Court Opinion

ID: 9912431
Source: CourtListenerOpinion
Date Created: 2023-12-22 15:01:54.628615+00
Date Added: 2024-06-11T12:59:18.632355
License: Public Domain

Rel: December 22, 2023

Notice: This opinion is subject to formal revision before publication in the advance sheets of Southern Reporter.
Readers are requested to notify the Reporter of Decisions, Alabama Appellate Courts, 300 Dexter Avenue,
Montgomery, Alabama 36104-3741 ((334) 229-0650), of any typographical or other errors, in order that corrections
may be made before the opinion is printed in Southern Reporter.

   SUPREME COURT OF ALABAMA
                               OCTOBER TERM, 2023-2024

                                   _________________________

                                         SC-2023-0289
                                   _________________________

                       Ex parte McKesson Corporation et al.

                      PETITION FOR WRIT OF MANDAMUS

                (In re: Fort Payne Hospital Corporation et al.

                                                      v.

                              McKesson Corporation et al.)

                      (Conecuh Circuit Court: CV-21-900016)

PER CURIAM.

        The petitioners -- McKesson Corporation, AmerisourceBergen Drug

Corporation, Cardinal Health, Inc., H.D. Smith, LLC, and Henry Schein,

Inc. -- petition this Court for a writ of mandamus directing the Conecuh
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Circuit Court to vacate its March 20, 2023, order denying their motion to

dismiss the claims asserted against them by the plaintiffs -- Fort Payne

Hospital Corporation, the Bibb County Healthcare Authority, the Dale

County Health Care Authority, Greene County Hospital Board, Jackson

Hospital & Clinic, Inc., Escambia County Alabama Community

Hospitals, Inc., Mizell Memorial Hospital, Inc., the Tombigbee Health

Care Authority, Geneva County Health Care Authority, Community

Hospital, Inc., the Sylacauga Health Care Authority, Russellville

Hospital, Inc., Lakeland Community Hospital, Inc., Monroe County

Healthcare Authority, Infirmary Health Hospitals, Inc., Gulf Health

Hospitals, Inc., Mobile Infirmary Association, the DCH Health Care

Authority, the Healthcare Authority for Baptist Health, Medical West

Hospital Authority, Evergreen Medical Center, LLC, Gilliard Health

Services, Inc., Crestwood Healthcare, L.P., Triad of Alabama, LLC, QHG

of Enterprise, Inc., Affinity Hospital, LLC, Gadsden Regional Medical

Center, LLC, Foley Hospital Corporation, the Health Care Authority of

Clarke County, BBH PBMC, LLC, BBH WBMC, LLC, BBH SBMC, LLC,

BBH CBMC, LLC, and BBH BMC, LLC -- and to enter an order

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dismissing the plaintiffs' claims with prejudice on the ground that those

claims are barred by the applicable statutes of limitations.

                      Facts and Procedural History

           "Because this petition concerns a motion to dismiss
     under Rule 12(b)(6), Ala. R. Civ. P., the facts in the complaint
     constitute the only operative facts for our review of the
     petition. See, e.g., Ex parte Alabama Dep't of Youth Servs.,
     880 So. 2d 393, 397 (Ala. 2003) ('Inasmuch as the issue before
     us is whether the trial court correctly denied a Rule 12(b)(6),
     Ala. R. Civ. P., motion to dismiss, "[t]his Court must accept
     the allegations of the complaint as true." ' (quoting Creola
     Land Dev., Inc. v. Bentbrooke Hous., L.L.C., 828 So. 2d 285,
     288 (Ala. 2002)))."

Ex parte Abbott Lab'ys, 342 So. 3d 186, 188 (Ala. 2021) (footnote omitted).

     The plaintiffs are 34 entities that own or operate hospitals in

Alabama. On March 26, 2021, the plaintiffs commenced this action in

the Conecuh Circuit Court against various manufacturers of prescription

opioids ("the manufacturing defendants"), various distributors of

prescription opioids ("the distributor defendants"), and various retail

pharmacies ("the pharmacy defendants") (collectively referred to as "the

defendants"). The distributor defendants included AmerisourceBergen

Drug Corporation, Anda, Inc., Cardinal Health, Inc., H.D. Smith, LLC,

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Henry Schein, Inc., and McKesson Corporation.1             In their initial

complaint, the plaintiffs alleged, in pertinent part:

            "1. Plaintiffs operate hospitals that provide acute care
     throughout Alabama including treatment for opioid-
     dependent patients suffering from opioid-related conditions.
     These patients routinely seek services at Plaintiffs'
     emergency rooms and occupy beds in the Plaintiffs' Hospitals.
     Hospitals are legally and morally compelled to act and treat
     all of these patients, regardless of the price.

           "2. Defendants are the manufacturers, distributors, and
     dispensers of prescription opioids. By flooding Plaintiffs'
     communities with opioids, by pushing false narratives
     surrounding the safety of opioids, and by failing to take steps
     to prevent diversion of opioids, they have created an epidemic
     of misuse, abuse, addiction, and death."

(Footnote omitted.) The plaintiffs also alleged that "[t]he average cost of

providing care for patients diagnosed with opioid use disorder is eight

times higher than for those without opioid use disorder"; that those

patients must still be provided with complete care; and that "private and

government insurance does not cover these increased costs." (Footnote

omitted.) In their initial complaint, the plaintiffs further alleged that the

opioid pandemic constituted a continuous and abatable public nuisance.

     1Although Anda was initially a party to this mandamus petition, it

filed a motion to withdraw as a petitioner on July 11, 2023. On July 19,
2023, this Court granted Anda's motion. Therefore, we have omitted any
specific allegations relating to Anda.
                                     4
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The plaintiffs stated claims of negligence, wantonness, public nuisance,

unjust enrichment, fraud and deceit, and civil conspiracy.

     On September 8, 2022, the pharmacy defendants filed a motion to

dismiss the plaintiffs' claims against them pursuant to Rule 12(b)(6), Ala.

R. Civ. P., which the trial court denied.     The pharmacy defendants

subsequently filed a petition for a writ of mandamus in this Court, which

was docketed as case number 1210329. This Court ordered answers and

briefs. However, the plaintiffs subsequently filed a motion to dismiss the

pharmacy defendants' petition as moot. In their motion to dismiss, they

asserted that they had filed a motion to dismiss their claims against the

pharmacy defendants and that the trial court had granted that motion.

On April 26, 2022, this Court granted the plaintiffs' motion and dismissed

the petition in case number 1210329.

     On September 27, 2022, the plaintiffs filed their amended

complaint against the manufacturing defendants and the distributor

defendants (collectively referred to as "the remaining defendants"). In

their amended petition, the plaintiffs restated the allegations quoted

above from the initial complaint and alleged that the actions of the

remaining defendants had created an opioid epidemic and that, "[in]

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addition to the cost of the opioid drugs themselves, the opioid epidemic

has caused hospitals to incur and continue to suffer an extensive

operational impact on their ability to do their jobs -- rendering care to all

members of the communities they serve." In their amended complaint,

they stated claims of negligence, wantonness, public nuisance, unjust

enrichment, fraud and deceit, and civil conspiracy against the remaining

defendants. In the section of the amended complaint setting forth the

parties, the plaintiffs included the following factual allegations regarding

the distributor defendants:

                 "2. Distributor Defendants

           "107. The Distributor Defendants are described below.
     At all relevant times, the Distributor Defendants have
     distributed, supplied, sold, and placed into the stream of
     commerce prescription opioids, without fulfilling the
     fundamental duty of wholesale drug distributors to detect and
     prevent diversion of dangerous drugs for non-medical
     purposes. The Distributor Defendants universally failed to
     comply with Alabama law, under which they are 'wholesaler
     distributors.'   Plaintiffs allege that the Distributor
     Defendants' unlawful conduct is a substantial cause of the
     volume of prescription opioids plaguing Plaintiffs'
     communities.

                 "a. AmerisourceBergen

           "108. Defendant AmerisourceBergen Drug Corporation
     (“AmerisourceBergen”) is a Delaware corporation with its
     principal place of business in Chesterbrook, Pennsylvania.
                                     6
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         "109. AmerisourceBergen is a wholesaler of
    pharmaceutical drugs and distributes opioids throughout the
    country, including in Alabama. AmerisourceBergen is the
    eleventh largest company by revenue in the United States,
    with annual revenue of $147 billion in 2016.

          "110. According to its 2016 annual report,
    AmerisourceBergen is 'one of the largest global
    pharmaceutical sourcing and distribution services companies,
    helping both healthcare providers and pharmaceutical and
    biotech manufacturers improve patient access to products and
    enhance patient care.'

          "111. Between 2006 and 2014, AmerisourceBergen
    distributed the second highest number of hydrocodone and
    oxycodone pills into Alabama and into Conecuh County. It
    distributed 282,139,350 pills into the state, 2,982,040 of which
    went to Conecuh County. Although the ARCOS [Automated
    Reports and Consolidated Ordering System] data from which
    this information is drawn has only been made publicly
    available through 2014, AmerisourceBergen continues to
    distribute prescription opioids into Alabama to the present
    day.

          "112. AmerisourceBergen currently holds a Wholesale
    Distributor license from the Alabama Board of Pharmacy as
    well as a license to distribute controlled substances in
    Alabama. It continues to use this license to distribute
    pharmaceuticals, including controlled substances, into
    Alabama.

          "113.   As     described     in     this    complaint,
    AmerisourceBergen has had multiple instances in which it
    has inappropriately distributed controlled substances. From
    this pattern of instances, it can be inferred that
    AmerisourceBergen's policies and procedures have failed to
    adapt and change in order to prevent the future diversion of
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    prescription opioids. On that basis, Plaintiffs allege on
    information and belief that AmerisourceBergen continues to
    operate in ways that enable the diversion of prescription
    opioids.

          "114. On July 26, 2021, [AmerisourceBergen] paid a
    $5,000 fine to the Alabama Board of Pharmacy for violations
    arising out of its 2019 conduct in Florida of distributing
    prescription drugs, including controlled substances, without a
    proper license to do so.

          "115. [AmerisourceBergen] continues to make false or
    misleading statements about its involvement in the
    promotion of prescription opioids and its contribution to the
    ongoing opioid epidemic. [AmerisourceBergen] falsely claims
    on its website that it 'take[s] no action whatsoever to promote
    prescribing or otherwise increase demand for opioids.'

               "….

               "c. Cardinal

         "121. Defendant Cardinal Health, Inc. ('Cardinal') is an
    Ohio corporation with its principal place of business in
    Dublin, Ohio.   In 2016, Cardinal generated revenues of
    $121.5 billion.

