Medlin v. Crosby

• Decision Date: 14 June 1991
• Citation: 583 So.2d 1290
• Parties: Betty Jean MEDLIN, as administratrix of the Estate of Alice Bell Shoffeitt, deceased v. Dr. J. Dell CROSBY. 89-1464.
• Court: Alabama Supreme Court

Page 1290

583 So.2d 1290

Betty Jean MEDLIN, as administratrix of the Estate of Alice Bell Shoffeitt, deceased v. Dr. J. Dell CROSBY.

89-1464.

Supreme Court of Alabama.

June 14, 1991.

Michael A. Worel and Andrew T. Citrin of Cunningham, Bounds, Yance, Crowder and Brown, Mobile, for appellant.

Robert A. Huffaker and Thomas H. Keene of Rushton, Stakely, Johnston & Garrett, Montgomery, and Phillip E. Adams, Jr. of Walker, Hill, Adams, Umbach & Meadows, Opelika, for appellee.

INGRAM, Justice.

This is an appeal from a summary judgment for the defendant "health care provider" entered by the trial court because the plaintiff failed to provide an expert witness who was a "similarly situated health care provider," as defined in § 6-5-548, Ala.Code 1975, to establish the standard of care alleged to have been breached.

On the morning of March 22, 1989, Alice Bell Shoffeitt was taken to the emergency room at East Alabama Medical Center (hereinafter "EAMC"), complaining of nausea, vomiting, and pain in her chest and arms. Dr. J. Dell Crosby, the physician in attendance in the emergency room, diagnosed her as suffering from osteoarthritis and advised her to consult her regular physician if her complaints continued, worsened, or changed. He prescribed Demerol, Vistaril, and Darvocet for pain and then released Mrs. Shoffeitt.

Later that day, Mrs. Shoffeitt's husband found that she had stopped breathing. Paramedics, summoned by Mr. Shoffeitt, transported Mrs. Shoffeitt to the emergency room at EAMC. The physicians and staff of the emergency room were able to restore her heartbeat, but she was kept alive only by means of life-support systems. After several days on the life-support systems, the family requested that the systems be terminated. Mrs. Shoffeitt died on March 28, 1989. An autopsy revealed that her death was caused by cardiopulmonary arrest due to an acute myocardial infarction.

Betty Jean Medlin, Mrs. Shoffeitt's daughter, in her capacity as administratrix of Mrs. Shoffeitt's estate, sued Dr. Crosby. Dr. Crosby filed a motion for summary judgment on the basis that Medlin had failed to designate an expert witness who met the definition of "similarly situated health care provider" within the meaning of § 6-5-548(c), Ala.Code 1975. The statute provides:

"In any action for injury or damages or wrongful death, whether in contract or in tort, against a health care provider for breach of the standard of care the plaintiff shall have the burden of proving by substantial evidence that the 'health care provider' failed to exercise such reasonable care, skill and diligence as other similarly situated health care providers in the same general line of practice...."

Ala.Code 1975, § 6-5-548(a).

Subsection (c), the section applied by the trial court, defines a "similarly situated health care provider" as one who:

"(1) Is licensed by the appropriate regulatory board or agency of this or some other state; and

"(2) Is trained and experienced in the same specialty; and

"(3) Is certified by an appropriate American board in the same specialty; and

"(4) Has practiced in this specialty during the year preceding the date that the alleged breach of the standard of care occurred."

Id. (c).

Dr. Crosby is board certified in family medicine. He has practiced as a full-time emergency room physician since June 1986. Medlin's expert, Dr. Jonathan Borak, is certified in internal medicine, has practiced emergency medicine, and currently teaches emergency medicine at Yale Medical School.

After a hearing, the trial court entered a summary judgment in favor of Dr. Crosby because "[n]o expert testimony ha[d] been offered by the Plaintiff by any medical witness who is 'certified by an appropriate American board in the same specialty' as the defendant Physician, within the meaning of Section 6-5-548(c)(3), Code of Alabama, 1975." It is from this summary judgment that Medlin appeals.

The trial court found that Medlin's expert witness, Dr. Borak, failed to meet the qualifications, established by § 6-5-548(c), of a "similarly situated health care provider," and that, therefore, Dr. Borak could not provide testimony as to the standard of care Dr. Crosby, the defendant "health care provider," allegedly breached, which was required to withstand the motion for summary judgment.

