PER CURIAM.
Felice McGathey appeals from summary judgments entered by the Jefferson Circuit Court in favor of Brookwood Health Services, Inc., d/b/a Brookwood Medical Center ("Brookwood"), and Scott Appell, M.D. ("Dr. Appell"), in her medical-malpractice action; she also challenges the trial court's order denying her motion for leave to amend her complaint to substitute real parties for fictitiously named defendants. We affirm in part, reverse in part, and remand.
On September 12, 2008, McGathey was admitted to Brookwood Medical Center for outpatient surgery to be performed by Dr. Appell. Dr. Appell performed a left-shoulder arthroscopy, a subacromial decompression, and a distal clavicle resection. McGathey was placed under general anaesthesia before the surgery. A Spider Limb Positioner manufactured by Smith & Nephew, Inc., was used to hold McGathey's left arm in place during the surgery. A metal bar was strapped onto McGathey's arm, and that bar was strapped to a coupler that immobilized her shoulder.
Before the surgery, the circulating registered nurse ("RN"), Kelly Forrest, noticed that the metal bar had not been sterilized. He placed the metal bar in a sterile basket and then placed the basket in an autoclave, which is a device that heats objects to the sterilization temperature of 270 degrees Fahrenheit.
Operating-room technician ("ORT") Paul Nunnally, a Brookwood employee, entered the operating room at 11:21 a.m. on the day of the surgery and began to place the equipment needed for the procedure on a sterile table. Sometime thereafter Forrest entered the operating room with the metal bar still in the sterile basket and placed the basket next to Nunnally. In his deposition, Nunnally testified that he transferred the metal bar from the sterile basket to the sterile table with a glove or a
Nunnally also testified that, if necessary, a member of the operating-room team can cool a piece of sterilized equipment down before it is used. He stated that he sometimes has a pan in the operating room, into which he can pour saline and then place hot equipment into the saline to cool it down before it is used in surgery. Nunnally testified that he did not have such a pan in the operating room before McGathey's surgery because he forgot to bring one and because he was busy before the surgery and forgot to ask someone to retrieve one. Nunnally stated that generally the "sterile team"
At 12:00 p.m., PA Rawlings, who was an employee of Alabama Spine and Joint (Dr. Appell's physician-practice group),
At 12:07 p.m., Dr. Appell entered the operating room and began the procedure. The Spider Limb Positioner held McGathey's arm throughout the surgery. Present in the operating room during the procedure were Dr. Appell, PA Rawlings, RN Forrest, ORT Nunnally, Certified Registered Nurse Anesthetist Wendy Dial, and Michael Carra, a sales representative with Smith & Nephew, Inc.
On October 31, 2008, at the request of McGathey's counsel, Brookwood released to McGathey copies of the medical records for her surgery. The medical records provided the names of the individuals involved in the surgery but did not detail the specific activities of the surgical team during the procedure.
On September 9, 2010, McGathey filed a complaint in the Jefferson Circuit Court against Brookwood, Dr. Appell, and fictitiously named defendants in which she asserted several medical-negligence claims, including claims arising under the Alabama Medical Liability Act, § 6-5-480 et. seq. and § 6-5-540 et seq., Ala.Code 1975 ("the AMLA"). McGathey alleged that she had suffered a severe burn on the little finger of her left hand as a result of the defendants' actions and that the burn had caused permanent disfigurement and impaired mobility in her hand.
On March 22, 2011, McGathey served interrogatories on Brookwood, requesting, among other things, the names and duties of everyone who was present during the surgery and what each person did to prepare McGathey for the surgery. Brookwood's answer listed the names and titles of the surgery participants, but it did not detail the activities or duties of each person with regard to the surgery.
On October 27, 2011, McGathey deposed Forrest and Nunnally. On December 15, 2011, McGathey deposed Rawlings. On December 21, 2011, McGathey filed a motion for leave to amend her complaint to substitute Nunnally and Rawlings for two of the fictitiously named defendants.
On January 9, 2012, Brookwood moved for a summary judgment. McGathey responded to Brookwood's motion on January 12, 2012. On the same date, Dr. Appell moved for a summary judgment. McGathey responded to Dr. Appell's motion on January 25, 2012.