          "122. Cardinal is a global distributor of pharmaceutical
    drugs and medical products. It is one of the largest
    distributors of opioids in the United States. From 2006 to
    2014, Cardinal was the third largest distributor of opioids in
    Alabama.

         "123. In December 2013, Cardinal formed a ten-year
    agreement with CVS Caremark to form the largest generic
    drug sourcing operation in the United States.

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          "124. Cardinal currently holds a Wholesale Distributor
    license from the Alabama Board of Pharmacy as well as a
    license to distribute controlled substances in Alabama. It
    continues to use this license to distribute pharmaceuticals,
    including controlled substances, into Alabama.

          "125. As described in this complaint, Cardinal has had
    multiple instances in which it has inappropriately distributed
    controlled substances. From this pattern of instances, it can
    be inferred that Cardinal's policies and procedures have failed
    to adapt and change in order to prevent the future diversion
    of prescriptive opioids. On that basis, Plaintiffs allege on
    information and belief that Cardinal continues to operate in
    ways that enable the diversion of prescription opioids.

               "d. H.D. Smith

          "126. Defendant H.D. Smith, LLC f/k/a H.D. Smith
    Wholesale Drug Co. ('H.D. Smith') through its various DEA
    [Drug Enforcement Administration]-registered subsidiaries
    and affiliated entities, is a wholesaler of pharmaceutical
    drugs that distributes opioids throughout the United States,
    including in Alabama and the communities served by
    Plaintiffs. H.D. Smith is a privately held independent
    pharmaceuticals distributor of wholesale brand, generic, and
    specialty pharmaceuticals and is a Delaware corporation with
    its principal place of business in Illinois. H.D. Smith
    Wholesale Drug Co. has been restructured and is currently
    doing business as H.D. Smith, LLC. H.D. Smith, LLC's sole
    member is H.D. Smith Holdings, LLC, and its sole member is
    H.D. Smith Holding Company, a Delaware corporation with
    its principal place of business in Illinois. H.D. Smith is the
    largest independent wholesaler in the United States. In
    January 2018, Defendant AmerisourceBergen acquired H.D.
    Smith.

          "127. Prior to its acquisition by AmerisourceBergen and
    at least through March 29, 2019, H.D. Smith held a Wholesale
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    Distributor license from the Alabama Board of Pharmacy as
    well as a license to distribute controlled substances in
    Alabama. It used this license to distribute pharmaceuticals,
    including controlled substances, into Alabama.

          "128. In 2016, H.D. Smith entered into a settlement with
    West Virginia, agreeing to pay $3.5 million to resolve an
    action alleging that the company contributed to the state's
    opioid addiction epidemic by negligently distributing opioids.

          "129. H.D. Smith's shipments to West Virginia were so
    extensive that the [United States] House [of Representatives']
    Energy and Commerce Committee wrote to H.D. Smith in
    2018, citing DEA data showing 2008 sales of 1.1 million
    hydrocodone doses to Family Discount Pharmacy in Mount
    Gay-Shamrock, a West Virginia town home to only 1,800
    people. That same year, H.D. Smith sold more than 1.3
    million hydrocodone and oxycodone to a Sav-Rite Pharmacy
    in Kermit, West Virginia, a town with a population of 406.
    Between 2007 and 2008, H.D. Smith also sold 5 million
    hydrocodone pills to pharmacies in Williamson, West
    Virginia, where approximately 3,000 people lived.
    Representatives from both parties were concerned about the
    volume of opioids H.D. Smith was distributing to West
    Virginia: 'Data provided to the committee by the Drug
    Enforcement Administration raises ... questions regarding
    H.D. Smith's efforts to monitor for, and mitigate, controlled
    substance diversion in West Virginia.'

           "130. In 2019, in the MDL [multidistrict-litigation]
    proceeding styled In re: National Prescription Opiate
    Litigation, H.D. Smith and certain other smaller distributors
    filed a motion for summary judgment styled 'Non-RICO Small
    Distributors' Motion for Summary Judgment Based on their
    De Minimis Status (DKT # 1879).' In opposing the motion,
    the factual record presented by the plaintiffs (two Ohio
    municipalities) relating to H.D. Smith consisted of a subset of
    the information enumerated in this Complaint. The MDL
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    court denied the motion for summary judgment as to all of the
    moving defendants, including H.D. Smith.

         "131. H.D. Smith executives were active in industry
    groups such as HDA [the Healthcare Distribution Alliance],
    HDMA      [the   Healthcare  Distribution   Management
    Association], and PCF [the Pain Care Forum] (via HDA's
    membership).

          "132. J. Christopher Smith, while President and COO,
    was an active member of HDMA, serving as Co-Chair of its
    Industry Relations Counsel. Ron Lanton, Government Affairs
    Counsel, was a member of HDMA's Government and Public
    Policy Counsel. Thomas Doyle, Executive Vice President,
    Commercial Solutions, was part of HDMA's Specialty &
    Biotech Distributors Council. Dale Smith, President of H.D.
    Smith, appears to be an active member of HDA. On HDA's
    website, he is identified as HDA Vice Chairman and was
    Chairman and CEO of HAD's Board of Directors and
    Executive Committee (as of Nov. 2015), having also served on
    HDA's Government and Public Policy Council and Industry
    Relations Council. Dale Smith, President of H.D. Smith, was
    Vice Chairman, Chairman, and CEO of HDA's Board of
    Directors and Executive Committee, and also served on
    HDA's Government and Public Policy Council and Industry
    Relations Council.

          "133. When distributing prescription opioids, H.D.
    Smith had a duty to prevent diversion by implementing an
    effective system to detect and halt suspicious orders and by
    conducting regular investigations of current and prospective
    customers. But H.D. Smith's policies and procedures for
    monitoring pharmaceutical orders have long been
    insufficient, which has allowed opioid diversion in Maine for
    an extensive period of time.

         "134. From 2006 to 2008, H.D. Smith's SOM [suspicious-
    order-monitoring] program was manual, rather than
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    automated. H.D. Smith had two undated and little-used
    written policies covering suspicious order monitoring. Few
    employees of H.D. Smith knew these policies existed.

          "135. Starting in 2006, H.D. Smith began working on an
    automated compliance system, but this 'system' was never
    really a viable automated system, just iterations and
    attempts.

         "136. In or around 2008, H.D. Smith began developing a
    computer-based suspicious-order-monitoring program, which
    H.D. Smith called 'CSOMP.' CSOMP had multiple flaws that
    undermined its purpose of detecting and reporting suspicious
    orders.

          "137. First, H.D. Smith's suspicious-order-monitoring
    reports, which might have identified suspicious orders, were
    not reviewed until after the flagged orders had been shipped.

         "138. Second, CSOMP did not consider opioid order
    pattern or frequency. H.D. Smith's SOM program permitted
    automated release of any and all orders by new pharmacies
    during a 90- to 120-day period, allowing them to 'ramp up,'
    even when they exceeded order volume limits.

          "For instance, in a May 21, 2008 internal email, George
    Euson ('Euson'), Director of Corporate Security, wrote to H.D.
    Smith employees regarding CSOMP enhancements: 'You are
    allowed to release all orders that show up in the system for
    new accounts for up to 120 days after the start date listed.
    This will allow ramp up of new accounts.' When opioid orders
    neared threshold limits, the orders were still released without
    further investigation or reporting, allowing the customer to
    build a high-volume-sales 'history.' In fact, in order to avoid
    reporting a suspicious order to the DEA, H.D. Smith would
    notify customers when they approached their threshold
    limits, allowing customers to request threshold increases and
    avoid triggering thresholds. Additionally, those thresholds
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    for reporting were based on the client's prior sales. So, if a
    client spent more, their limit could be reset to that higher
    point.

          "139. Issues with CSOMP requiring modifications and
    fixes to address broken functionality continued until at least
    February 2015. These issues included stopping only one large
    controlled drug order at a time for review, while allowing a
    smaller order for the same customer to be filled while larger
    order was being reviewed; allowing 448 people within H.D.
    Smith to release holds in CSOMP; having a lack of tools to
    detect orders of unusual frequency or pattern; and having
    multiple accounts assigned to one customer or DEA number,
    each of which was assigned thresholds (i.e., 3 accounts; 3x the
    threshold limit for that customer).

        "140. H.D. Smith was aware of deficiencies with its
    SOM, and management deliberately tried to hide this
    knowledge.

          "141. An H.D. Smith employee with responsibilities for
    CSOMP monitoring who resigned in February 2015 explained
    her concerns with H.D. Smith's SOM system in her exit
    interview. At the time of the interview, Lori Kirbach stated
    as a main reason for leaving, 'the company is and has been
    breaking the law for some time.' She did not understand why
    this was being tolerated. Specifically, Ms. Kirbach stated that
    'CSOMP has not been working correctly since OPUS Go Live
    and that no one will listen to them when they bring it up.
    Compliance is releasing orders that they should not be
    releasing.' She added that the 'DEA is about two years behind
    in looking at CSOMP data and it[']s only a matter of time
    before they catch up to us and questions are asked.' Ms.
    Kirbach also added that her manager 'often said not to put
    certain issues (such as the CSOMP issue) in email so in the
    event the company is ever sued and the email is produced'
    other employees could 'deny any knowledge.' She recalled

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    getting her 'ass chewed' by her manager, Tom, for putting
    something in an email that he thought she shouldn't have.

          "142. Other H.D. Smith employees have also admitted
    its SOM program was insufficient. For example, Euson wrote
    an email on September 28, 2007 regarding a list of suspicious
    pharmacies he had circulated internally in February 2006 and
    an updated list of suspicious pharmacies in May 2007. The
    listed pharmacies had been identified as suspicious by other
    wholesalers and the DEA due to 'excess purchases of
    controlled substances.'     Two of the DEA's suspicious
    pharmacies had also been identified by H.D. Smith as one of
    nine pharmacy customers comprising 80% of H.D. Smith's
    Florida distribution of oxycodone. One, Pharmcore, was a
    customer at the time of the February 2006 email. The other,
    Pharmacy Express, was set up as a customer in December
    2006. According to Euson: 'Both have huge and excessive
    amounts of controlled substance purchases.' He continued,
    'We will have a hard time explaining to DEA why after we
    were warned nearly 1 1/2 years ago, we continued to sell
    excessive quantities of CS [controlled substances] to these
    businesses.'

