Opinion ID: 1104158
Heading Depth: 1
Heading Rank: 2

Heading: The Defendants' Expert Witness

Text: The plaintiffs objected to the testimony of Dr. William R. Higgs, an expert proffered by the defendants, on the grounds that he did not qualify as a similarly situated health care provider within the meaning of the Alabama Medical Liability Act of 1987. The plaintiffs, citing Ala.Code 1975, § 6-5-548(c), contend that because Dr. Rich is a board certified cardiologist, Dr. Higgs also must be a board certified cardiologist in order to testify regarding the standard of care. The Alabama Medical Liability Act of 1987, Ala.Code 1975, § 6-5-540 et seq., governs this action against Dr. Rich, because he is a health care provider as defined in § 6-5-481(8) and § 6-5-542(1). Dowdy v. Lewis, 612 So.2d 1149 (Ala.1992). Under § 6-5-481(8), in order to hold Dr. Rich liable for Mrs. Olsen's injuries, the plaintiffs must prove by substantial evidence that Dr. Rich 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. Dowdy, 612 So.2d at 1151. In Medlin v. Crosby, 583 So.2d 1290 (Ala. 1991), this Court stated: Our interpretation of the statute leads us to conclude that the trial court must answer three questions before deciding whether a proffered expert witness qualifies as a `similarly situated health care provider' within the meaning of the statute: (1) What is the standard of care alleged to have been breached? (2) Is the defendant `health care provider' a specialist in the discipline or school or practice of the standard of care that the court has previously determined is alleged to have been breached? (3) Does the proffered expert witness qualify as a `similarly situated health care provider' under the subsection determined in the second step to apply? This three-question test requires that the trial court first determine the field of medical practice in which the negligence is alleged to have occurred, in order to properly classify the defendant health care provider as a specialist or as one who is not a specialist. If the defendant health care provider is a specialist, then § 6-5-548(c) will dictate what requirements the proffered expert witness must meet before testifying regarding whether the defendant breached the standard of care. However, if the defendant health care provider is not a specialist, then the witness must meet the requirements of § 6-5-548(b). Therefore, we first determine what standard of care applies in this case. The plaintiffs allege that Dr. Rich failed to appropriately assess Mrs. Olsen's complaints of pain, inspect the injection site, and discontinue the medications. Specifically, the plaintiffs alleged that the Hep-lock device was negligently placed into an artery, so that it provided what is called an intra-arterial injection, instead of being placed into a vein. The plaintiffs argue that this placement constituted negligence; that this negligence caused Mrs. Olsen tremendous pain; that Dr. Rich and his assisting nurses failed to identify the swelling and redness around the injection; and that they failed to correctly respond to her complaints of pain during the administration of the medications. The plaintiffs objected to the following testimony by Dr. Higgs regarding the injury to Mrs. Olsen's hand: Q: Doctor, if this had been an intra-arterial injection, would we have seen this result? A: No. Q: When the pressure was relieved, the circulation returned; correct? A: That's correct. That's how that tourniquet works. Q: Doctor, in your practice you are familiar with the use of Hep-locks and IVs; correct? A: Yes. Q: Doctor, I want you to assume that Mrs. Olsen complained of right-hand pain as reflected in the record at 11:01. Do you have an opinion as to whether Dr. Rich was acting within the standard of care in having a nurse check the IV site at that time? R.T. at 431. At this point the plaintiffs' counsel objected to Dr. Higgs's testifying regarding the standard of care, pointing out that Dr. Higgs was not a board certified cardiologist. Defense counsel argued to the trial judge that Dr. Higgs's testimony regarded Hep-lock devices and IVs, which counsel argued were directly within the field of Dr. Higgs's particular specialties. The trial court admitted the testimony regarding Dr. Rich's standard of care regarding the Hep-lock device and the IV site. It is important to note that the plaintiffs did not allege negligence regarding the actual catheterization procedure and that Dr. Higgs did not attempt to testify regarding the standard of care applicable to a heart catheterization. Therefore, we conclude that the standard of care applicable in this case is that of a health care provider intravenously administering medications during a medical procedure. Medlin v. Crosby, supra . Having determined the standard of care to be applied, we must determine whether the defendant health care provider, Dr. Rich, is a specialist, in the practice of intravenous administration of medications (see § 6-5-548(c)) or is not a specialist (see § 6-5-548(b)). This Court has held that a defendant health care provider, to