Bell v. Hart
| Decision Date | 25 September 1987 |
| Citation | 516 So.2d 562 |
| Parties | Katie C. BELL and John P. Bell v. G. Rodney HART. 85-878. |
| Court | Alabama Supreme Court |
Barry Hess and William B. Jackson II of Hess, Atchison & Horne, Mobile, for appellants.
W. Boyd Reeves, Edward C. Greene, and Richard E. Jesmonth of Armbrecht, Jackson, DeMouy, Crowe, Holmes & Reeves, Mobile, for appellee.
The issue on appeal is whether John Guy Fisher III, Phar.D. (pharmacist), and Howard Lee Miller, Ph.D. (psychologist), were competent to testify as expert witnesses concerning the correct dosage and effect of the anti-depressant drug Elavil. The trial court determined that they were not competent to testify and granted summary judgment in favor of a doctor who had been sued for malpractice. We affirm.
On April 24, 1981, plaintiff Katie Bell went to Dr. G. Rodney Hart's office, complaining of headaches, weakness, insomnia, agitation, depression, and painful leg cramps. Bell had complained of these symptoms on prior visits to Dr. Hart's office. In view of the persistent nature of these problems, Dr. Hart had her admitted to Mobile Infirmary on April 24, 1981, for a complete medical evaluation.
Bell remained in the hospital for approximately two weeks. During this time, she underwent a thorough medical evaluation, which included examinations by vascular and neurological specialists, as well as tests of her liver, kidney, blood, muscle, and thyroid functions. After these tests, Dr. Hart was still unable to determine the source of her complaints, and on May 5, 1981, she was discharged from the hospital, at which time Dr. Hart prescribed Elavil, a tricyclic anti-depressant. She was to take the Elavil daily in a single 300-milligram dosage at bedtime. Dr. Hart hoped that the Elavil would eliminate her insomnia and the intense pain that she suffered as a consequence of leg cramps. She took the prescribed dosage on the first night she was home from the hospital, May 5, 1981. On the morning of May 6, her husband, John Bell, telephoned Dr. Hart's office and informed his receptionist that his wife had been incoherent and confused following her ingestion of Elavil. The Bells were instructed to proceed to the Providence Hospital Emergency Room for treatment; instead Mrs. Bell went to the Mobile Infirmary Emergency Room, where her condition was monitored for several hours. Subsequently, she was discharged to her home under orders from Dr. Hart.
The following day, May 7, she returned to Dr. Hart's office. At this visit, she appeared to be agitated and upset, attributing her incoherence and confusion to her ingestion of Elavil. Dr. Hart discontinued her use of Elavil and advised her to return to his office in one week. She did not return as instructed, and within four months filed this suit.
In her suit, she and her husband alleged that Dr. Hart committed medical malpractice in connection with his care and treatment of her during April and May of 1981. Specifically, they alleged that Dr. Hart negligently prescribed Elavil for her, and that his malpractice was so egregious as to constitute wanton and reckless misconduct.
Dr. Hart answered the complaint by denying any negligence or other improper conduct in connection with his care and treatment of her. Before trial, he filed three motions for summary judgment, alleging that the Bells had failed to present expert medical testimony regarding his negligence. The trial court denied all of these motions. Prior to the selection of the jury at trial, however, Dr. Hart filed motions, in limine, seeking to exclude the testimony of John Fisher and Howard Miller, a pharmacist and a psychologist respectively, on the ground that they were not competent to testify as experts.
The Bells were relying on the testimony of these two experts to prove that Dr. Hart negligently prescribed Elavil for Katie Bell. The first of these experts, Fisher, received a B.S. degree in pharmacy in 1974, from Samford University. He completed a one-year pharmacy internship at the Veterans' Administration Hospital in Birmingham after graduation. In 1976, he graduated with a Doctor of Pharmacy degree from the University of Tennessee Center for Health Sciences. While earning his doctorate in pharmacy, Fisher had two to four quarters of classroom work primarily involving the use of drugs and their effect when used in various disease states, which is referred to as pharmacotherapeutics. In addition, he took a number of courses in pharmacokinetics, which is the study of how the body reacts to drugs once they are in the body.
