Joey Frazier, as executor of the estate of Florine Bryant v. Frank Gillis, M.D.

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REL: 08/05/2011 Notice: T h i s o p i n i o n i s s u b j e c t t o formal r e v i s i o n b e f o r e p u b l i c a t i o n i n t h e advance s h e e t s o f Southern R e p o r t e r . R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e R e p o r t e r o f D e c i s i o n s , Alabama A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y t y p o g r a p h i c a l o r o t h e r e r r o r s , i n o r d e r t h a t c o r r e c t i o n s may b e made b e f o r e t h e o p i n i o n i s p r i n t e d i n Southern R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS SPECIAL TERM, 2011 2100202 Joey F r a z i e r , as executor o f the e s t a t e o f F l o r i n e Bryant v. Frank G i l l i s , M.D. Appeal from C o l b e r t C i r c u i t (CV-07-900030) Court THOMPSON, P r e s i d i n g J u d g e . Joey F r a z i e r , Florine Bryant, entered i n favor malpractice the executor appeals case. o f t h e e s t a t e o f h i s mother, from a judgment as a m a t t e r of Frank Gillis, M.D., i n this of law medical- 2100202 The record, viewed in the light most favorable to F r a z i e r , s e e L e o n a r d v. Cunningham, 4 So. 3d 1181, 1184 ( A l a . C i v . App. 2 0 0 8 ) , i n d i c a t e s t h e f o l l o w i n g : Dr. Gillis B r y a n t i n May 1999. practitioner, Healthcare but, I n 2000, C a r o l D a v i s , began working i n Florence. supervising Gillis i s a f a m i l y p r a c t i t i o n e r who Davis Dr. collaborating supervised with Dr. Gillis a certified Gillis was physician." began t r e a t i n g Davis's In that the treatment Davis provided testified, Dr. Gillis was at not nurse Lister "primary role, Dr. to patients, required to be p h y s i c a l l y p r e s e n t when she r e n d e r e d t h a t t r e a t m e n t . Bryant's medical numerous records times over the On i n d i c a t e that Davis treated Bryant years. A u g u s t 29, 2005, Dr. Gillis diagnosed Bryant with atrial fibrillation, a heart formation c l o t , w h i c h , i n t u r n , can t r a v e l t o t h e of a blood b r a i n and cause a s t r o k e . c o n d i t i o n t h a t can r e s u l t i n t h e To t r e a t B r y a n t , Dr. G i l l i s her on Coumadin, a b l o o d thinner that lessens the formation clot. of a blood However, b l o o d Coumadin a l s o p o s e a r i s k f o r p a t i e n t s . placed the chances of thinners Dr. G i l l i s like testified t h a t he t y p i c a l l y a d v i s e s h i s p a t i e n t s t h a t Coumadin c a n be " a 2 2100202 very dangerous drug u n l e s s taken a p p r o p r i a t e l y . " Coumadin i s a " h i g h l y i n d i v i d u a l i z e d " d r u g a n d t h e p r o p e r d o s a g e c a n n o t be established Gillis without said that c a r e f u l l y monitoring patients taking the p a t i e n t . Coumadin "need[] Dr. t o be c h e c k e d f r e q u e n t l y i n i t i a l l y , u s u a l l y e v e r y two t o t h r e e and a t most once a week u n t i l they--that should t i m e may the range, monitored. for with The f r e q u e n t patient "therapeutic that be e x t e n d e d A f t e r which t o a month, b u t i n no way t h e y be c h e c k e d l e s s t h a n s h o u l d be c h e c k e d l e s s t h a n once a month." that i ti s stabilized. days, Coumadin Dr. regarding within To e n s u r e testified atrial is the patients that fibrillation i s between 2.0 t o ensure called remain who a r e b e i n g An within ("INR") i s the therapeutic a n d 3.0. the range treated INR o f 1.0 i s normal. Gillis stated the dangers frequent monitoring; that he gave B r y a n t i s t o make the i n s t r u c t i o n s o f Coumadin a n d t h e n e e d for initial h o w e v e r , B r y a n t ' s r e c o r d s do n o t i n d i c a t e t h a t t h e i n s t r u c t i o n s were g i v e n practice what International Normalized Ratio Dr. G i l l i s patients with considered remains range." their t e s t i n g i s intended a notation 3 t o h e r . Dr. G i l l i s said his i n the patient's records 2100202 regarding the acknowledged s h o u l d be instructions that a he provides notation regarding i n Bryant's record. t h a t he h a d no i n d e p e n d e n t Dr. to them, and he those instructions also acknowledged Gillis r e c o l l e c t i o n of i n s t r u c t i n g Bryant on t h e use o f Coumadin; he b a s e d h i s t e s t i m o n y on h i s u s u a l practice. D a v i s a l s o t e s t i f i e d t h a t she had no of Dr. She Gillis's instructing Bryant on the use s t a t e d t h a t she p r o v i d e d t h e i n s t r u c t i o n s she, too, failed instructions Davis to include a i n Bryant's medical testified notation records. recollection of Coumadin. to Bryant, but regarding the Like t h a t a n o t a t i o n r e g a r d i n g the Dr. Gillis, instructions s h o u l d have b e e n i n c l u d e d i n B r y a n t ' s r e c o r d s . When B r y a n t was she was instructed p r e s c r i b e d Coumadin on A u g u s t 29, 2005, to r e t u r n to the l a b at L i s t e r H e a l t h c a r e on A u g u s t 31 t o have h e r INR c h e c k e d and t o b e g i n t h e process o f e s t a b l i s h i n g t h e p r o p e r d o s a g e o f Coumadin f o r h e r t o t a k e . B r y a n t came t o t h e l a b as o r d e r e d . 