         "143.   Another     H.D.   Smith     employee,  P.J.
    VanderMeersch, Compliance Specialist, wrote in September
    2013 about her serious concerns with H.D. Smith's CSOMP:
    'we are absolutely not compliant with Federal Regulations
    and we know we aren't.'

         "144. As recently as 2014, in a PowerPoint presentation
    regarding Compliance and Security, the Compliance
    Department noted the need to develop CSOMP enhancements
    to meet DEA standards.

         "145. An H.D. Smith employee wrote an email in July
    2014 noting that CSOMP program issues had 'resulted in
    customers receiving products which they were not supposed
    to.' As a result of these shortfalls, H.D. Smith shipped 17
                                 14
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    bottles of oxycodone to one customer who was not supposed to
    be able to order any.

         "146. In or around 2014, H.D. Smith hired a new
    compliance officer and began to create an improved CSOMP
    program that would comply with applicable laws. However,
    before any enhancements went into effect, that new
    compliance officer was terminated in 2016.

         "147. On May 31, 2016, H.D. Smith rehired their former
    Vice President of Compliance.

          "148. At a May 8, 2018 hearing before the House Energy
    and Commerce subcommittee, H.D. Smith refused to take any
    responsibility for the massive amounts of opioids it shipped to
    West Virginia, the state which at the time had the highest
    overdose rate in the United States. At this time, J.
    Christopher Smith, former President and CEO, stated, 'H.D.
    Smith conducted itself responsibly and discharged its
    obligations.'

         "149. The implication that H.D. Smith has effectively
    addressed diversion is false, as H.D. Smith's repeated
    payments to settle diversion-related violations indicate.

         "150. H.D. Smith's public statements misled the public,
    including Plaintiffs, into believing that H.D. Smith was
    taking effective steps to fight the opioid epidemic.

          "151. Although Plaintiffs allege the dates of particular
    enforcement actions and other admissions or evidence of
    failures to prevent diversion, Plaintiffs do not allege that H.D.
    Smith ceased conduct that contributed to the opioid epidemic
    upon the last date of such an action, admission, or evidence.

          "152. The fact that H.D. Smith had a pattern of
    violations resulting in a series of enforcement actions and a
    pattern of conduct evincing a failure to devise effective
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    procedures according with its role as a distributor of
    controlled substances provides grounds to infer that despite
    its promises to improve its policies and procedures so as to
    prevent the diversion of prescriptions opioids (and so
    contributing to the opioid epidemic in Alabama), H.D. Smith
    failed to do so and, in fact, on information and belief,
    continues to operate in ways that enable the diversion of
    prescription opioids.

               "e. Henry Schein

          "153. Defendant Henry Schein, Inc. ('Henry Schein') is
    incorporated in Delaware with its principal place of business
    located in Melville, New York.

         "154. Henry Schein describes its business as providing
    products and services to integrated health systems in the non-
    acute care space and distributes, among other things, branded
    and generic pharmaceuticals to customers that include dental
    practitioners, dental laboratories, animal health practices
    and clinics, office-based medical practitioners, and
    ambulatory surgery centers. Overall, it is the world's largest
    provider of health care products and services to office-based
    dental, animal health, and medical practitioners.

          "155. Henry Schein currently holds a Wholesale
    Distributor license from the Alabama Board of Pharmacy as
    well as a license to distribute controlled substances in
    Alabama. It continues to use this license to distribute
    pharmaceuticals, including controlled substances, into
    Alabama.

          "156. As described in this complaint, Henry Schein has
    had multiple instances in which it has inappropriately
    distributed controlled substances. From this pattern of
    instances, it can be inferred that Henry Schein's policies and
    procedures have failed to adapt and change in order to
    prevent the future diversion of prescription opioids. On that
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    basis, Plaintiffs allege on information and belief that Henry
    Schein continues to operate in ways that enable the diversion
    of prescription opioids.

               "f. McKesson

         "157. Defendant McKesson Corporation ('McKesson') is
    a Delaware corporation with its principal place of business in
    Irving, Texas.

          "158. McKesson is the largest pharmaceutical
    distributor in North America.         McKesson distributes
    approximately one-third of all pharmaceuticals used in North
    America. At all times relevant to this Complaint, McKesson
    distributed prescription opioids throughout the United
    States, including in Alabama.

          "159. From 2006 to 2014, McKesson was the largest
    distributor of oxycodone and hydrocodone in Alabama.
    McKesson continues to distribute products, including
    controlled substances, to customers within the State of
    Alabama. McKesson currently holds an active license from
    the Alabama Board of Pharmacy to distribute controlled
    substances in Alabama.

          "160. In its 2018 annual report, McKesson stated that it
    'partner[s] with [pharmaceutical] manufacturers, providers,
    pharmacies, governments and other organizations in
    healthcare to help provide the right medicines, medical
    products and healthcare services to the right patients at the
    right time, safely and cost-effectively.'

          "161. As described in this complaint, McKesson has had
    multiple instances in which it has inappropriately distributed
    controlled substances. From this pattern of instances, it can
    be inferred that McKesson's policies and procedures have
    failed to adapt and change in order to prevent the future
    diversion of prescription opioids. On that basis, Plaintiffs
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     allege on information and belief that McKesson continues to
     operate in ways that enable the diversion of prescription
     opioids.

          "162. Collectively, McKesson, AmerisourceBergen, and
     Cardinal account for 85% of drug shipments in the United
     States and take in about $400 billion in annual revenue.

          "163. Cardinal, Anda, H.D. Smith, Henry Schein,
     AmerisourceBergen, and McKesson are collectively referred
     to as the 'Distributor Defendants' or the 'Supply Chain
     Defendants.' "

(Emphasis added; footnotes omitted.)

     Additionally, in their factual allegations, the plaintiffs asserted

that the distributor defendants "have and have breached duties to guard

against, prevent, and report suspicious orders and unlawful diversion" of

opioids. They also asserted that the distributor defendants have "worked

together to achieve their common purpose through trade or other

organizations, such as the Pain Care Forum and the Healthcare

Distribution Alliance."    They further asserted that the distributor

defendants "were aware of and have acknowledged their obligations to

prevent diversion and report and take steps to halt suspicious orders";

that the distributor defendants "kept careful track of prescribing data

and knew about suspicious orders and prescribers"; and that the

distributor defendants "failed to report suspicious orders or otherwise act
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to prevent diversion."    After discussing conduct that goes back many

years, the plaintiffs stated:

          "876. Defendants have admitted to disregarding their
     duties. They have admitted that they pumped massive
     quantities of opioids into communities around the country
     despite their obligations to control supply, prevent diversion,
     and report and take steps to halt suspicious orders.

           "877. On the basis of this pattern of misconduct,
     Plaintiffs allege that, despite these enforcement activities and
     despite their promises to improve their policies and
     procedures so as to prevent the diversion of prescription
     opioids (and so contributing to the opioid epidemic in
     Alabama), Defendants have failed to do so and, in fact, on
     information and belief, continue to operate in ways that
     enable the diversion of prescription opioids."

The plaintiffs further asserted that the distributor defendants "delayed

a response to the opioid crisis by pretending to cooperate with law

enforcement"; that the distributor defendants unlawfully distributed

opioids; that the distributor defendants breached their duties; and that

each of the distributor defendants have engaged in wrongful conduct.

     With regard to Cardinal, the plaintiffs alleged that "Cardinal's

flawed written policies enabled opioid diversion"; that Cardinal failed to

effectively prevent diversion in practice; and that Cardinal had been put

on notice of its wrongful conduct. They further alleged:

                                   19
SC-2023-0289

           "976. From this pattern of misconduct and Cardinal's
     evident refusal to adopt policies and procedures that would
     effectively prevent diversion -- despite promising to do so,
     Plaintiffs allege that Cardinal has continued to engage in
     conduct contributing to the opioid epidemic in Alabama by
     distributing opioids under circumstances suggestive of
     potential diversion."

     With regard to AmerisourceBergen, the plaintiffs alleged that

"AmerisourceBergen's flawed written policies enabled opioid diversion";

that AmerisourceBergen failed to effectively prevent diversion in

practice; and that AmerisourceBergen had been put on notice of its

wrongful conduct. They further alleged:

           "990. AmerisourceBergen continues to distribute opioids
     into Alabama and, on information and belief, continues to
     distribute them under circumstances suggestive of potential
     diversion."

     With regard to H.D. Smith, the plaintiffs alleged:

           "1000. H.D. Smith was the seventh largest distributor of
     opioids in Alabama during this time period. H.D. Smith's
     excessive distribution was made possible by, and is evidence
     of, H.D. Smith's failure to comply with its duties under state
     and federal law.

          "1001. As described elsewhere in this Complaint,
     Plaintiffs allege based on H.D. Smith's pattern of misconduct
     that it engaged in activities contributing to the opioid
     epidemic within the relevant limitations period."

                                  20
SC-2023-0289

     With regard to Henry Schein, the plaintiffs alleged that "Henry

Schein continues to distribute controlled substances into Alabama." They

further included allegations regarding "Henry Schein's inadequate SOM

program."

     With regard to McKesson, the plaintiffs alleged:

           "1011. In May 2008, McKesson entered into a settlement
     agreement with the DEA to settle claims that McKesson had
     failed to maintain effective controls against diversion of
     controlled substances in Florida, Maryland, Colorado, Texas,
     Utah, and California (the '2008 McKesson Settlement
     Agreement').

            "1012. In the 2008 McKesson Settlement Agreement,
     McKesson 'recognized that it had a duty to monitor its sales
     of all controlled substances and report suspicious orders to
     DEA.' McKesson agreed to 'maintain a compliance program
     designed to detect and prevent the diversion of controlled
     substances, inform DEA of suspicious orders ... and follow the
     procedures established by its Controlled Substance
     Monitoring Program.' But McKesson failed to do so. It was
     later revealed that McKesson's system for detecting
     'suspicious orders' from pharmacies was so ineffective and
     dysfunctional that, in a five-year period, it filled more than
     1.6 million orders, but reported just 16 orders as suspicious --
     all from a single consumer.

           "1013. In January 2017, McKesson admitted to its
     ongoing breach of its duties to monitor, report, and prevent
     suspicious orders of oxycodone and hydrocodone by entering
     into a Settlement Agreement and Release with the DEA and
     the DOJ [Department of Justice] (the 'the 2017 McKesson
     Settlement Agreement').