On appeal, Medlin raises two issues: (1) whether the trial court correctly interpreted and applied § 6-5-548, and (2) whether the statute is unconstitutional.

The only ground given by the trial court for not qualifying Dr. Borak as a "similarly situated health care provider" was that he was not certified in the same specialty as Dr. Crosby. Dr. Borak is board certified in internal medicine, and Dr. Crosby is board certified in family medicine. However, both doctors practice emergency medicine, and the standard of care required by a doctor practicing emergency medicine is the standard that Dr. Crosby allegedly breached. The incident from which this cause of action arose occurred in the emergency room of EAMC. Dr. Crosby worked exclusively in that emergency room and had no private practice.

Medlin argues that the trial court erred in applying subsection (c) of § 6-5-548 to the facts before it. As stated previously, subsection (c) provides that in order to testify against a health care provider whose acts created the cause of action, the "similarly situated health care provider" (1) must be licensed to practice medicine in this or another state, (2) must be trained and experienced in the same specialty as the defendant "health care provider," (3) must be board certified in the same specialty, and (4) must have practiced in the same specialty during the year preceding the alleged breach.

Medlin argues that, because Dr. Crosby was not board certified in emergency medicine, this case, factually, falls outside of subsection (c) and should have been determined under subsection (b). Subsection (b) applies when the defendant "health care provider" (1) is not certified as a specialist, (2) is not trained or experienced in a specialty, or (3) does not hold himself out as a specialist. § 6-5-548(b).

Dr. Crosby contends that the trial court properly applied subsection (c). Subsection (c) applies when the defendant "health care provider" (1) is certified as a specialist, (2) is trained and experienced in a specialty, or (3) holds himself out as a specialist. Id. (c). He contends that the trial judge interpreted the statute according to the plain language, which requires a "similarly situated health care provider" to be board certified in the same specialty as the defendant "health care provider."

Our interpretation of the statute leads us to conclude that the trial court must answer three questions before deciding whether a proffered expert witness qualifies as a "similarly situated health care provider" within the meaning of the statute: (1) What is the standard of care alleged to have been breached? (2) Is the defendant "health care provider" a specialist in the discipline or school of practice of the standard of care that the court has previously determined is alleged to have been breached? (3) Does the proffered expert witness qualify as a "similarly situated health care provider" under the subsection determined in the second step to apply.

First, a trial court must determine the standard of care the defendant "health care provider" allegedly breached. In the instant case, Medlin alleged that Dr. Crosby did not properly diagnose Mrs. Shoffeitt's heart attack because, she says, he failed to take a proper history and failed to perform the tests required by the situation. Specifically, Medlin alleged that, when Dr. Crosby saw Mrs. Shoffeitt in the emergency room, he negligently failed to take an adequate history of her complaints, which included nausea, fatigue, and dizziness. She also alleged that he negligently failed to perform an adequate physical examination and that he negligently failed to rule out that Mrs. Shoffeitt was suffering a myocardial infarction, through his failure to do enzyme studies and an electrocardiogram. The standard of care to be applied in the instant case is that of a "health care provider" practicing emergency medicine.

After determining the standard of care alleged to have been breached, the trial court must next determine whether the defendant "health care provider" is a specialist, as defined in subsection (c), in that discipline, i.e., emergency medicine, or not a specialist, as defined in subsection (b). In the instant case, the appropriate specialty is emergency medicine, the discipline Dr. Crosby was practicing when he allegedly breached the standard of care with regard to Mrs. Shoffeitt's treatment. The classification of the defendant "health care provider" as a specialist determines the qualifications required of an expert witness who is a "similarly situated health care provider"; therefore, before a trial court can decide whether a particular expert is qualified to testify, the court must determine whether the defendant "health care provider" is to be treated as a specialist under § 6-5-548(c).

In order for a defendant "health care provider" to be classified as a specialist under subsection (c), the defendant "health care provider" must (1) be board certified, (2) be trained and experienced in the specialty, or (3) hold himself out as a specialist. § 6-5-548(c). The criteria by which a defendant "health care provider" is to be classified as a specialist are joined by the disjunctive conjunction "or." The plain-language interpretation of the statute would appear to be that the defendant "health care provider" need meet only one of the requirements to qualify as a specialist under subsection (c).

Subsection (b), on the other hand, applies to a defendant "health care provider" who (1) is not board certified in a specialty; (2) is not trained and experienced in a specialty; or (3) does not hold himself out as a specialist. Again, ...