Thompson v. Patton

• Decision Date: 10 October 2008
• Docket Number: 1061540.
• Parties: Marty THOMPSON, administrator of the estate of Peggy Sue Ellis v. Rita W. PATTON, M.D., and Frank Kay Psychiatric Clinic.
• Court: Alabama Supreme Court

6 So.3d 1129

Marty THOMPSON, administrator of the estate of Peggy Sue Ellis v. Rita W. PATTON, M.D., and Frank Kay Psychiatric Clinic.

1061540.

Supreme Court of Alabama.

October 10, 2008.

Kenneth E. Riley of Farris, Riley & Pitt, L.L.P., Birmingham, for appellant.

Randal H. Sellers, Laura H. Peck, and Joseph L. Reese, Jr., of Starnes & Atchison, LLP, Birmingham, for appellees.

SMITH, Justice.

Marty Thompson, administrator of the estate of Peggy Sue Ellis, appeals from a judgment entered in favor of Dr. Rita W. Patton and her employer, Frank Kay Psychiatric Clinic ("the Clinic"). We affirm.

Facts and Procedural History

This is the second time this case has come before this Court. See Patton v. Thompson, 958 So.2d 303 (Ala.2006). The following facts and procedural history as summarized in Patton are relevant to this appeal:

"Peggy Sue Ellis suffered from and had been treated for a serious psychiatric illness for approximately 30 years when she was admitted to Baptist Medical Center Montclair (hereinafter `BMCM') on November 11, 1999. She had previously been hospitalized for management of her psychiatric illness, and she had a history of suicide attempts. Before her November 11, 1999, admission, Ellis had been admitted three times to BMCM in 1999 for management of her psychiatric illness. Dr. Patton was Ellis's physician during all of her admissions in 1999.

"Ellis was admitted to BMCM on November 11, 1999, following a suicide attempt. Dr. Patton prescribed Seroquel, a psychotropic agent used to treat schizophrenia. Ellis was placed on a suicide watch in the hospital; the watch continued during her hospital stay. Her condition waxed and waned during her stay. Her condition regressed from November 18 to November 19, and the dosage of her medication was increased. On November 22, 1999, when Ellis was asked whether she would hurt herself, she replied `I hope not.' That same day, Ellis stated that she was scared and worried, and she showed signs of paranoia and unreasonable fears regarding her family. She also stated that she was anxious about being discharged the next day.

"Ellis was discharged on November 23, 1999, with a discharge plan formulated by Dr. Patton. The plan included: (1) a follow-up appointment with Ellis's therapist at the Eastside Mental Health Center for the next morning; (2) arrangements for daily visits by a home-health psychiatric nurse to monitor Ellis's mental state and to monitor compliance with the prescribed medication; and (3) help from Ellis's cousin in monitoring compliance with the prescribed medication.

"On November 24, 1999, Ellis went to the Eastside Mental Health Center, where she was evaluated by her therapist. The therapist noted that Ellis had been unable to fill her prescription for Seroquel and that she was confused about her medications, obsessed with psychotic thoughts, and frightened and that she had an `inappropriate and blunted affect.' Dr. Patton was unaware that Ellis had not been able to fill her prescription. On November 26, 1999, Ellis was found dead in her apartment of a drug overdose. The coroner determined that the manner of death was suicide. At the time of her death, Ellis was 53 years old.

"On November 19, 2001, Marty Thompson, as administrator of Ellis's estate, sued Dr. Patton and the Clinic, alleging wrongful death under the Alabama Medical Liability Act, § 6-5-480 et seq. and § 6-5-541 et seq., Ala.Code 1975 (`the AMLA'). Thompson alleged that Dr. Patton had breached the standard of care by discharging Ellis from the hospital prematurely, failing to formulate an appropriate outpatient-treatment plan, failing to readmit Ellis to a psychiatric unit, and failing to implement proper suicide precautions.

"At trial on March 19, 2004, Dr. Nathan Strahl, a psychiatrist, testified as an expert witness for Thompson.[¹] . . .

"`. . . .'

"Dr. Patton and the Clinic moved for a judgment as a matter of law at the close of Thompson's case, which the trial court denied. Dr. Patton and Dr. Joseph Lucas, a psychiatrist, testified for the defense. Dr. Patton and the Clinic again moved for a judgment as a matter of law at the conclusion of all the evidence. The trial court denied the motion. The jury was unable to reach a verdict, and the trial court declared a mistrial. Dr. Patton and the Clinic filed a motion entitled `Defendants' Rule 50(b)[, Ala. R. Civ. P.,] Renewed Motion for a Judgment as a Matter of Law, or, Alternatively Styled, Motion for a Summary Judgment.' In that motion, they argued that Thompson failed to meet his burden of producing sufficient evidence to prove that Dr. Patton's alleged negligence was the proximate cause of Ellis's death. The trial court denied the motion. . . ."