On January 26, 2012, the trial court heard arguments concerning the motions for a summary judgment and McGathey's motion for leave to amend her complaint. On February 3, 2012, the trial court denied McGathey's motion for leave to amend her complaint. Finding that McGathey had failed to present expert testimony as required by the AMLA, the trial court granted the motions for a summary judgment filed by Brookwood and Dr. Appell. McGathey appeals.
Our standard of review of a summary judgment is well settled:
Pritchett v. ICN Med. Alliance, Inc., 938 So.2d 933, 935 (Ala.2006).
Prior v. Cancer Surgery of Mobile, P.C., 959 So.2d 1092, 1094-95 (Ala.2006).
McGathey raises three issues on appeal. First, she contends that the trial court erred by granting Brookwood's and Dr. Appell's motions for summary judgment. She argues that she was not required to present expert testimony to demonstrate that those defendants had breached the standard of care. Second, she argues that the trial court erred in dismissing her claims of assault and battery, which, she insists, can be maintained in a medical-malpractice action. Third, McGathey contends that the trial court erred by refusing to allow her to amend her complaint to substitute Nunnally and Rawlings for the fictitiously named defendants in her original complaint that her naming of them as defendants related back to the filing of her original complaint, thus avoiding the bar of the two-year statute of limitations in § 6-5-482, Ala.Code 1975. We address each argument in turn.
In its summary-judgment motion, Brookwood submitted excerpts from the depositions of ORT Nunnally and RN Forrest in which they testified that they had met the requisite standard of care both before and during McGathey's surgery. In his summary-judgment motion, Dr. Appell submitted excerpts of the deposition testimony of PA Rawlings and ORT Nunnally, as well as his own affidavit, in which he stated that he "met the standard of care, skill, and diligence required of me in my treatment of Ms. McGathey." McGathey does not dispute that Brookwood and Dr. Appell met their prima facie burden on summary judgment.
Cain v. Howorth, 877 So.2d 566, 575-76 (Ala.2003).
In response to the summary-judgment motions filed by Brookwood and Dr. Appell, McGathey did not submit testimony from her own medical expert. Instead, she relied on excerpts from the depositions of PA Rawlings, ORT Nunnally, and RN Forrest. Brookwood and Dr. Appell argued to the trial court that this was not sufficient. McGathey responded that her medical-malpractice action fell into the class of cases in which expert testimony is not necessary to establish a breach of the applicable standard of care. The trial court apparently disagreed with McGathey.
Bibb v. Center for Pain of Montgomery, P.C., 23 So.3d 1135, 1137-38 (Ala.2009).
McGathey contends that expert testimony is not required to demonstrate that attaching a metal bar to a patient's arm and hand that is hot enough to burn the skin falls below the acceptable standard of care owed her by the surgical team. For support, McGathey cites Ford v. Stringfellow Memorial Hospital, 39 So.3d 184 (Ala.Civ.App.2009), a case containing strikingly similar facts. In Ford, an hour before the plaintiff's surgery, a nurse sterilized the parts of a "wrist-traction tower," the purpose of which is "to elevate and to hold in place the patient's hand and wrist as surgery was performed on the patient's wrist." 39 So.3d at 186. The nurse allowed the device parts to air-cool in the operating room for the hour before the surgery. Before the procedure began, the plaintiff was placed under general anaesthesia and another nurse and the doctor who performed the surgery assembled the wrist-traction tower and attached it to the plaintiff's arm. "At the conclusion of the surgery, as [the plaintiff]'s arm was being removed from the wrist traction tower, it was discovered that [the plaintiff]'s upper arm, in an area near her tricep that had been resting on the wrist traction tower, had been burned." 39 So.3d at 187. The plaintiff did not present her own expert testimony in contending that the doctor and the hospital that employed the nurses had breached the standard of care.