                                   21
SC-2023-0289

         "1014. In the 2017 McKesson Settlement Agreement,
    McKesson admitted that, between January 1, 2009 and
    January 17, 2017, it 'did not identify or report to DEA certain
    orders placed by certain pharmacies which should have been
    detected by McKesson as suspicious based on the guidance
    contained in the DEA Letters.' Despite its obligations under
    the 2008 Settlement Agreement, McKesson still 'failed to
    properly monitor its sales of controlled substances and/or
    report suspicious orders to DEA, in accordance with
    McKesson's obligations under the 2008 Agreements, the CSA
    [Controlled Substances Act], and 21 C.F.R. § 1301.74(b).'

           "1015. In the 2017 McKesson Settlement Agreement,
    McKesson further admitted that it had 'distributed controlled
    substances to pharmacies even though those [McKesson]
    Distribution Centers should have known that the
    pharmacists practicing within those pharmacies had failed to
    fulfill their corresponding responsibility to ensure that
    controlled substances were dispensed pursuant to
    prescriptions issued for legitimate medical purposes by
    practitioners acting in the usual course of their professional
    practice, as required by 21 C.F.R. § 1306.04(a).' McKesson
    admitted that it had 'failed to maintain effective controls
    against diversion of particular controlled substances into
    other than legitimate medical scientific and industrial
    channels by sales to certain of its customers in violation of the
    CSA and the CSA's implementing regulations.'

          "1016. As part of the 2017 McKesson Settlement
    Agreement, McKesson agreed that its authority to distribute
    controlled substances from 12 distribution centers would be
    partially suspended for several years. The overall sanctions
    included in the 2017 Settlement Agreement were the most
    severe ever imposed on a DEA-registered distributor.

         "1017. According to the Washington Post and 60
    Minutes, DEA staff recommended a much larger penalty than
    the $150 million ultimately agreed to -- as much as a billion
                                   22
SC-2023-0289

     dollars -- and delicensing of certain facilities. A DEA memo
     outlining the investigative findings in connection with the
     administrative case against 12 McKesson distribution centers
     included in the 2017 Settlement stated that McKesson
     '[s]upplied controlled substances in support of criminal
     diversion activities'; '[i]gnored blatant diversion'; had a
     '[p]attern of raising thresholds arbitrarily'; '[f]ailed to review
     orders or suspicious activity'; and '[i]gnored [the company’s]
     own procedures designed to prevent diversion.' "

(Footnotes omitted.)       The amended complaint also alleged that the

distributor defendants "have sought to and have misrepresented their

compliance with their legal duties" and that "repeated admonishments

and fines did not stop the distributor defendants from ignoring their

obligations to control the supply chain and prevent diversion."

     In their "additional allegations pertaining to punitive damages,"

the plaintiffs asserted:

          "1033. Each Defendant knew that large and suspicious
     quantities of opioids were being poured into communities
     throughout the United States. Despite this knowledge,
     Defendants took either no steps or utterly inadequate steps to
     report suspicious orders, control the supply of opioids, or
     otherwise prevent diversion. Indeed, as described above,
     Defendants acted in concert to maintain high quotas for their
     products and to ensure that suspicious orders would not be
     reported to regulators.

           "1034. Defendants' conduct was so willful and deliberate
     that it continued in the face of numerous enforcement actions,
     fines, and other warnings from federal and state governments
     and regulatory agencies. Defendants paid their fines, made
                                     23
SC-2023-0289

     promises to do better, and continued on with their marketing
     and supply schemes.       This ongoing course of conduct
     knowingly, deliberately, and repeatedly threatened and
     accomplished harm to public health and safety and large-scale
     economic loss to hospitals, families, communities, and
     governments across the state.

          "1035. As all of the governmental actions against
     Defendants show, Defendants knew that their actions were
     unlawful, and yet deliberately refused to change their
     practices because compliance with their legal obligations
     would have decreased their sales and profits."

(Emphasis added.)

     On September 8, 2022, the distributor defendants filed a motion to

dismiss the plaintiffs' claims against them pursuant to Rule 12(b)(6), Ala.

R. Civ. P. In their motion, the distributor defendants alleged, among

other things, that the plaintiffs' claims against them were barred by the

applicable statutes of limitations. On March 20, 2023, the trial court

entered an order denying the motion to dismiss.           The petitioners

subsequently filed their petition for a writ of mandamus directing the

trial court to vacate its March 20, 2023, order denying their motion to

dismiss and to enter an order dismissing the plaintiffs' claims against

them with prejudice.

                           Standard of Review

                                    24
SC-2023-0289

               " 'A writ of mandamus is an extraordinary
         remedy available only when the petitioner can
         demonstrate: " '(1) a clear legal right to the order
         sought; (2) an imperative duty upon the
         respondent to perform, accompanied by a refusal
         to do so; (3) the lack of another adequate remedy;
         and (4) the properly invoked jurisdiction of the
         court.' " Ex parte Nall, 879 So. 2d 541, 543 (Ala.
         2003) (quoting Ex parte BOC Grp., Inc., 823 So. 2d
         1270, 1272 (Ala. 2001)).'

    "Ex parte Watters, 212 So. 3d 174, 180 (Ala. 2016).

         " 'The general rule is that, subject to certain narrow
    exceptions, the denial of a motion to dismiss is not reviewable
    by petition for a writ of mandamus.' Ex parte Brown, 331 So.
    3d 79, 81 (Ala. 2021). However,

               " '[t]his Court has recognized that an appeal
         is an inadequate remedy in cases where it has
         determined that a defendant should not have been
         subjected to the inconvenience of litigation
         because it was clear from the face of the complaint
         that the defendant was entitled to a dismissal or
         to a judgment in its favor.'

    "Ex parte Sanderson, 263 So. 3d 681, 687-88 (Ala. 2018)
    (citing Ex parte Hodge, 153 So. 3d 734 (Ala. 2014), and Ex
    parte U.S. Bank Nat'l Ass'n, 148 So. 3d 1060 (Ala. 2014)). In
    particular, in Ex parte Hodge, this Court permitted
    mandamus review of a trial court's denial of a motion to
    dismiss contending that the plaintiff's malpractice claim was
    barred by the four-year statute of repose contained in § 6-5-
    482(a), Ala. Code 1975, when the applicability of that statute
    was clear from the face of the complaint. Cf. Ex parte
    Watters, 212 So. 3d at 182 (denying a mandamus petition
    because 'it [was] not abundantly clear from the face of [the
    plaintiff's] complaint whether the survival statute dictate[d]
                                  25
SC-2023-0289

     dismissal of the legal-malpractice claim because the issue
     whether the claim sound[ed] in tort, in contract, or in both for
     that matter, [was] sharply disputed by the parties'). Thus, if
     it is clear from the face of [the plaintiff's] complaint that the
     claims against [the defendant] are barred by the rule of repose
     or the applicable statute of limitations, then [the defendant]
     is entitled to mandamus relief.

          "With respect to evaluating a trial court's denial of a
     Rule 12(b)(6) motion to dismiss,

                  " '[t]he appropriate standard of review ... is
           whether "when the allegations of the complaint
           are viewed most strongly in the pleader's favor, it
           appears that the pleader could prove any set of
           circumstances that would entitle [the pleader] to
           relief." Nance v. Matthews, 622 So. 2d 297, 299
           (Ala.       1993);    Raley       v.  Citibanc      of
           Alabama/Andalusia, 474 So. 2d 640, 641 (Ala.
           1985). This Court does not consider whether the
           plaintiff will ultimately prevail, but only whether
           the plaintiff may possibly prevail. Nance, 622 So.
           2d at 299. A "dismissal is proper only when it
           appears beyond doubt that the plaintiff can prove
           no set of facts in support of the claim that would
           entitle the plaintiff to relief." Nance, 622 So. 2d at
           299; Garrett v. Hadden, 495 So. 2d 616, 617 (Ala.
           1986); Hill v. Kraft, Inc., 496 So. 2d 768, 769 (Ala.
           1986).'

     "Lyons v. River Rd. Constr., Inc., 858 So. 2d 257, 260 (Ala.
     2003)."

Abbott, 342 So. 3d at 193-94.

                " ' "[A] Rule 12(b)(6) dismissal is proper only
           when it appears beyond doubt that the plaintiff
           can prove no set of facts in support of the claim
                                    26
SC-2023-0289

           that would entitle the plaintiff to relief." Nance v.
           Matthews, 622 So. 2d 297, 299 (Ala. 1993)
           (citations omitted).     "Next, the standard for
           granting a motion to dismiss based upon the
           expiration of the statute of limitations is whether
           the existence of the affirmative defense appears
           clearly on the face of the pleading." Braggs v. Jim
           Skinner Ford, Inc., 396 So. 2d 1055, 1058
           (Ala.1981) (citations omitted).'

     "Jones v. Alfa Mut. Ins. Co., 875 So. 2d 1189, 1193 (Ala.
     2003)."

Limon v. Sandlin, 200 So. 3d 21, 23-24 (Ala. 2015).

                               Discussion

     The petitioners argue that the trial court erroneously denied their

motion to dismiss based upon statute-of-limitations grounds.            They

contend that

           "Plaintiffs' claims against Distributors are barred by the
     applicable two-year statute of limitations. See Abbott, 342 So.
     3d at 194 & n.7; Ex parte Brian Nelson Excavating, LLC, 25
     So. 3d 1143, 1154 (Ala. 2009) (discussing 'the two-year statute
     of limitations in § 6-2-38, Ala. Code 1975, for nuisance
     claims')."

Petition at 6. In Abbott, this Court stated:

     "The statute of limitations for a nuisance claim is two years.7
     See, e.g., Ex parte Brian Nelson Excavating, LLC, 25 So. 3d
     1143, 1145 (Ala. 2009) (discussing 'the two-year statute of
     limitations in § 6-2-38, Ala. Code 1975, for nuisance claims').

     "____________________
                                    27
SC-2023-0289

           "7The applicable statute of limitations for most of Mobile
     Health's other claims against Abbott -- negligence,
     wantonness, and fraud and deceit -- is also two years. See,
     e.g., Ex parte Capstone Bldg. Corp., 96 So. 3d 77, 88 (Ala.
     2012) ('We once again reaffirm the proposition that
     wantonness claims are governed by the two-year statute of
     limitations now embodied in § 6-2-38(l)[, Ala. Code 1975].');
     Bush v. Ford Life Ins. Co., 682 So. 2d 46, 47 (Ala. 1996) ('The
     statute of limitations applicable to a negligence claim is two
     years.'); Liberty Nat'l Life Ins. Co. v. McAllister, 675 So. 2d
     1292, 1297 (Ala. 1995) ('A fraud action is subject to a two-year
     statute of limitations.'). The same limitations period applies
     to the civil-conspiracy claims. See, e.g., Freeman v. Holyfield,
     179 So. 3d 101, 105 (Ala. 2015). This Court has not decided
     whether the applicable limitations period for an unjust-
     enrichment claim is two years or six years. See Snider v.
     Morgan, 113 So. 3d 643, 655 (Ala. 2012) ('Our research
     similarly confirms that there is a distinct absence of authority
     definitively stating the statute of limitations applicable to an
     unjust-enrichment claim. We need not, however, decide that
     issue here.'). However, Mobile Health did not argue before
     the circuit court or in this Court that its unjust-enrichment
     claim against Abbott is within the statute of limitations
     absent tolling through fraud, an argument we address later
     in this opinion."

