Hannah v. . Naughton
| Decision Date | 25 September 2020 |
| Docket Number | 1190216 |
| Citation | 328 So.3d 777 |
| Parties | Regina D. HANNAH v. Michael J. NAUGHTON, M.D., Michael J. Naughton, M.D., Ph.D., LLC, Terisa A. Thomas, M.D., and Terisa A. Thomas, M.D., P.C. |
| Court | Alabama Supreme Court |
Ralph K. Strawn, Jr., of Strawn & Robertson, LLC, Gadsden, for appellant.
Walter W. Bates, Sybil V. Newton , and J. Bennett White of Starnes Davis Florie LLP, Birmingham, for appellees.
Regina D. Hannah appeals from a summary judgment entered by the Etowah Circuit Court in favor of Michael J. Naughton, M.D.; Michael J. Naughton, M.D., Ph.D., LLC; Terisa A. Thomas, M.D.; and Terisa A. Thomas, M.D., P.C. (hereinafter collectively referred to as "the defendants"), on Hannah's claims alleging medical malpractice.
On August 1, 2005, Hannah was seen by Dr. Terisa A. Thomas, a board-certified general surgeon, for a female health-care examination. Hannah was 32 years old at the time she was first seen by Dr. Thomas and was complaining of fatigue, weight gain, heavy menstrual cycles, cramping, and painful sexual relations. Hannah also reported a significant family medical history of cervical cancer and stated that she was fearful of getting cancer. Hannah stated that her mother, grandmother, and sister had suffered from cervical cancer. Dr. Thomas ordered a number of tests, including a pelvic ultrasound and a Pap smear. Hannah returned to Dr. Thomas on August 10, 2005. Dr. Thomas informed Hannah at that time that the pelvic ultrasound was normal and that the results of the Pap smear were still pending.
Dr. Thomas received the results of Hannah's Pap smear on August 12, 2005. The Pap-smear report indicated that it was "abnormal" with a diagnosis of Dr. Thomas stated that this was not a diagnosis of cancer but, rather, that she considered it an abnormal finding indicative of an "increased risk" of cancer. After receiving the Pap-smear report, Dr. Thomas's office contacted Hannah to schedule a follow-up appointment for August 15. Dr. Thomas's office also faxed a copy of the Pap-smear report to Dr. John Morgan, an obstetrician/gynecologist, and scheduled an appointment for Hannah with Dr. Morgan for August 16. Dr. Thomas explained that she went ahead and scheduled the appointment for Hannah with Dr. Morgan before actually seeing Hannah because she anticipated the need for follow-up care and testing and because she did not want Hannah to have to wait for follow-up care in light of her extreme fear of cancer and her family history of cancer.
Hannah testified that a nurse from Dr. Thomas's office contacted her while she was at work to schedule the follow-up appointment for August 15. Hannah testified that the nurse told her that the results of the Pap smear indicated the presence of atypical squamous cells. Hannah stated that she asked the nurse what atypical squamous cells were and that the nurse responded that they were cervical cancer. Hannah testified that when the nurse told her on the telephone that she had cervical cancer she became very upset and started crying. Hannah stated that at that point Dr. Thomas got on the telephone to ask her to come into the office and that they would discuss the results of the Pap smear further. Hannah testified that her coworkers were present and witnessed her conversation with Dr. Thomas's office. Dr. Thomas stated that her staff would not discuss the results of the Pap smear with Hannah over the telephone and that she "would just be told that she needed to come back in to discuss her results." Dr. Thomas further stated that she did not remember talking to Hannah on the telephone.
Hannah was seen by Dr. Thomas on August 15 for the follow-up appointment regarding the results of the Pap smear. Dr. Thomas testified that she discussed the results of the Pap smear with Hannah, telling her that the Pap smear showed the presence of "abnormal squamous cells" and that "it could not exclude high grade squamous intraepithelial lesion." Dr. Thomas stated that she told Hannah the Pap smear was abnormal but that it "certainly was not cancer." Dr. Thomas said she further informed Hannah that the presence of abnormal cells put her at an increased risk for cervical cancer and that she would need to be closely monitored.