39 So.3d at 192-93. In Timmerman v. Fitts, 514 So.2d 907, 913 (Ala.1987), this Court also stated: "There is no requirement that the plaintiff produce an independent expert where the testimony of the defendant, as here, establishes the standard required of him by his profession." See also Ford, 39 So.3d at 191. McGathey also cites Lloyd Noland Foundation, Inc. v. Harris, 295 Ala. 63, 66, 322 So.2d 709, 712 (1975), in which this Court stated that "[i]t does not require an expert to prove a hot object will burn human skin."
Brookwood contends that Ford is distinguishable because in Ford the doctor and a hospital nurse assembled the medical device that caused the plaintiff's burns, whereas, in this case, a nurse employed by Alabama Spine and Joint attached the metal bar to McGathey's hand and arm. Brookwood argues that McGathey needed expert testimony to establish that a Brookwood employee committed a breach of the standard of care.
This distinction does not undermine the principle articulated by the Court of Civil Appeals. As was the case in Ford, expert testimony was not necessary to establish that there was a breach in the standard of care owed McGathey that resulted in her hand and arm being burned by a metal bar during surgery because such "matters ... can be easily understood and determined by the average person without the aid of a medical expert." Ford, 39 So.3d at 193. Also, like the testimony of the RN in Ford, the testimony of ORT Nunnally was sufficient to raise a question of fact as to whether that breach was the result of action or inaction by a Brookwood employee. ORT Nunnally, who was a Brookwood employee, testified that when he picked up the metal bar from the sterilization basket and placed it on the sterile table it was so hot that it would have burned him had he not insulated his hand. Nunnally admitted that he could, on his own initiative, cool down a piece of equipment that was too hot to be used. Despite his knowledge, Nunnally did not attempt to cool the metal bar before it was attached to McGathey.
Nunnally also testified that he informed PA Rawlings when she entered the operating room that the metal bar was hot, intending, in his words, "to caution her that it needed to cool before we used it." Despite his warning, within six minutes of entering the operating room, Rawlings had attached the metal bar to McGathey's left arm and hand. Nunnally acknowledged that he had a duty to ensure a patient's safety and that, if he observed anything wrong in the course of a surgery, he was supposed to intervene to protect the patient's
Given the facts in this case and Nunnally's testimony, we conclude that McGathey produced substantial evidence creating a genuine issue of material fact as to whether a Brookwood employee violated the applicable standard of care by failing to ensure that a hot medical device was sufficiently cool before it was attached to the patient's arm and hand. Expert testimony was not required. See Timmerman, 514 So.2d at 913. Consequently, the trial court's summary judgment with regard to Brookwood on this issue is due to be reversed.
McGathey's claims against Dr. Appell, however, are another matter. As Dr. Appell noted in the trial court and as he reiterates on appeal, the undisputed evidence indicates that he was not present in the operating room from the time the metal bar was brought into the operating room through the moment it was attached to McGathey's arm and hand. Therefore, the evidence does not indicate that he had any knowledge of the temperature of the metal bar at the time of its use, and he played no role in the negligence alleged by McGathey.
McGathey contends that Dr. Appell is liable through the actions of PA Rawlings, who worked under his direction. For Dr. Appell to be vicariously liable for Rawlings's actions, however, McGathey would have had to demonstrate that Dr. Appell was Rawlings's master. See Ware v. Timmons, 954 So.2d 545, 549 (Ala.2006) (explaining that the doctrine of respondeat superior stems from a master-servant relationship). It is undisputed that Rawlings was employed by Alabama Spine and Joint and that Dr. Appell was not her direct employer. The situation is similar to the one presented in Ware, in which the plaintiff attempted to hold an anesthesiologist vicariously liable for the allegedly negligent acts of a nurse anesthetist. Id. In Ware, the doctor argued that "he cannot be vicariously liable for the acts or omissions of Nurse Hayes because she was an employee of Anesthesiology & Pain Medicine of Montgomery, P.C., not of Dr. Ware individually." 954 So.2d at 550. This Court agreed with the doctor, reasoning:
954 So.2d at 553 (footnote omitted).
There is no evidence indicating that Dr. Appell hired Rawlings or that he had the power to fire her. Indeed, Rawlings's deposition testimony indicates that she worked for the physician-practice group, that she had been assigned to assist Dr. Appell for a period, and that she had been assigned to other doctors at other times. In short, McGathey failed to establish that Dr. Appell was Rawlings's master; therefore, he cannot be held vicariously liable for her actions.