342 So. 3d at 194-95.2 The petitioners assert that "[t]his Court should

grant mandamus review and confirm that Abbott compels dismissal

because Plaintiffs' own allegations establish that their purported injuries

-- increased costs associated with the treatment of patients with opioid-

     2Inthis case, the plaintiffs have not argued that their unjust-
enrichment claims are subject to a six-year statute of limitations.
                                   28
SC-2023-0289

related conditions -- necessarily occurred years before the applicable

accrual date of March 26, 2019." Petition at 1.

     In the "Tolling and Fraudulent Concealment" section of the

amended complaint, the plaintiffs alleged:

           "1060. Plaintiffs maintain that each Defendant has
     engaged in conduct within the applicable limitations period
     and that has been described above. Such misconduct
     indicates that the statute of limitations does not operate as a
     bar to Plaintiffs' claims. Nevertheless, Plaintiffs also allege
     facts, as described below, that toll the running of the statute
     of limitations.

           "….

          "1067. As described in this complaint, although
     Defendants' misconduct that caused the opioid epidemic
     began many years ago, Defendants have continued to engage
     in such conduct within the relevant statute of limitations
     period."

In their amended complaint, the plaintiffs alleged that the remaining

defendants have "engaged in conduct within the applicable limitation

period" and that "[s]uch misconduct indicates that the statute of

limitations does not operate as a bar to Plaintiffs' claims." They further

alleged that the applicable statutes of limitations were tolled because the

remaining defendants had fraudulently concealed the various causes of

action.

                                    29
SC-2023-0289

     The petitioners argue that this Court's decision in Abbott "confirms

that the continuing tort doctrine does not apply." Petition at 17. They

go on to argue:

           "Plaintiffs' Amended Complaint preemptively attempts
     to circumvent the statute of limitations by invoking the
     continuing tort doctrine, alleging in a conclusory fashion that
     Distributors' misconduct continues through today. See, e.g.,
     Am. Compl. ¶¶ 113, 120, 125, 152, 156, 161, 990.17 But
     Plaintiffs do not identify any specific conduct within the
     limitations period. On the contrary, they say that it 'can be
     inferred' based solely on alleged misconduct in earlier periods.
     Id. ¶¶ 113, 120, 125, 156, 161. These allegations are not
     sufficient to trigger the continuing tort doctrine under
     Alabama law.

           "This Court rejected that precise outcome and confirmed
     the limits of the continuing tort doctrine in Abbott. This
     Court held that generic allegations that defendants
     'continue[] to conduct' wrongdoing or that a particular
     defendant's tort 'was a continuing pattern of conduct that
     continued at least until the time that [plaintiffs] filed the
     lawsuit' are insufficient as a matter of law to avoid the statute
     of limitations. Abbott, 342 So. 3d at 195 (quoting the
     complaint). Instead, to invoke the continuing tort doctrine,
     the complaint must raise 'specific allegations against' the
     defendant of conduct within the limitations period. Id.
     (emphasis added).

     "_________________

          "17As to each Distributor, Plaintiffs rotely allege 'on
     information and belief that [distributor] continues to operate
     in ways that enable the diversion of prescription opioids.' Id.
     ¶¶ 113, 120, 125, 152, 156, 161."

                                    30
SC-2023-0289

Petition at 17-18. However, the petitioners overstate this Court's holding

in Abbott regarding the pleading requirements for a continuing tort.

     In Abbott, the Mobile County Board of Health and the Family

Oriented Primary Health Care Clinic (collectively referred to as "Mobile

Health") sued over 60 defendants, including Abbott Laboratories and

Abbott Laboratories, Inc. (collectively referred to as "Abbott"). In its

complaint, "Mobile Health alleged that Abbott had participated in the

marketing of a specific prescription drug, Oxycontin." 342 So. 3d at 188.

Mobile Health alleged that the defendants "had caused a public nuisance

in the form of an opioid epidemic." Additionally,

           "[w]ith respect to Abbott's conduct, Mobile Health
     alleged:

           " '143. Abbott was primarily engaged in the
           promotion and distribution of opioids nationally
           due to a co-promotional agreement with Purdue.
           Pursuant to that agreement, between 1996 and
           2006, Abbott actively promoted, marketed, and
           distributed Purdue's opioid products as set forth
           above.

           " '144. Abbott, as part of the co-promotional
           agreement, helped turn OxyContin into the largest
           selling opioid in the nation. Under the co-
           promotional agreement with Purdue, the more
           Abbott generated in sales, the higher the reward.
           Specifically, Abbott received twenty-five to thirty
           percent (25-30%) of all net sales for prescriptions
                                   31
SC-2023-0289

         written by doctors its sales force called on. This
         agreement was in operation from 1996-2002,
         following which Abbott continued to receive a
         residual payment of six percent (6%) of net sales
         up through at least 2006.

         " '145. With Abbott's help, sales of OxyContin went
         from a mere $49 million in its first full year on the
         market to $1.2 billion in 2002. Over the life of the
         co-promotional agreement, Purdue paid Abbott
         nearly half a billion dollars.'

    "(Emphasis added.)

          "Mobile Health asserted that it brought this action
    because of the burdens it has had to bear as a result of the
    'opioid epidemic.'

         " '36. Boards of health and their affiliated primary
         care providers -- legally and morally -- are
         compelled to act and treat patients with opioid-
         related conditions[] and, as a result, are directly
         and monetarily damaged by the opioid epidemic.
         In addition to the cost of the opioid drugs
         themselves, boards of health and their affiliated
         primary care providers have incurred and
         continue to incur millions of dollars in damages for
         the costs of uncompensated care as a result of the
         unlawful marketing, distribution, and sale of
         opioids. Boards of health and their affiliated
         primary care providers directly and monetarily
         bear the brunt of the opioid crisis.

         " '37. [Mobile Health is] struggling from the
         relentless and crushing financial burdens caused
         by the epidemic of opioid addiction.

                                  32
SC-2023-0289

         " '38. The effects of the opioid epidemic on boards
         of health and their affiliated primary care
         providers may soon become even greater. The
         coverage rules under the Affordable Care Act
         ("ACA") are in transition, thus creating the
         possibility of increased costs for boards of health
         for treatment of opioid-addicted patients admitted
         under the Emergency Medical Treatment and
         Labor Act ("EMTALA"), 42 U.S.C. § 395dd. Those
         increased costs would increase the likelihood that
         patients would seek treatment through boards of
         health and their primary care providers.

         " '39. [Mobile Health] encounter[s] patients with
         opioid addiction on a daily basis. [It] must deal
         with patients who have serious medical conditions
         that require extra care and expense because the
         patients are addicted to opioids.

         " '40. The statistics are startling.        Adult
         hospitalizations due substantially to opioid-
         related medical conditions doubled from 2000 to
         2012. From 2005 to 2014, emergency department
         visits exhibited a 99.4% cumulative increase.
         [Mobile Health has] experienced similar increases
         in the number of patients seen with opioid-related
         medical issues.

         " '41. Between 2005 and 2014, there was a
         dramatic increase nationally in hospitalizations
         involving opioids:    the rate of opioid-related
         inpatient stays increased 64%, and the rate of
         opioid-related emergency department ("ED") visits
         nearly doubled. And, likewise, [Mobile Health
         has] experienced a similar increase in visits from
         patients with opioid-related medical issues.

         " '....
                                 33
SC-2023-0289

         " '43. The cost to treat those with opioid addiction
         has more than tripled in a decade, up to nearly $15
         billion in 2012. Similarly, the number of patients
         hospitalized due to the effects of these drugs
         surged by more than 72% in 2012, although overall
         hospitalizations during that time stayed relatively
         flat. [Mobile Health has] experienced similar
         increases and similar associated increased costs.

         " '44. Private insurance covers only a portion of
         those costs. The burden is carried by hospitals,
         boards of health, primary care providers, patients,
         and government programs. In 2012, hospitals
         provided almost $15 billion for opioid-related
         inpatient care, more than double of what they
         billed in 2002. A substantial portion of these costs
         were under-insured or unreimbursed.

         " '45. In 2012, an average hospital stay for a
         patient with an opioid-related condition cost about
         $28,000 and only about 20% of the hospital stays
         related to those incidents were covered by private
         insurance. The number increased to $107,000 if
         there was an associated infection, with merely
         14% covered by insurance.

         " '46. Patients with complex opioid addiction-
         related histories (medically and psychosocially)
         often cannot get treatment at skilled nursing
         facilities if they are discharged by hospitals.

         " ' 47. The cost of treating opioid overdose victims
         in hospital intensive care units jumped 58% in a
         seven-year span. Between 2009 and 2015, the
         average cost of care per opioid overdose admission
         increased from $58,000 to $92,400. This was
         during a period where the overall medical cost
                                 34
SC-2023-0289

         escalation was about 19%. This cost increase also
         highlights a troubling trend: overdose patients are
         arriving in worse shape, requiring longer stays
         and a higher level of treatment.

         " '....

         " '49. The rates of opioid abuse during pregnancy
         have increased nationally and in Alabama. There
         has been an almost four-fold increase in
         admissions to NICUs [neonatal intensive-care
         units] for NAS over the past decade: from seven
         cases per 1,000 NICU admissions in 2004, to 27
         cases per 1,000 NICU admissions in 2012.

         " '….'

    "(Emphasis added.)

          "On October 15, 2019, Mobile Health filed its original
    complaint in the Mobile Circuit Court against Abbott and
    numerous other defendants -- over 60 defendants in all --
    alleging that they had caused a public nuisance in the form of
    an opioid epidemic:

         " '1. The opioid epidemic is an ongoing crisis in
         Alabama. Opioid use has had tragic consequences
         for communities across Alabama, including those
         in Mobile, Baldwin, and Conecuh Counties.
         Thousands of people have died from opioid
         overdoses, and many thousands more suffer from
         Opioid use disorders and related health conditions
         in Alabama.         The misrepresentations by
         Defendants described herein regarding the risks
         and benefits of opioids enabled, and are continuing
         to enable, the widespread prescribing of opioids for
         common chronic pain conditions like lower back
         pain, arthritis, and headaches.
                                 35
SC-2023-0289

         " '....