958 So.2d at 304-06.

In its order denying Dr. Patton and the Clinic's motion, the trial court concluded "`that [Thompson] has proffered sufficient evidence that a genuine issue of material fact exists, so as to allow this case to proceed to trial.'" 958 So.2d at 306. Relying on the decisions of this Court in Keeton v. Fayette County, 558 So.2d 884 (Ala.1989), and Keebler v. Winfield Carraway Hospital, 531 So.2d 841 (Ala.1988), the trial court held that Thompson's evidence regarding the foreseeability of Ellis's suicide was also sufficient to create a genuine issue of fact as to whether Dr. Patton's alleged negligence proximately caused Ellis's death. Patton, 958 So.2d at 306. The trial court then certified, for a permissive appeal to this Court under Rule 5, Ala. R.App. P., the following controlling question of law:

"`The controlling question of law is the degree of proof necessary to establish the essential element of proximate causation in a medical malpractice/wrongful death action against a psychiatrist for the suicide of that psychiatrist's patient and whether the plaintiff in this case has met that requisite degree of proof.'"

958 So.2d at 304.

In Patton, this Court noted that "the record support[ed] the trial court's findings in its order that Dr. Patton knew that Ellis had suicidal proclivities and that she was aware that Ellis had manifested suicidal proclivities during her last hospitalization," and Thompson argued that "he [had] established proximate cause by presenting evidence of Ellis's suicidal proclivities, in accordance with Keebler." 958 So.2d at 311. However, this Court stated that Thompson's reliance on Keebler and Keeton was misplaced, because those decisions addressed "the duty owed, based upon the presence or absence of the foreseeability of suicide, rather than the proximate-causation issue presented by the trial court in the controlling question here." Patton, 958 So.2d at 309 (emphasis added). Accordingly, this Court concluded:

"The trial court in its order denying the defendants' motion for a judgment as a matter of law blurred the distinction between the different elements necessary to establish medical malpractice when it stated, based on Keebler and Keeton: `Alabama law bases proximate causation in suicide cases on the foreseeability of the decedent's suicide.' However, the answer to the first part of the controlling question is that the plaintiff in any medical-malpractice action, including medical-malpractice/wrongful-death actions against a psychiatrist resulting from the suicide of that psychiatrist's patient, must prove by substantial evidence that the psychiatrist breached the applicable standard of care and that that breach was a proximate cause of the patient's injuries."

958 So.2d at 312.

Noting that "`"the question of proximate cause is almost always a question of fact,"'" however, this Court refused to answer that part of the question certified by the trial court asking "whether Thompson met the burden of proof in this case regarding proximate cause." 958 So.2d at 312 (quoting Norris v. City of Montgomery, 821 So.2d 149, 155 (Ala.2001), quoting in turn Lemond Constr. Co. v. Wheeler, 669 So.2d 855, 862 (Ala.1995)). This Court stated that "`Rule 5[, Ala. R.App. P.,] is not a vehicle by which to obtain review of "significant and unresolved factual issues."'" 958 So.2d at 312 (quoting Gowens v. Tys. S., 948 So.2d 513, 530 (Ala. 2006), quoting in turn Spain v. Brown & Williamson Tobacco Corp., 872 So.2d 101 104 (Ala.2003) (emphasis added in Gowens)).

After this Court's decision in Patton, Dr. Patton and the Clinic filed another motion entitled "Rule 50(b) Renewed Motion for Judgment as a Matter of Law or, Alternatively Styled, Motion for Summary Judgment." Dr. Patton and the Clinic again argued that Thompson had failed to offer sufficient evidence of proximate cause.

The trial court granted Dr. Patton and the Clinic's motion and entered a judgment against Thompson on June 26, 2007. The trial court held that expert testimony was required to establish proximate causation in Thompson's case because, the trial court held, the issue was "beyond the ken of the layman in his common knowledge and experience." The trial court concluded that the expert testimony of Dr. Nathan Strahl, the psychiatrist who testified as Thompson's expert witness, was not substantial evidence suggesting that Dr. Patton's alleged negligence probably caused Ellis's suicide.

Thompson timely appealed to this Court.

Standard of Review

The trial court, in its order granting Dr. Patton and the Clinic's motion, did not state whether it was treating the motion as a renewed motion for a judgment as a matter of law under Rule 50(b), Ala. R. Civ. P., or as a motion for a summary judgment under Rule 56, Ala. R. Civ. P. In either case, our review of the sufficiency of the evidence of proximate causation, as well as the trial court's application of law in making its causation determinations, is de novo. See Leiser v. Raymond R. Fletcher, M.D., P.C., 978 So.2d 700, 705-06 (Ala.2007), in which this Court quoted the following from Waddell & Reed, Inc. v. United Investors Life Insurance Co., 875 So.2d 1143, 1152 (Ala.2003):

"`When reviewing a ruling on a motion for...