Court: Supreme Court of Alabama; August 16, 2013; Alabama; State Supreme Court
Michelle D. Morgan appealed a summary judgment from the Jefferson Circuit Court in favor of Publix Super Markets, Inc. regarding her claim under the Alabama Medical Liability Act (AMLA). The incident occurred on December 19, 2010, when Morgan refilled her prescription for amlodipine at Publix, receiving a mixture of amlodipine and furosemide pills, which she ingested daily for two weeks. This led to adverse physical reactions, including facial swelling and hives, which she initially treated with Benadryl. After discovering the error, Morgan consulted various medical professionals, and while her symptoms improved, she experienced prolonged hyperpigmentation.
On October 5, 2011, Morgan sued Publix for negligence in dispensing the incorrect medication. Publix denied liability and argued that Morgan's claim required expert testimony to meet the AMLA standards. However, Morgan contended that the pharmacy's negligence was evident to a layperson and did not require expert input. After a hearing, the trial court granted Publix's summary judgment, citing Morgan's failure to provide timely expert testimony on the standard of care for pharmacists. Morgan filed a notice of appeal on February 1, 2013. The appellate court reversed the trial court's decision and remanded the case.
Morgan contends that the trial court incorrectly granted summary judgment in favor of Publix regarding her claim. The review of this summary judgment is conducted de novo, meaning the appellate court applies the same legal standards as the trial court. The court must evaluate whether the party seeking judgment has demonstrated there is no genuine issue of material fact and is entitled to judgment as a matter of law, reviewing evidence in the light most favorable to the nonmovant. If the movant establishes a prima facie case, the burden shifts to the nonmovant to present substantial evidence of a genuine issue of material fact.
It is acknowledged that the Alabama Medical Liability Act (AMLA) governs the case, which includes pharmacists under the definition of 'other health-care providers.' This interpretation aligns with previous rulings that established the integral role of pharmacists in the healthcare delivery system. Therefore, pharmacists and pharmacies fall within the AMLA's purview, as established in case law. Under the AMLA, the plaintiff must prove by substantial evidence that the health-care provider did not meet the applicable standard of care, which involves demonstrating the standard of care, the provider’s deviation from it, and the causal connection between the breach and the injury sustained.
Establishing the applicable standard of care and proving a breach typically requires expert testimony from a similarly situated health-care provider, as defined under Alabama law (6-5-548), highlighted in Holcomb v. Carraway. Morgan identified two potential expert physicians; however, Publix contends these individuals lack the qualifications to testify on pharmacist standards of care. Consequently, Publix argues that the trial court's summary judgment was justified because Morgan cannot substantiate her claim without proper expert evidence. Morgan acknowledges the necessity of expert testimony under the Alabama Medical Liability Act (AMLA) but claims her case falls within a specific category where expert testimony is not required, as the pharmacist’s error in providing the wrong medication is apparent to a layperson. She supports this view with precedents from other jurisdictions. The severity of the pharmacist's error is likened to a dentist extracting the wrong tooth, which is easily understood as negligence. Publix, while not disputing the apparent nature of the pharmacist's error, argues that the court has not recognized this scenario as exempt from the expert testimony requirement, cautioning against expanding such exceptions based on the doctrine of res ipsa loquitur. However, prior rulings, such as in Ex parte HealthSouth Corp., have established that expert testimony may not be necessary in cases where the negligence is clear to an average person, contrasting with the general requirement for expert medical testimony in medical malpractice cases.
An exception exists to the general requirement for expert testimony in medical negligence cases when the lack of skill or care is evident to a layperson based on common knowledge. This Court has identified four scenarios where this exception applies: (1) discovery of a foreign object in a patient post-surgery; (2) injuries unrelated to the treatment sought; (3) use of recognized medical texts to demonstrate proper practice; and (4) when the plaintiff is a qualified medical expert. The petitioner contended that since the plaintiffs did not provide expert testimony and their claims did not meet any of the four identified exceptions, the trial court rightly granted summary judgment. However, the Court noted that the list of exceptions is not exhaustive and could allow for other circumstances where negligence is apparent to a layperson.
The Court specifically addressed whether a pharmacist's error in dispensing the wrong medication could be understood without expert testimony. Publix argued against this, asserting that the exception relies on the res ipsa loquitur doctrine, which it claimed was not applicable here. Res ipsa loquitur allows for an inference of negligence when direct evidence is absent, requiring proof that the defendant controlled the instrument causing the injury, that the circumstances indicate negligence, and that the injury resulted from the incident. Publix contended that it did not have complete control over the medication provided, suggesting that a third party could have been responsible for the mix-up.
Publix's argument is undermined by evidence showing that Publix identified an issue with Morgan's prescription refill, specifically that a pharmacist informed her that 10 to 12 furosemide pills could not be accounted for. The court noted that while the Alabama Medical Liability Act (AMLA) typically requires expert testimony in medical malpractice cases, exceptions exist where medical expertise is unnecessary to prove a plaintiff's case. These exceptions apply in situations such as when nurses fail to respond to a routine call, as established in previous cases like Anderson and Loeb v. Cappelluzzo. Although res ipsa loquitur does not apply here, the court stated that expert testimony is not needed when the lack of skill or care is evident to a layperson. Prescription drugs are complex, necessitating their dispensing by licensed pharmacists, a fact within common understanding. Therefore, it was concluded that Morgan did not need expert testimony to prove her claim that Publix negligently filled her prescription with the wrong medication. Morgan's lawsuit against Publix for physical, mental, and emotional injuries due to this negligence was initially dismissed due to her failure to present an expert witness; however, the court reversed this decision, asserting that the negligence was sufficiently clear for a layperson to understand without expert assistance, and remanded the case for further proceedings.
Furosemide is identified as a loop diuretic utilized for treating edema related to congestive heart failure, hepatic, or renal disease, as well as hypertension, based on Dorland’s Illustrated Medical Dictionary. Publix contends that Morgan's appeal arguments should be disregarded because her response against Publix’s summary judgment motion lacked a required summary of disputed material facts, contravening Rule 56(c)(1) of the Alabama Rules of Civil Procedure. This rule mandates that if a party claims material facts are disputed, they must file a supporting statement akin to that for undisputed facts. However, Morgan asserts that her case does not hinge on demonstrating a genuine issue of material fact for summary judgment but rather on the legal position that she is not obligated to provide expert testimony to establish that Publix breached the standard of care. Morgan has substantiated her argument with relevant legal citations, which are appropriately presented before the court.