         " '953. This [nuisance] claim is brought under the
         Alabama common law of nuisance. This claim is
         also brought pursuant to Ala. Code § 22-3-2(3),
         which instructs Plaintiff Mobile County Board of
         Health to abate nuisances.

         " '....

         " '958. The nuisance created by Defendants is the
         over-saturation of opioids in the patient
         population of the geographic area served by
         [Mobile Health] for illegitimate purposes, as well
         as the adverse social, economic, and human health
         outcomes associated with widespread illegal opioid
         use.'

    "Mobile Health asserted against Abbott claims of negligence,
    wantonness, nuisance, unjust enrichment, fraud and deceit,
    and civil conspiracy. With respect to all of their claims
    against all the defendants, Mobile Health alleged:

         " '918. [Mobile Health is] entitled to a tolling of any
         statutes of limitation because Defendants
         fraudulently concealed the existence of their
         causes of action from [it]. [Mobile Health] did not
         know, and did not have any reason to know, any of
         the facts regarding Defendants' marketing
         misconduct until the DEA's [Drug Enforcement
         Administration] ARCOS [Automated Reports and
         Consolidated Ordering System] data was released
         in 2019. Until then, [Mobile Health was] not
         aware that the opioid crisis was the result of
         massive and improper distribution of opioids in
         the counties that [it] serve[s]. Also, [Mobile
         Health] did not know, and did not have any reason
                                   36
SC-2023-0289

             to know, of the Defendants' failures to report
             suspicious orders and otherwise prevent diversion
             of opioids in the three counties that [it] serve[s]
             until [it was] able to obtain in 2019 excerpts of
             pleadings, documents, and testimony produced in
             the MDL [multidistrict litigation].        [Mobile
             Health] first became aware of allegations about
             Defendants' marketing practices from news
             articles in 2018. Without the ARCOS data, and
             without the information from the MDL, [Mobile
             Health was] unable to determine that [it] had a
             cause of action to pursue against Defendants.' "

Abbott, 342 So. 3d at 189-93 (footnotes omitted).

        Abbott filed a motion to dismiss all the claims Mobile Health had

stated against it, asserting, among other things, that the claims were

barred by the applicable statutes of limitations and the 20-year common-

law rule of repose. After Mobile Health filed a response and Abbott filed

a reply in support of its motion to dismiss, the trial court entered an order

in which it denied Abbott's motion to dismiss. Abbott subsequently filed

a mandamus petition in this court. In its mandamus petition, Abbott

argued, in part, that Mobile Health's claims against it were barred by the

applicable statutes of limitations.

        In addressing Abbott's arguments, this Court stated, in pertinent

part:

                                      37
SC-2023-0289

           " 'The statute of limitations begins to run when the cause
    of action accrues, which this Court has held is the date the
    first legal injury occurs.' Ex parte Integra LifeSciences Corp.,
    271 So. 3d 814, 818 (Ala. 2018). 'A cause of action accrues as
    soon as the claimant is entitled to maintain an action,
    regardless of whether the full amount of the damage is
    apparent at the time of the first legal injury.' Chandiwala v.
    Pate Constr. Co., 889 So. 2d 540, 543 (Ala. 2004).

           "The claim both parties focus on with respect to the
    statute of limitations is Mobile Health's nuisance claim. The
    statute of limitations for a nuisance claim is two years. See,
    e.g., Ex parte Brian Nelson Excavating, LLC, 25 So. 3d 1143,
    1145 (Ala. 2009) (discussing 'the two-year statute of
    limitations in § 6-2-38, Ala. Code 1975, for nuisance claims').
    As Abbott observes, according to the complaint, Abbott last
    actively marketed OxyContin in 2002 and it received its last
    payments from its co-promotion agreement with Purdue in
    2006, but Mobile Health commenced this action on October
    15, 2019. Abbott therefore argues that from the face of the
    complaint Mobile Health commenced its action 11 years after
    the expiration of the applicable statute of limitations.

          "Mobile Health presents three arguments in response.
    First, it contends that it alleged that the public nuisance is a
    continuing tort and, thus, is not barred by the statute of
    limitations.

               " 'The Complaint shows that [Mobile Health]
         alleges that Abbott's tort was a continuing pattern
         of conduct that continued at least until the time
         that [Mobile Health] filed the lawsuit.         See
         generally Complaint. Thus, under established
         Alabama law, the Complaint sufficiently alleges
         continuing tortious conduct and the statute of
         limitations does not bar this continuing nuisance
         claim.'

                                   38
SC-2023-0289

    "Mobile Health's brief, p. 15. For support, Mobile Health cites
    such cases as Alabama Great Southern R.R. v. Denton, 239
    Ala. 301, 305, 195 So. 218, 221 (1940), in which this Court
    stated: 'We recognize that one maintaining a continuing
    public nuisance, as for example, one endangering the public
    health or public safety, cannot defend against a suit to abate
    same because of the lapse of time.' See also Holz v. Lyles, 287
    Ala. 280, 284, 251 So. 2d 583, 587 (1971) ('But one
    maintaining a continuing public nuisance cannot defend
    against a suit to abate the nuisance because of lapse of time
    ....').

          "Mobile Health is certainly correct that it generally
    alleged a continuous tort against the marketing defendants[,
    which included Abbott].

         " '221. Each Marketing Defendant has conducted,
         and continues to conduct, a marketing scheme
         designed to persuade doctors and patients that
         opioids can and should be used for chronic pain,
         resulting in opioid treatment for a far broader
         group of patients who are much more likely to
         become addicted and suffer other adverse effects
         from the long-term use of opioids. In connection
         with this scheme, each Marketing Defendant
         spent, and continues to spend, millions of dollars
         on promotional activities and materials that
         falsely deny, trivialize, or materially understate
         the risks of opioids while overstating the benefits
         of using them for chronic pain.'

    "However, the specific allegations against Abbott in the
    complaint do not mention conduct of any kind by Abbott after
    2006. This is important because there must be a connection
    between the defendant's actions and the ongoing tort.

         " 'This Court has used the term "continuous tort"
         to describe a defendant's repeated tortious conduct
                                  39
SC-2023-0289

         which has repeatedly and continuously injured a
         plaintiff.   These cases can be analyzed by
         analogizing the plaintiffs' cause of action to the
         common law action of continuing trespass or
         trespass on the case.

               " 'This Court has held that a defendant's
         repeated wrongs to the plaintiff can constitute a
         "continuous tort," such as: (1) when an employer
         exposes its employee on a continuing basis to
         harmful substances and conditions [American
         Mut. Liability Ins. Co. v. Agricola Furnace Co., 236
         Ala. 535, 183 So. 677 (1938)]; (2) when there is a
         "single sustained method pursued in executing one
         general scheme," as in a blasting case [Lehigh
         Portland Cement Co. v. Donaldson, 231 Ala. 242,
         246, 164 So. 97 (1935)]; and (3) when a plaintiff
         landowner seeks damages for the contamination of
         a well or stream [Howell v. City of Dothan, 234
         Ala. 158, 174 So. 624 (1937); Employers Insurance
         Company of Alabama v. Rives, 264 Ala. 310, 87 So.
         2d 653 (1955); and Alabama Fuel & Iron Co. v.
         Vaughn, 203 Ala. 461, 83 So. 323 (1919)].

               " ' The stream and well pollution cases, the
         blasting cases, and the employer-employee cases
         are all cases in which this Court has held that the
         defendants committed a continuous tort. The
         cases are analogous to a continuing trespass in
         that the repeated actions of the defendants
         combined to create a single cause of action in tort.'

    "Moon v. Harco Drugs, Inc., 435 So. 2d 218, 220-21 (Ala. 1983)
    (emphasis added). See also Continental Cas. Ins. Co. v.
    McDonald, 567 So. 2d 1208, 1216 (Ala. 1990) (holding that 'an
    action such as this, arising from continuing dealings between
    the parties, will not be barred until two years after the last
    tortious act by the defendant' (emphasis added)). Holz and
                                  40
SC-2023-0289

    Denton contain this same idea by discussing a defendant's
    'maintaining a continuing public nuisance,' indicating that
    the reason the statute of limitations does not expire for a
    continuous tort is because the defendant's conduct is ongoing
    within the period of the statute of limitations. Cf. Payton v.
    Monsanto Co., 801 So. 2d 829, 836 (Ala. 2001) (concluding that
    the plaintiff's 'complaint describing continuing discharge of
    PCBs as of the time of the commencement of this action'
    allowed the claims to 'survive a defense of limitations by proof
    of conduct occurring within the limitations period'); Alabama
    Power Co. v. Gielle, 373 So. 2d 851, 854 (Ala. Civ. App. 1979)
    ('A continuing trespass creates successive causes of action,
    and damages may be recovered for the trespass occurring
    within the statutory period.').

         "In short, the fact that the alleged opioid epidemic itself
    was ongoing at the time Mobile Health filed its original
    complaint does not mean that Abbott's conduct in relation to
    the epidemic is not subject to the statute of limitations. As
    the Court explained in Payton:

         " 'Alabama law does not recognize a continuing tort
         in instances where there has been a single act
         followed by multiple consequences.2

         " '___________________

                " ' 2Moon v. Harco Drugs, Inc., 435 So. 2d 218,
         220-21 (Ala. 1983), discusses the concept of
         "continuous tort," describing it as a defendant's
         liability for repeated wrongs to the plaintiff. Then,
         the Court offers several illustrations, including
         "when a plaintiff landowner seeks damages for the
         contamination of a well or stream." Id. at 221.
         However, the three cases cited to support this
         proposition involve repetitive acts or ongoing
         wrongdoing[:] Howell v. City of Dothan, 234 Ala.
         158, 174 So. 624 (1937) (ongoing discharge of
                                  41
SC-2023-0289

           sewage), Employers Insurance Co. of Alabama v.
           Rives, 264 Ala. 310, 87 So. 2d 653 (1955) (opinion
           refers to repetitive acts), Alabama Fuel & Iron Co.
           v. Vaughn, 203 Ala. 461, 83 So. 323 (1919) (damage
           resulting from the ongoing operations of a coal
           mine).'

     "801 So. 2d at 835 (emphasis added). There are no allegations
     of ongoing wrongdoing by Abbott within two years of the date
     Mobile Health filed its original complaint. Therefore, Mobile
     Health's general allegation of a continuous public nuisance
     does not save its claims against Abbott from the statute-of-
     limitations bar."