Dr. Thomas explained to Hannah that her normal practice with patients who have an abnormal Pap smear is to refer them to an obstetrician/gynecologist for a second opinion and that they had already scheduled an appointment for her with Dr. Morgan. Dr. Thomas testified that Hannah continued to be extremely anxious and repeatedly stated that she had a significant family history of cervical cancer and that she was fearful of getting cancer. Dr. Thomas testified that Hannah told her that "she wanted to have it all [taken] out" and wanted to discuss surgical options. Dr. Thomas stated that she proceeded to discuss a total abdominal hysterectomy with Hannah, which may or may not involve the removal of her ovaries. Dr. Thomas stated that she told Hannah that if she had her ovaries removed she would require hormone-replacement therapy. Dr. Thomas documented her conversation with Hannah in her records, noting that the "[patient] wishes to proceed [with] hysterectomy due to abnormal Pap and strong [family history of cancer ]."
Hannah testified that, when she arrived at Dr. Thomas's office on August 15, she signed in and was taken to Dr. Thomas's private office. Hannah testified that Dr. Thomas told her that she had cervical cancer and that she recommended Hannah have a hysterectomy, including the removal of her ovaries. Hannah stated that no options were given other than a hysterectomy. Hannah denied making the statement to Dr. Thomas that she "wanted it all out." Hannah testified that she was upset and that Dr. Thomas was "very consoling."
Hannah's appointment with Dr. Morgan was canceled. Because Dr. Thomas does not perform hysterectomies, Hannah was given the names of several surgeons to whom Dr. Thomas referred patients for hysterectomies. Hannah selected Dr. Naughton, a board-certified general surgeon. Dr. Thomas contacted Dr. Naughton while Hannah was still in her office. Dr. Thomas related to Dr. Naughton that she had a patient she wanted to refer to him for a second opinion following an abnormal Pap smear. Dr. Thomas told Dr. Naughton that Hannah was 32 years old and was extremely fearful of contracting cervical cancer because of her significant family history of cervical cancer. Dr. Thomas informed Dr. Naughton that Hannah insisted on having a complete hysterectomy. Dr. Naughton asked Dr. Thomas if Hannah had children because she was young to have a hysterectomy. Dr. Thomas responded that Hannah had a previous tubal ligation and did not want to have more children. Dr. Naughton agreed to see Hannah that day.
Hannah was first seen by Dr. Naughton on August 15, for an evaluation for a hysterectomy. Hannah related a history to Dr. Naughton of two vaginal births, heavy bleeding during menstrual cycles, painful sexual intercourse, a tubal ligation, and a significant family history of breast cancer and cervical cancer. Dr. Naughton stated that Hannah told him that she was "very fearful of having cancer." Dr. Naughton performed a pelvic exam on Hannah and noted that she experienced pain upon any movement of her cervix or uterus. Dr. Naughton also noted that he did not observe any lesions or abnormal tissue during the examination. Dr. Naughton testified that he told Hannah "at least three times" that she did not have cancer and that the majority of abnormal Pap smears revert to normal.
Dr. Naughton testified that he told Hannah there were "multiple options" available to her and that his initial recommendation to her was to repeat the Pap smear in six months. Dr. Naughton informed her that if the second Pap smear came back abnormal they could discuss the option of having a directed biopsy performed. Dr. Naughton also discussed more aggressive treatment options, including the removal of the uterus and cervix with the preservation of the ovaries or the removal of the uterus, cervix, and the ovaries. Dr. Naughton testified that Hannah chose the most aggressive option, specifically stating that she wanted "it all out," including her ovaries. Dr. Naughton agreed that Hannah's choice to remove her ovaries was indicated, given her fear of developing ovarian cancer as well as the fact that an abnormality on the ovaries could be the cause of her painful intercourse. Dr. Naughton informed Hannah that if her ovaries were removed she would require hormone-replacement therapy.
Dr. Naughton had Hannah execute a "surgical-awareness" form indicating that she accepted full responsibility for her decision to have the surgery. Dr. Naughton stated that he made the following notes on the form in Hannah's presence: Both Dr. Naughton and Hannah signed the "surgical-awareness" form. The form containing Dr. Naughton's handwritten notations was faxed by Dr. Naughton's office to the Riverview Medical Center before surgery and was received by that facility at 6:34 A.M. on August 18, 2005.1
Hannah testified that when she first saw Dr. Naughton he reviewed her test results, took a medical history, and performed a pelvic exam. Hannah stated that Dr. Naughton then told her that he "agreed with Dr. Thomas ... that I had cervical cancer, and he told me [that] his staff could set the surgery." Hannah stated that she asked Dr. Naughton about preserving her ovaries and that he stated that there was a chance the cancer would come back in the ovaries so he recommended removing the ovaries. Hannah stated that Dr. Naughton never informed her that cancer could not be diagnosed from...
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