging veins, and we showed you that those bridging veins are small little vessels that cross the subarachnoid space between the brain and the dura. [4] And those veins could be ruptured by some external force or some rotary forceG-forceany G-force on those veins could rupture them. . . . . . . . Q. Dr. Maertens, could you assume for me that Daniel Wade did not experience any force or trauma placed on his . . . head up until the time that he goes into the delivery; in other words, in his labor there is no force on his head, there is no trauma that he has experienced. Would you assume for me that after Daniel was born, he goes to the nursery room, there is no force or trauma put on his head. If you assume further for me that as Dr. Long says that when he brought Daniel out in the breech, it was easy and there was no trauma or just an easy slipped him out of the birth canal. If you assume further for me that Dr. Long and two nurses put force on Angela Wade's abdomen for what she has testified . . . seemed like a long time to her, and that force was sufficient to cause her extreme pain, do you have an opinion based upon a reasonable degree of medical probability as to the cause of Daniel's primary subarachnoid hemorrhage? . . . . Do you have an opinion as to whether it happened as a result of the force placed on him during the rotational maneuver? . . . . [The court:] Now, he is asking you, based on these things, is this so, and the answer is either yes or no. A. [Dr. Maertens:] Okay, yes. (Emphasis added.) The defendants argue that the Wades' evidence did not explain the mechanism by which the alleged PSH occurred. Mobile Central's brief, at 78-79. They contend that Dr. Maertens did not explain how hand pressure that was not sufficient to rupture the amniotic sac or to leave a mark of any kind on the mother or the baby, could . . . cause[ ] a bleed underneath the fetal skull in the subarachnoid space. Mobile Central's brief, at 79 (emphasis in original). However, the Wades also presented the testimony of Dr. Larry Griffin, who opined that Dr. Long had used excessive force in the attempted versions. He based that view, in part, on the fact that there were at least five hands . . . putting pressure on the abdomen, only two of which [were] controlled by any one person at any one time, and no one [could] know what the other force from anyone else [was] doing. He stated: That is a lot of potential force that cannot be controlled by the person who is supposed to be in control of this situation, that is, the operating doctor. (Emphasis added.) He testified that babies occasionally suffer soft-tissue injuries and traumatic fractures, including fractures of the cervical spine, during attempted external versions. He testified that, in attempting an external version, you can certainly injure the head. (Emphasis added.) Debbie Burroughs, a registered nurse, testified that it was a breach of the standard of care for a nurse to apply pressure to an abdomen [during a version attempt], whether she uses a transducer or her hand. (Emphasis added.) The Wades also presented the testimony of Dr. Daniel Strickland, who found very strong evidence of external trauma at birth, and testified that direct pressure to the head during the version attempts caused a PSH. He also stated that the amniotic sac resists rupture, because, [i]n most cases, it is very strong. Based on this testimony, it is deducible as a reasonable inference, Dixon, 865 So.2d at 1166, that the simultaneous use of five hands to attempt the external version of Daniel Wade probably resulted in direct head trauma [and a PSH]. Consequently, the Wades have presented substantial evidence of causation, and the defendants have not demonstrated that they were entitled to a JML on the Wades' claims alleging that excessive force was used in the attempted version.