Abbott, 342 So. 3d at 194-96 (footnote omitted).

     The petitioners argue that, in Abbott, this Court held that, "to

invoke the continuing tort doctrine, the complaint must raise 'specific

allegations against' the defendant of conduct within the limitations

period. [Abbott, 342 So. 3d at 195] (emphasis added)." Petition at 18.

However, the petitioners overstate this Court's holding in Abbott.

     Contrary to the petitioners' argument, Abbott did not hold that a

complaint must allege specific factual allegations against a defendant "to

invoke the continuing tort doctrine." Petition at 18. In Abbott, Mobile

Health's complaint alleged that "Abbott last actively marketed

OxyContin in 2002 and it received its last payments from its co-

promotion agreement with Purdue in 2006, but Mobile Health

                                   42
SC-2023-0289

commenced this action on October 15, 2019." 342 So. 3d at 195. This

Court acknowledged that Mobile Health had "generally alleged a

continuous tort against the marketing defendants." Id. Additionally, we

did not hold that such general allegations against the marketing

defendants were insufficient to allege a continuing tort for statute-of-

limitations purposes.   Rather, this Court looked at Mobile Health's

specific factual allegations against Abbott. The complaint in that case

included specific factual allegations that "Abbott last actively marketed

OxyContin in 2002 and it received its last payments from its co-

promotion agreement with Purdue in 2006." Id. This Court emphasized

that "the specific factual allegations against Abbott did not mention

conduct of any kind by Abbott after 2006" and that "[t]his is important

because there must be a connection between the defendant's actions and

the ongoing tort." Id. (second emphasis added). This Court went on to

state that "[t]here are no allegations of ongoing wrongdoing by Abbott

within two years of the date Mobile Health filed its original complaint.

Therefore, Mobile Health's general allegation of a continuous public

nuisance does not save its claim against Abbott from the statute-of-

limitations bar." Id. at 196. Based on the foregoing, it is clear that in

                                   43
SC-2023-0289

Abbott this Court did not hold that a complaint alleging a continuous tort

must include specific factual allegations regarding a defendant's conduct

that purportedly occurs during the limitations period.         Rather, our

decision was based on the fact that the compliant in that case included

specific factual allegations showing that Abbott's alleged misconduct had

ended more than two years before the filing of the complaint in that case.

      In this case, the amended complaint, which was filed after this

Court decided Abbott, included specific factual allegations regarding

conduct by each of the petitioners that took place outside the two-year

statute of limitations and conduct that took place outside Alabama.

However, based on those allegations, the plaintiffs asserted that the

petitioners have engaged in a pattern of misconduct.         They further

asserted, "on information and belief," that each of the petitioners

"continues to operate in ways that enable the diversion of prescriptive

opioids."   Additionally, with regard to the "impact of defendants'

activities on plaintiffs," the plaintiffs alleged:

            "266. Plaintiffs have treated, and continue to treat,
      numerous patients for opioid-related conditions, including:
      (1) opioid overdose; (2) opioid addiction; (3) hepatitis C, HIV,
      and other infections occurring as a result of intravenous drug
      use; (4) neonatal treatment in its NICU for babies born opioid-
      dependent, for which treatment is specialized, intensive,
                                      44
SC-2023-0289

    complex, lengthy and highly expensive; and (5) psychiatric
    and related treatment for patients with opioid addiction who
    present in need of mental health treatment programs.

         "267. Plaintiffs' hospitals have suffered a continuing
    operational impact as a consequence of the opioid epidemic
    created by Defendants' conduct. Simply put, providing the
    same level of care and service to patients is more expensive in
    the presence of an opioid epidemic than it would be without
    that epidemic. For instance, the same medical or surgical
    procedure is often more expensive to perform on a patient
    with an opioid use disorder than on a patient without that
    disorder due to the need to take additional measures and
    steps to ensure the patient's safety during and after the
    procedure.

          "268. Additionally, individuals with opioid addiction
    have presented and continue to present themselves to
    Plaintiffs claiming to have illnesses and medical problems in
    an effort to obtain opioids. Plaintiffs have incurred and
    continue to incur operational costs related to the time and
    expenses in diagnosing, testing, and otherwise attempting to
    treat these individuals.

         "….

          "271. Patients with opioid-related conditions seek
    treatment from Plaintiffs as a proximate result of the opioid
    epidemic created and engineered by Defendants. As a result,
    Plaintiffs' monetary losses with respect to treatment of these
    patients were and are foreseeable to Defendants and were and
    are the proximate result of Defendants' acts and omissions
    specified herein. Second, patients with opioid conditions have
    caused Plaintiffs to incur, and continue to incur, increased
    costs in the form of surgical procedures and other care that
    have been and are more complex and expensive than they
    would otherwise be if the patients were not using or abusing
    opioids."
                                  45
SC-2023-0289

(Emphasis added.)

     Based on those factual allegations, the amended complaint

generally alleged a continuing tort against the petitioners. However,

unlike the situation in Abbott, the amended complaint did not include

any specific allegations stating or suggesting that any of the petitioners'

alleged misconduct had ended before March 26, 2019, or at any time

before the filing of the complaint. Rather, the complaint specifically

alleged that each of the petitioners "continues to operate in ways that

enable the diversion of prescriptive opioids." Thus, the facts in this case

are clearly distinguishable from the facts in Abbott.

     As we have stated:

     "We note that pleadings are to be liberally construed in order
     to effect the purpose of the Alabama Rules of Civil Procedure
     and that every reasonable intendment and presumption must
     be made in favor of the pleader. See Rule 8, Ala. R. Civ. P.;
     Ex parte International Refining & Mfg. Co., 972 So. 2d 784,
     789 (Ala. 2007)."

Ex parte Moulton, 116 So. 3d 1119, 1132 (Ala. 2013). As this Court noted

in Abbott,

          "[w]ith respect to evaluating a trial court's denial of a
     Rule 12(b)(6) motion to dismiss,

                                    46
SC-2023-0289

                  " '[t]he appropriate standard of review ... is
           whether "when the allegations of the complaint
           are viewed most strongly in the pleader's favor, it
           appears that the pleader could prove any set of
           circumstances that would entitle [the pleader] to
           relief." Nance v. Matthews, 622 So. 2d 297, 299
           (Ala.       1993);    Raley       v.  Citibanc      of
           Alabama/Andalusia, 474 So. 2d 640, 641 (Ala.
           1985). This Court does not consider whether the
           plaintiff will ultimately prevail, but only whether
           the plaintiff may possibly prevail. Nance, 622 So.
           2d at 299. A "dismissal is proper only when it
           appears beyond doubt that the plaintiff can prove
           no set of facts in support of the claim that would
           entitle the plaintiff to relief." Nance, 622 So. 2d at
           299; Garrett v. Hadden, 495 So. 2d 616, 617 (Ala.
           1986); Hill v. Kraft, Inc., 496 So. 2d 768, 769 (Ala.
           1986).'

     "Lyons v. River Rd. Constr., Inc., 858 So. 2d 257, 260 (Ala.
     2003)."

342 So. 3d at 194.

           "We emphasize that, at this stage of the proceedings, the
     applicable standard of review required the circuit court and
     requires this Court to view [the plaintiffs'] allegations most
     strongly in [their] favor and to consider only whether [they]
     might possibly prevail if [they] can prove [their] allegations.
     See Ex parte Abbott Lab'ys, 342 So. 3d at 194. The issue
     before us is not one of proof; rather, the issue is whether the
     action can be maintained if [the plaintiffs'] allegations are
     true. See id."

Ex parte Mobile Infirmary Ass'n, 349 So. 3d 842, 847 (Ala. 2021).

                                    47
SC-2023-0289

     Viewing the plaintiffs' allegations that the petitioners' alleged

misconduct continued through the time of the filing of the complaint as

true, the plaintiffs' claims would not be barred by the applicable statutes

of limitations. Thus, it is not clear from the face of the complaint that

the plaintiffs' claims against the petitioners are barred by the applicable

statutes of limitations. Whether the plaintiffs will be able to present

proof that the petitioners actually engaged in misconduct within the

limitations period is not before us at this time. Therefore, the trial court

did not err when it denied the petitioners' motion to dismiss on statute-

of-limitations grounds. Accordingly, the petitioners are not entitled to an

order dismissing the plaintiffs' claims against them. 3

                                Conclusion

     Based on the foregoing, the petitioners have not established that

the face of the amended complaint clearly demonstrated that the

plaintiffs' claims against them are barred by the applicable statutes of

limitations and that the trial court erred when it denied their motion to

dismiss. Accordingly, the petitioners have not established a clear legal

     3Based on this holding, we pretermit discussion of the petitioners'

argument that the doctrine of fraudulent concealment does not apply.
                                  48
SC-2023-0289

right to the relief they seek. Therefore, the petition for a writ of

mandamus is denied.

     PETITION DENIED.

     Parker, C.J., and Shaw, Wise, Bryan, Mendheim, Stewart, and

Mitchell, JJ., concur.

     Cook, J., concurs in the result, with opinion.

     Sellers, J., dissents.

                                   49
SC-2023-0289

COOK, Justice (concurring in the result).

     I concur in the result but do so with hesitation. The question

presented is whether the claims alleged in the most recent amended

complaint were sufficiently pleaded to withstand the petitioners' motion

to dismiss. What makes this question particularly difficult in the present

case is that the petitioners moved to dismiss the plaintiffs' claims against

them based upon an affirmative defense -- that the claims are barred by

the applicable statutes of limitations.

     On the one hand, the most recent amended complaint is voluminous

and contains conclusory, general allegations of wrongdoing by each of the

petitioners that are within the applicable two-year statute-of-limitations

period. For instance, as to each of the petitioners, the amended complaint

stated:

     "From this pattern of instances, it can be inferred that [the
     petitioners'] policies and procedures have failed to adapt and
     change in order to prevent the future diversion of prescription
     opioids. On that basis, Plaintiffs allege on information and
     belief that [the petitioners] continue[] to operate in ways that
     enable the diversion of prescription opioids."

(Emphasis added.) On the other hand, the complaint also cited specific

dates for alleged wrongdoing by the petitioners that are outside of the

applicable limitations period. What are we to make of this?

                                    50
SC-2023-0289

     The main opinion concludes that, at the pleading stage, these

allegations are sufficient to satisfy the pleading requirements for a

continuous-tort claim. I am not so sure.