Fisher testified in deposition that, after his graduation in 1976, he taught at the College of Community Health Sciences at the University of Alabama as an assistant professor of family medicine. He was also the head of the family medicine department in applied pharmacology. In this position, Fisher was a consultant in drug therapy for third- and fourth-year medical students and for the 30 family medicine residents in the College of Community Health Sciences. He made the rounds with these students as they saw their patients and acted as a consultant about "alternative methods of treatments, proper doses, and potential side effects."
Fisher is presently employed as the chief of clinical pharmacokinetic services at Druid City Hospital, Regional Medical Center, in Tuscaloosa. In this job Fisher consults with doctors on the staff regarding drug problems that are occurring in their patients. It is also his job to run a drug and toxicology laboratory at the hospital, to perform all of the drug screens that are done in the hospital, and to measure the quantities of various drugs in the blood and other parts of the body. Fisher is also an associate director of the Alabama Poison Center, and he has worked as a pharmacist in Tuscaloosa. Finally, Fisher testified that he has had occasion to study and review literature and treatises by experts and various professionals that examined the effect of certain prescriptive drugs, including what are generally referred to as tricyclic anti-depressants such as amitriptylene hydrochloride (Elavil).
The Bells wanted to use Howard Lee Miller as their second expert witness. Miller had a bachelor's degree and a master's degree in psychology from Western Missouri University. He received a doctorate in external psychology from the University of Hawaii, and he obtained a post-doctoral degree in the basic medical sciences program at Western Missouri University School of Medicine. Additionally, Miller had an experimental pathology fellowship at the Institute of Pathology and received a master of public health degree from the School of Public Health at the University of Alabama in Birmingham. Miller testified in deposition that he has had occasions to take courses and to do research related to the prescription, use, dosage, and administration of various drugs under different circumstances. He has studied pharmacology, psychopharmacology, and toxicology. In addition, Miller has taught college level courses in psychopharmacology, which is related to the use, dosage, and administration of drugs and the effects of drugs upon individuals who have taken them under varying circumstances, including, but not limited to, psychiatric drugs that might affect the central nervous system. Miller testified that he had been a certified or licensed drug investigator for the Drug Enforcement Agency and that part of his responsibilities included doing research on drugs and their effects.
Miller has been a consultant to numerous mental health clinics, including the Alabama Bureau of Vocational Rehabilitation, the Ohio Bureau of Vocational Rehabilitation, the Lowndes County Health Department, the Northwest Alabama Rehabilitation Center, and the Muscle Shoals Mental Health Center. Part of his duties included consultation, diagnosis, and recommendations to doctors about clients or patients and the medications that they were taking. Miller further testified that his education, his clinical and professional experience, and his studies gave him the opportunity to consider, review, and ascertain the accepted standard of care in the medical community for the use, dosage, and administration of amitriptyline hydrochloride, or Elavil. In this connection, Miller testified that tricyclic anti-depressants formed a major subject of the consulting and teaching that he did in psychopharmacology, and that he had reviewed the primary literature and original research studies on these drugs and was familiar with them.
Both "experts" testified that Dr. Hart deviated from the accepted standard of care in the medical community for the prescription, dosage, and administration of the drug Elavil to plaintiff Katie Bell.
After reviewing the depositions of Fisher and Miller, the court granted Hart's motion in limine. Hart then filed a motion to have the court reconsider its order denying his third motion for summary judgment. The trial court granted the third motion for summary judgment. The Bells appeal from that judgment.
The first issue raised on appeal is whether the trial court erred when it excluded the testimony of Fisher and Miller on the ground that they were not competent to testify as to the standard of care within the medical community with respect to the use, dosage, and administration of Elavil.
The plaintiffs contend that the trial court erred when it determined that the only expert who can testify to the acceptable standard of care in the community, and whether someone has deviated from that standard of care, is a physician licensed to practice medicine. The Bells argue that a person who can show that he has the educational, clinical, and professional experience and the affiliations with the medical community that Fisher and Miller have is competent to testify in medical malpractice cases as an expert witness as to the acceptable standard of care in the medical community. Dr. Hart contends that, in...
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