McGathey's other allegation against Dr. Appell — that he "[n]egligently failed to properly formulate and implement a proper, adequate, and safe plan of care, including the use and monitoring of medical products, equipment and instruments"
McGathey also contends that the trial court erred in entering summary judgments on her claims against Brookwood and Dr. Appell alleging assault and battery. McGathey argues that a plaintiff is permitted to bring more than one type of claim under the AMLA, citing for support Collins v. Ashurst, 821 So.2d 173 (Ala. 2001). In Collins, this Court explained:
821 So.2d at 176-77 (footnote omitted).
McGathey's citation of Collins is unrelated to the basis upon which the trial court granted the summary-judgment motions. McGathey argues that assault and battery are legitimate claims under the AMLA, even when the defendant's actions were unintentional. However, the trial court did not grant Brookwood's and Dr. Appell's summary-judgment motions because the assault and battery claims are impermissible under the AMLA, but instead because it found that "there is no genuine issue as to any material fact." The evidence in the record shows, however, that McGathey gave Dr. Appell a signed informed-consent form. Although she argued that she "did not give informed consent," McGathey has presented no evidence to that effect. Absent substantial evidence demonstrating that she did not give informed consent for the surgery, the trial court correctly entered summary judgments in favor of Brookwood and Dr. Appell as to these claims.
McGathey contends that the trial court should have allowed her to amend
Ex parte Hensel Phelps Constr. Co., 7 So.3d 999, 1002-03 (Ala.2008) (some emphasis omitted and some emphasis added).
McGathey concedes that the medical records she obtained contained the names and positions of Rawlings and Nunnally, but she emphasizes that those medical records did not detail the activities of Rawlings and Nunnally before or during the surgery. McGathey notes that the answers to the interrogatories she propounded to Brookwood and Dr. Appell in March 2011 provided the names and positions of all the individuals who were present in the operating room for the surgery but that Brookwood's and Dr. Appell's answers did not provide any more details concerning the activities of Rawlings and Nunnally before or during the surgery. McGathey argues that "[t]he fact that two relevant names were contained in the list of seven individuals who were present or participated during the surgery did not identify Jennifer Rawlings nor Jeffery Paul Nunnally as being responsible for [McGathey's] injury nor did it give [McGathey] sufficient information to name those parties as defendants without further discovery." McGathey's brief, at 40. McGathey insists that it was not until she deposed Forrest, Nunnally, and Rawlings that she obtained a clear picture of how she was injured and who was responsible for the injury. Because she moved to amend her complaint almost immediately following the last of those depositions, McGathey contends that her substitution of Rawlings and Nunnally for fictitiously named defendants should have been permitted.
McGathey's argument mistakenly focuses on when she learned of the specific details of Rawlings's and Nunnally's roles in causing her injury rather than on when she knew the identities of those potential parties. Our cases emphasize that Rule 9(h) concerns the identity of a party, not the cause of action against a party. In Weber v. Freeman, 3 So.3d 825 (Ala.2008), this Court summarized several cases that illustrate what is permissible and what is impermissible with regard to the relation-back principle:
3 So.3d at 832-33 (some emphasis added).
All the cases highlighted in the above-quoted portion of Weber illustrate that McGathey failed to fulfill the duty required to allow an amendment to her complaint to substitute real parties for fictitiously named defendants and to invoke the doctrine of relation back. Because of the medical records she obtained, McGathey knew Rawlings's and Nunnally's names shortly after her surgery and knew that they were involved in her treatment during the surgery. Despite this knowledge, there is no indication that, in the nearly two years between the time McGathey received the medical records and the time she filed her complaint, McGathey performed any investigation to determine whether either of those individuals was responsible for her injury. Even after McGathey filed her complaint in September 2010, it was not until late 2011 that she ascertained the roles of the two individuals in the surgery. Based on the record, it cannot be said that McGathey "exercise[d] due diligence to determine the true identity of the defendants" either before or after the filing of her original complaint. Ex parte Hensel Phelps Constr. Co., 7 So.3d at 1003. Accordingly, the trial court did not err in refusing to allow McGathey to amend her complaint to substitute Rawlings and Nunnally for fictitiously named defendants in her original complaint.