     The petitioners rely almost exclusively upon this Court's recent

decision in Ex parte Abbott Laboratories, 342 So. 3d 186 (Ala. 2021), in

arguing that we must grant their petition for a writ of mandamus and

order the trial court to grant their motion to dismiss. Specifically, they

assert that "[t]his Court should grant mandamus review and confirm that

Abbott compels dismissal because [the plaintiffs'] own allegations

establish that their purported injuries … necessarily occurred years

before the applicable accrual date" in the present action. Petition at 1.

     In Abbott, we explained:

            " 'The statute of limitations begins to run when the cause
     of action accrues, which this Court has held is the date the
     first legal injury occurs.' Ex parte Integra LifeSciences Corp.,
     271 So. 3d 814, 818 (Ala. 2018). 'A cause of action accrues as
     soon as the claimant is entitled to maintain an action,
     regardless of whether the full amount of the damage is
     apparent at the time of the first legal injury.' Chandiwala v.
     Pate Constr. Co., 889 So. 2d 540, 543 (Ala. 2004).

           "….

           "Mobile Health is certainly correct that it generally
     alleged a continuous tort against the marketing defendants[,
     including Abbott].
                                    51
SC-2023-0289

           "'….'

     "However, the specific allegations against Abbott in the
     complaint do not mention conduct of any kind by Abbott after
     2006. This is important because there must be a connection
     between the defendant's actions and the ongoing tort.

           "'….'

           "… There are no allegations of ongoing wrongdoing by
     Abbott within two years of the date Mobile Health filed its
     original complaint.    Therefore, Mobile Health's general
     allegation of a continuous public nuisance does not save its
     claims against Abbott from the statute-of-limitations bar."

342 So. 3d at 194-96 (some emphasis added).4

     4We   also explained that continued consequences of the original
tortious conduct do not constitute a continuing tort; rather, we explained,
there must be continued tortious conduct:

     "[T]he fact that the alleged opioid epidemic itself was ongoing
     at the time Mobile Health filed its original complaint does not
     mean that Abbott's conduct in relation to the epidemic is not
     subject to the statute of limitations. As the Court explained
     in Payton[ v. Monsanto Co., 801 So. 2d 829 (Ala. 2001)]:

           " 'Alabama law does not recognize a continuing tort
           in instances where there has been a single act
           followed by multiple consequences.'2

           " '_______________

                 " '2Moon v. Harco Drugs, Inc., 435 So. 2d 218,
           220-21 (Ala. 1983), discusses the concept of
           "continuous tort," describing it as a defendant's
                                    52
SC-2023-0289

      The petitioners certainly have a point that this case is very similar

to Abbott. I find it very difficult to distinguish that case from the

procedural posture in this case. Both this case and Abbott present (1)

nuisance claims regarding improper prescription-drug distribution; (2)

allegations based on specific facts that occurred more than two years

before the lawsuit was commenced; and (3) general allegations that the

wrongful conduct continued.

      The main opinion contends, among other things, that Abbott can be

distinguished because the complaint in that case specifically alleged that

              liability for repeated wrongs to the plaintiff. Then,
              the Court offers several illustrations, including
              "when a plaintiff landowner seeks damages for the
              contamination of a well or stream." Id. at 221.
              However, the three cases cited to support this
              proposition involve repetitive acts or ongoing
              wrongdoing[:] Howell v. City of Dothan, 234 Ala.
              158, 174 So. 624 (1937) (ongoing discharge of
              sewage), Employers Insurance Co. of Alabama v.
              Rives, 264 Ala. 310, 87 So. 2d 653 (1955) (opinion
              refers to repetitive acts), Alabama Fuel & Iron Co.
              v. Vaughn, 203 Ala. 461, 83 So. 323 (1919) (damage
              resulting from the ongoing operations of a coal
              mine).'

      "801 So. 2d at 835 (emphasis added)."

Id. at 196.
                                       53
SC-2023-0289

the wrongful "co-promotion agreement" to market the opioid OxyContin

between Abbott and Purdue had expired. True. But Abbott also included

general allegations of continued wrongful conduct after that agreement

had expired, just like here. For instance, the complaint in Abbott alleged:

     "'221. Each Marketing Defendant has conducted, and
     continues to conduct, a marketing scheme designed to
     persuade doctors and patients that opioids can and should be
     used for chronic pain, resulting in opioid treatment for a far
     broader group of patients who are much more likely to become
     addicted and suffer other adverse effects from the long-term
     use of opioids. In connection with this scheme, each
     Marketing Defendant spent, and continues to spend, millions
     of dollars on promotional activities and materials that falsely
     deny, trivialize, or materially understate the risks of opioids
     while overstating the benefits of using them for chronic pain.'"

Id. at 195 (emphasis added). And yet, this Court in Abbott held that the

claims against Abbott were due to be dismissed.

     Thus, how do we distinguish Abbott? Is it enough that the plaintiffs'

most recent amended complaint uses the words "upon information and

belief"? Is it enough that the complaint in this case uses a separate

paragraph for each defendant (by name) to make generalized allegations

of continued conduct? Perhaps the best argument is that there was no

reason to think in Abbott that the wrongful conduct persisted (even

though the complaint claimed that it did) because one particular factual

                                    54
SC-2023-0289

allegation of wrongdoing (the co-marketing agreement) had ended.

Whereas in the present case, perhaps there is reason to think that the

wrongs might have continued because the wrongs alleged with actual

facts did not include an end date. 5 I do not find any of these arguments

to be particularly persuasive in distinguishing Abbott from the present

case.

        If I were to only focus on distinguishing Abbott, I would dissent.

However, I note that this Court has a long line of caselaw holding that

our pleading standard is liberal. For instance, this Court has previously

stated:

        5It might be possible to argue that the language of Abbott requires

that allegations of continuing conduct be specific. For instance, in
rejecting the argument about general allegations of continued wrongful
conduct, this Court noted that "Mobile Health is certainly correct that it
generally alleged a continuous tort against the marketing defendants"
but that "the specific allegations against Abbott in the complaint do not
mention conduct of any kind by Abbott after 2006." Id. at 195 (some
emphasis added).

      However, the only textual basis in the Alabama Rules of Civil
Procedure for a requirement of "specific allegations" is in relation to
allegations of fraud or mistake, per Rule 9(b), Ala. R. Civ. P. ("In all
averments of fraud or mistake, the circumstances constituting fraud or
mistake shall be stated with particularity."). The petitioners have not
argued that Rule 9, Ala. R. Civ. P., applies to the continuing-tort
allegations here.

                                     55
SC-2023-0289

     " '[T]he dismissal of a complaint is not proper if the pleading
     contains "even a generalized statement of facts which will
     support a claim for relief under [Ala. R. Civ. P.] 8" (Dunson v.
     Friedlander Realty, 369 So. 2d 792, 796 (Ala. 1979)), because
     "[t]he purpose of the Alabama Rules of Civil Procedure is to
     effect justice upon the merits of the claim and to renounce the
     technicality of procedure." Crawford v. Crawford, 349 So. 2d
     65, 66 (Ala. Civ. App. 1977).' "

Segrest v. Segrest, 328 So. 3d 256, 274 (Ala. 2020) (quoting Simpson v.

Jones, 460 So. 2d 1282, 1285 (Ala. 1984)).

     Notably, this pleading standard is more liberal than the standard

currently applied in federal courts.     See generally Bell Atl. Corp. v.

Twombly, 550 U.S. 544 (2007), and Ashcroft v. Iqbal, 556 U.S. 662, 679

(2009) (requiring that the complaint state a "plausible claim"). If we were

to apply the federal pleading standard in this case, we would be called

upon to determine whether the allegation that "on information and

belief" the petitioners "continue[] to operate in ways that enable the

diversion of prescription opioids" is plausible in light of, among other

things, the actual facts pleaded in the most recent amended complaint.

However, in this case, we have been asked neither to adopt the federal

pleading standard nor to overrule our caselaw upholding Alabama's

                                    56
SC-2023-0289

liberal pleading standard. 6

     Moreover, the petitioners' motion was not an ordinary motion to

dismiss. It was a motion to dismiss based upon an affirmative defense.

As noted in the main opinion, " 'the standard for granting a motion to

dismiss based upon the expiration of the statute of limitations is whether

the existence of the affirmative defense appears clearly on the face of the

pleading.' " Jones v. Alfa Mut. Ins. Co., 875 So. 2d 1189, 1193 (Ala. 2003)

(quoting Braggs v. Jim Skinner Ford, Inc., 396 So. 2d 1055, 1058 (Ala.

1981)) (some emphasis added). I agree with the main opinion that it is

not clear from the face of the most recent amended complaint that the

plaintiffs' claims against the petitioners are barred by the applicable

statutes of limitations.

     Because this case is before us on a petition for a writ of mandamus

     6I note that federal courts and many state courts across the country

have operated under the heightened pleading standard enunciated in
Twombly and Iqbal, supra, for many years. While I offer no opinion on
whether this more stringent pleading standard should be adopted in
Alabama, I make this observation in the hope that future litigants may
consider raising this issue in an appropriate case for our Court to fully
consider after input from members of the public wishing to file amicus
briefs (including whether the heightened standard might be appropriate
in all cases or only in a subset of cases).

                                    57
SC-2023-0289

-- an "extraordinary remedy" which is applicable only when there is "'a

clear legal right,'" Ex parte Watters, 212 So. 3d 174, 180 (Ala. 2016)

(citation omitted) -- we need not decide at this time whether the plaintiffs

will be able to present proof that the petitioners actually engaged in the

alleged misconduct during the applicable limitations period. This Court

can confront that question, if necessary, on appeal, upon the facts that

are in the record, rather than upon the limited basis of the pleadings. 7 It

is for this reason that I concur in the result.

     7I note the argument of the plaintiffs that the petitioners' alleged

activity also constituted an "abatable nuisance." The petitioners reply by
arguing, among other things, that "abatable nuisance" was not pleaded
and that no abatable nuisance existed because it would require
additional tortious conduct within the limitations period, rather than
additional consequences from the earlier tortious conduct. They state
that each case cited by the plaintiffs involved "wrongdoing that occurred
within (and led to harm during) the limitations period." Petitioner's reply
brief at 6. Given the majority's resolution of this mandamus petition, we
need not reach the question whether the plaintiffs alleged an abatable
nuisance or whether, under Alabama law, an abatable nuisance requires
wrongful conduct within the limitations period -- i.e., whether in this case
the alleged nuisance is abated when the wrongful distribution of opioids
ceases or whether the alleged nuisance is abated only when the resulting
consequences of the distribution are remedied.
                                     58