be a specialist, must meet all three of the requirements in subsection (c): (1) board certification as a specialist in the medical field involved in the case; (2) training and experience in that field; and (3) holding himself out as a specialist in that field. Medlin, 583 So.2d at 1296. It is clear that Dr. Rich meets all the requirements in subsection (c) to qualify as a cardiac specialist. Dr. Rich is a board certified cardiologist, he did a cardiology residency at hospitals affiliated with Emory University, and he has been practicing in the field of cardiology since 1975. Presently, Dr. Rich practices with five other doctors at the Mobile Heart Center as a cardiologist, and he performs an estimated 500 heart catheterizations a year. He is also a member of the American College of Cardiology. Therefore, if the alleged negligence had occurred in the actual catheterization procedure, it is clear that § 6-5-548(c) would apply. However, cardiology is not the medical field in which the negligence is alleged to have occurred. As explained above, the alleged breach of the standard of care occurred while Dr. Rich was intravenously administering medication. This Court has held that, for purposes of determining whether a `health care provider' is a `specialist,' ... the trial court should look to whether the defendant `health care provider' is board certified in the specialty or discipline or school of practice that covers the area of the alleged breach. Medlin, 583 So.2d at 1294 (emphasis added). See also Rodgers v. Adams, 657 So.2d 838 (Ala.1995). The appropriate focus is on whether Dr. Rich is board certified in the area of the alleged breach. Dr. Rich is not board certified in pulmonary or vascular medicine, which would specifically include intravenous injections and injury to veins, arteries, or blood vessels. Because all three requirements of subsection (c) are not met, we must conclude that in this case Dr. Rich is not to be considered a specialist for the purposes of § 6-5-548(c). Because in the practice out of which the negligence is alleged to have arisen, Dr. Rich was not acting as a specialist within the meaning of § 6-5-548(c), the question whether the expert proffered to testify as to Dr. Higgs's standard of care is a similarly situated health care provider must be determined by applying § 6-5-548(b). Section 6-5-548(b) defines a similarly situated health care provider as one who: (1) Is licensed by the appropriate regulatory board or agency of this or some other state; and (2) Is trained and experienced in the same discipline or school of practice; and (3) Has practiced in the same discipline or school of practice during the year preceding the date that the alleged breach of the standard occurred. Dr. Higgs, the health care provider permitted to testify on behalf of the defendants, is a vascular, cardiac, pulmonary, and esophageal surgeon. He graduated from Louisiana Tech University with a degree in zoology and chemistry. He then received a medical degree from Baylor College of Medicine. Dr. Higgs did his internship at a Memphis hospital and served residencies in Houston and Atlanta. His residencies were in general and vascular surgery, and in pulmonary work. He is on the staff of Mobile Infirmary, Providence Hospital, and Springhill Hospital, and is on the consulting staff at the University of South Alabama Hospital. Dr. Higgs has been a clinical professor of surgery at the University of South Alabama since 1976. He has been in private practice with three other doctors since 1976. Dr. Higgs testified that in his medical practice his speciality consisted of conducting vascular, cardiac, pulmonary, and esophageal surgery, and he testified that he occasionally puts in pacemakers. He testified that doing vascular surgeries required working with injuries to, and/or complications with, veins, arteries, and blood vessels. Dr. Higgs further testified that the cardiac medical treatment and/or surgeries that he conducts are often performed in response to cardiac catheterization results. Dr. Higgs explained that because his speciality was working with veins, arteries, and blood vessels, he was often called upon for assistance or advice during catheterization procedures. He stated that he was in catheterization labs frequently. As mentioned earlier, dealing with Hep-lock devices and IV sites is an integral part of Dr. Higgs's daily practice. He testified that on the the day before the trial he had treated a patient with the exact complications as Mrs. Olsen. The record indicates that Dr. Rich sought Dr. Higgs's medical advice after realizing that Mrs. Olsen's right arm and hand had been injured during the heart catheterization procedure. Dr. Higgs is at least as qualified in the area of the alleged negligence as Dr. Rich, the defendant health care provider. Accordingly, Dr. Higgs met the § 6-5-548(b) definition of a similarly situated health care provider. The trial court properly allowed Dr. Higgs to testify. AFFIRMED. MADDOX, ALMON, SHORES, KENNEDY, INGRAM and BUTTS, JJ., concur. COOK, J., concurs in the result.