In 2021, the Alabama Supreme Court again addressed the need for expert testimony in medical liability cases as well as the timing of injury accrual for statute of limitations purposes. Most notably, the Alabama Supreme Court affirmed a $6.5 million medical malpractice wrongful death award which is the largest such award ever approved by the court. If we can provide any additional information on any of these matters, please feel free to contact Walter Price or any of our medical malpractice attorneys.
$6.5 Million Wrongful Death Award Affirmed
Bednarski v. Johnson, No. 1200183, 2021 Ala. LEXIS 109 (Sep. 30, 2021)
The deceased patient, an Auburn University student, visited her gynecologist with her mother for evaluation and prescription of a birth-control method. The patient’s mother informed the physician that she had experienced multiple blood clots and the physician ordered a test to determine if the daughter was also at risk of experiencing blood clots. The tests revealed the presence of factor V Leiden, which contributes to the possibility of blood clotting. Unfortunately, the physician failed to accurately determine the results of the test and both mother and daughter were informed that the test results were negative for blood-clotting factors. Hormonal birth-control pills were prescribed, which in combination with the presence of factor V Leiden, would increase the risk for blood clots.
Two months later, the patient visited Auburn Urgent Care complaining of shortness of breath, chest pain, coughing, a headache, and sore throat. Dr. Bednarski diagnosed her with bronchitis and prescribed an antibiotic. She returned two days later complaining of a much worsened condition, including sharp chest pain and extreme shortness of breath. A blood test was conducted, and Dr. Willis, the physician who she saw on the return visit, diagnosed the patient with leukocytosis and dyspnea and prescribed an inhaler. The next morning, the patient died from a pulmonary blood clot.
After a pro tanto settlement agreement was reached with the gynecologist, the case proceeded against Dr. Bednarski and the urgent care clinic. At trial, the jury returned a general verdict in favor of the Plaintiff in the amount of $9 million. In response to the Defendant’s request for a remittitur, the trial court reduced the punitive damages award to $6.5 million. This amount was affirmed on appeal. This is the largest medical malpractice wrongful death award affirmed by the Alabama Supreme Court.
In approving the award, the appellate court focused on aggravating factors which likely were the cause for the original $9 million verdict. The trial court found that Dr. Bednarski and the clinic undertook conduct contributing to the patient’s death which was the result of deliberate decisions to maximize financial gain. For example, the clinic had a system that assigned only one doctor to the clinic, and did not limit the number of patients that the doctor could see per shift, often resulting in one physician seeing between 50 and 90 patients in one 12-hour shift. The trial court found that this system encouraged doctors to take shortcuts and to make diagnostic guesses. The trial court further found that Dr. Bednarski had taken shortcuts when he treated the patient on the first visit by failing to properly document in her record. As regards to the second visit, the Court found that Dr. Bednarski had instructed Dr. Willis not to access the electronic medical-records system and that he had not given that second physician a code to do so because Dr. Bednarski did not want to pay for an additional code.
Interestingly, with respect to comparing the conduct and award in this matter to prior, comparable cases, Plaintiff argued that prior awards should be adjusted for inflation, meaning that the $6.5 million award in the Johnson case should be consistent with prior punitive awards. We have predicted that this argument would ultimately be made, though the Supreme Court of Alabama did not decide whether or not to adopt the inflation analysis.
Alleged Supply of Defective Medical Equipment Covered by the AMLA
Jackson Hosp. & Clinic, Inc. v. Murphy, No. 1190463, 2021 Ala. LEXIS 65 (June 25, 2021)
The Alabama Supreme Court reversed the trial court’s denial of Jackson’s post-judgment motion in a case where it was alleged that Jackson Hospital had supplied defective medical equipment. The Plaintiff had developed kidney stones and his urologist recommended a ureteroscopy procedure to remove the stones. During the procedure, the urologist used, among other surgical instruments, a guidewire to establish the correct surgical path to the patient’s kidneys. After an apparently uneventful procedure, a later x-ray revealed that a piece of the guidewire used during the procedure remained lodged in Plaintiff’s bladder.
Following the trial, a Montgomery County, Alabama jury returned a verdict in the amount of $100,000.00. While there appeared to be some question about whether Plaintiff had properly alleged a claim relating to Jackson Hospital’s supply of the guidewire, the appellate court, nonetheless, confirmed that a claim that a hospital provided defective equipment during the course of medical treatment is a claim governed by the provisions of the Alabama Medical Liability Act. Because Plaintiff presented no evidence, either by expert testimony or otherwise, that Jackson Hospital breached the applicable standard of care the jury verdict was unsupported and Jackson Hospital was due judgment as a matter of law.
Need for Expert Testimony
Fletcher v. Health Care Auth. of Huntsville, No. 1190706, 2021 Ala. LEXIS 73 (June 30, 2021)
Plaintiff presented to Huntsville Hospital for a laparoscopic tubal-ligation surgery. In the course of the procedure the physician asked that the operating table be manipulated so as to place the patient in deep Trendelenburg position. Although Plaintiff was secured to the table, she slipped downward off of the table and was lowered to the operating room floor by nursing staff. The patient filed suit claiming that she was injured during the event. The trial court granted summary judgment in favor of the hospital given the Plaintiff’s failure to present expert medical testimony proving the standard of care, a breach of that standard, or proximate causation. Plaintiff argued that she was not required to present expert medical testimony because the incident was foreseeable, the equipment was under control of hospital staff, and the equipment was misused. In affirming summary judgment, the Alabama Supreme Court disagreed finding that the standard of care for restraining a surgical patient who may be placed in the deep Trendelenburg position during surgery is not a matter of common knowledge and that this was not a case in which a lack of skill or care is so apparent that expert testimony is unnecessary.
Accrual of Injury for Statute of Limitations
Ex Parte Mobile Infirmary Ass’n, No. 1200200, 2021 Ala. LEXIS 94 (Sep. 10, 2021)
Here, the Alabama Supreme Court granted a Petition for Writ of Mandamus and issued the Writ finding that Plaintiff’s suit was due to be dismissed as barred by the statute of limitations. Medical liability cases in Alabama are generally subject to a two-year statute of limitations. In this case, Mobile Infirmary Association appealed a denial of its Motion to Dismiss. In the motion, it had argued that Plaintiff’s Complaint was filed more than two years after the date of discharge. In the Complaint, the Plaintiff claimed that at the time of discharge, he had already experienced pressure ulcers resulting in injury. However, in attempting to establish that the suit was timely filed, the Plaintiff claimed that his injuries actually developed after discharge when his lower leg was amputated. In finding for the Defendant, the Alabama Supreme Court again confirmed that “[t]he statutory limitations period begins to run whether or not the full amount of damages is apparent at the time of the first legal injury.”