Based on the foregoing, we conclude that McGathey produced substantial evidence of negligence on the part of Brookwood employee Nunnally; therefore, the summary judgment is due to be reversed insofar as it was entered in favor of Brookwood. We affirm the summary judgment in favor of Dr. Appell.
AFFIRMED IN PART; REVERSED IN PART; AND REMANDED.
PARKER, MAIN, WISE, and BRYAN, JJ., concur.
MOORE, C.J., and BOLIN, J., concur in the result.
STUART, MURDOCK, and SHAW, JJ., concur in part and dissent in part.
STUART, Justice (concurring in part and dissenting in part).
I respectfully dissent from the majority's reversal of the trial court's summary judgment for Brookwood Health Services, Inc., with regard to Felice McGathey's medical-negligence claims. Specifically, I believe that to produce substantial evidence creating a genuine issue of material fact as to whether Paul Nunnally, a Brookwood employee, violated the applicable standard of care by failing to ensure that the medical device was sufficiently cool before it was attached by Jennifer Rawlings, an employee of Alabama Spine and Joint, to McGathey's arm and hand, McGathey needed to produce expert testimony. I recognize that expert testimony to support claims arising under the Alabama Medical Liability Act, § 6-5-480 et seq. and § 6-5-540 et seq., Ala.Code 1975, is not required for "matters that can be easily understood and determined by the average person without the aid of a medical expert." Ford v. Stringfellow Mem'l
MURDOCK, Justice (concurring in part and dissenting in part).
I concur in all aspects of the main opinion except one. I respectfully dissent as to the determination in the main opinion that expert testimony was not needed in regard to the claim against Brookwood Health Services, Inc., and the corresponding reversal of the trial court's summary judgment in favor of Brookwood.
The plaintiff, Felice McGathey, contends that expert testimony is not required to demonstrate that attaching to a patient's hand a metal bar hot enough to burn human skin falls below the standard of care. McGathey cites Lloyd Noland Foundation, Inc. v. Harris, 295 Ala. 63, 66, 322 So.2d 709, 712 (1975), in which this Court stated that "[i]t does not require an expert to prove a hot object will burn human skin."
The main opinion agrees with McGathey's framing of the issue before us, stating that "expert testimony was not necessary to establish that there was a breach in the standard of care owed McGathey that resulted in her hand and arm being burned by a metal bar during surgery because such `matters ... can be easily understood and determined by the average person without the aid of a medical expert.'" 39 So.3d at 192-93 (quoting Ford v. Stringfellow Mem'l Hosp., 39 So.3d 184, 193 (Ala.Civ.App.2009)).
With respect, I do not believe the question as framed by McGathey and the main opinion is the correct, specific question that must be asked as to Brookwood. The question is not whether attaching to a patient's hand a metal bar hot enough to burn human skin falls below the standard of care. Indeed, the question before us is not even whether an expert is necessary to establish whether a 270-degree metal object of certain dimensions and metallurgical composition, when laid out on a table in an operating room of a certain temperature for approximately 40 minutes, if not more, will cool to a temperature safe for contact with human skin.
Instead, as I see it, the correct question in this particular case is whether an operating-room technician employed by a hospital, but assigned to assist a surgeon and that surgeon's "physician's assistant" in a given operating room, being aware that a metal bar had been heated to a temperature of 270 degrees and then been laid out to cool in that particular operating room for approximately 40 minutes or more, violated the standard of care by notifying the physician's assistant that the metal bar was "hot" but thereafter deferring to that physician's assistant's determination that it had become safe to place the bar in a foam sleeve and then attach it to the patient's hand. In short, did it violate the standard of care, given the particular circumstances of this case and the primary responsibilities
SHAW, J., concurs.