1.9. She was ordered to take Her INR on t h a t d a t e f i v e m i l l i g r a m s of e v e r y day to Coumadin and t o r e t u r n t o t h e l a b i n one week, on 7, 2005, orders. A have her INR rechecked, notation i n Bryant's 4 pursuant medical records was September to Davis's indicates, 2100202 "pt. n o t i f i e d , sb," which s i g n i f i e s t h a t Sherry Bates, a nurse at t h e l a b , gave B r y a n t the i n s t r u c t i o n s . Bates testified t h a t t h e n o t a t i o n i s n o t made i n t h e r e c o r d s u n t i l t h e p a t i e n t is n o t i f i e d of the i n s t r u c t i o n s . Bryant returned to the Lister Healthcare lab as i n s t r u c t e d on September 7, 2005, and e m p l o y e e s o f t h e l a b drew her blood. However, drawn b l o o d . On t h e INR t e s t was that not performed same d a y , Dr. G i l l i s on t h e saw B r y a n t for a s t r e s s t e s t ; h o w e v e r , he d i d n o t f o l l o w up on why t h e INR t e s t h a d n o t b e e n done. He s t a t e d t h a t , monitoring Coumadin testified Bryant's that the f a i l u r e dosage. only Gillis the next which, Dr. Gillis f o r Bryant an e r r o r and t h a t t h e p r o p e r could he testified INR that n o t be d e t e r m i n e d t e s t was a c k n o w l e d g e d , was his office performed "way B r y a n t ' s November 14, 2005, INR was that However, was based on t h e INR t e s t done on A u g u s t 29, 2005. Dr. that time, Davis t o do t h e INR t e s t on t h e b l o o d drawn on S e p t e m b e r 7, 2005, was d o s a g e o f Coumadin at that an INR o f 34.2 patient. too records indicate on November 14, long 34.2. 2005, between INRs." Dr. G i l l i s agreed i s an e x t r e m e l y d a n g e r o u s l e v e l f o r the B r y a n t h a d a c o l o n o s c o p y on September 13, 2005, and 5 2100202 the p h y s i c i a n performing t h a t examination t e m p o r a r i l y Coumadin from Bryant colonoscopy. to prevent possible bleeding w o u l d have t o be r e s t a r t e d . reviewed He s a i d t h a t he r e c e i v e d B r y a n t ' s Bryant's medical and, at that a n o t h e r c h e c k on h e r On pursuant October to the and t h a t t h e Coumadin c o l o n o s c o p y r e p o r t on O c t o b e r 4, 2005. received, from Dr. G i l l i s s t a t e d t h a t he w o u l d e x p e c t Coumadin t o be w i t h h e l d b e f o r e s u c h a p r o c e d u r e office withheld a 6, time, chart Bryant when t h e was by report was scheduled not seen Gillis's for INR. 2005, B r y a n t referral by Dr. was Gillis. r e p o r t i n d i c a t e d t h a t B r y a n t was by Dr. G i l l i s . No one i n Dr. The a cardiologist cardiologist's t a k i n g Coumadin as d i r e c t e d The r e p o r t i n d i c a t e d t h a t a c o p y was t o Dr. G i l l i s ; h o w e v e r , Dr. G i l l i s t e s t i f i e d forwarded t h a t he was not p r o v i d e d w i t h a c o p y o f t h e r e p o r t and t h a t he d i d n o t see t h e report u n t i l The no litigation in this case began. e v i d e n c e i s u n d i s p u t e d t h a t Dr. G i l l i s ' s further contact with Bryant until November office 9, had 2005. A c c o r d i n g t o B a t e s ' s t e s t i m o n y , on t h a t d a t e , she r e c e i v e d telephone c a l l from B r y a n t d u r i n g which B r y a n t complained she had 12 blue spots on the inside 6 of her left thigh a that and 2100202 three blue complained spots of having message, wrote slip to the that the on no "RTO" patient on shoulder. Davis Davis return and testified to the Bryant received t h e message s l i p , i s to A notation, However, b o t h Davis also Bryant's returned t h a t "RTO" office immediately. office "called," appears and testified Bates the means a c t u a l l y n o t i f i e d t o come i n t o t h e disputed at t r i a l . message s l i p . right energy. n u r s e s ' box. W h e t h e r B r y a n t was was her they d i d not c a l l Bryant to t e l l her to r e t u r n t o the on the that office. Dr. G i l l i s t e s t i f i e d t h a t he d i d n o t see t h e November 9, 2005, telephone Bryant message f r o m B r y a n t . returned to Bryant's 2005. medical Dr. the office records Gillis were T h e r e i s no indication f o r treatment not acknowledged reviewed that, i f at on that that time. November they had been r e v i e w e d , he o r D a v i s w o u l d have s e e n t h a t B r y a n t had n o t an INR t e s t p e r f o r m e d A u g u s t 31, On on 2005, Dr. On 2005. November 13, Davis performed. had s i n c e h e r one and o n l y INR t e s t c h e c k G i l l i s went o u t o f town. Monday, November 14, 2005, B r y a n t came t o Dr. G i l l i s ' s and 9, treated The her. results At that time, an INR i n d i c a t e d t h a t B r y a n t had 7 office test an INR was of 2100202 34.2. to D a v i s i n s t r u c t e d B r y a n t t o d i s c o n t i n u e t h e Coumadin and h a v e h e r INR c h e c k e d then s e n t B r y a n t home. never on F r i d a y , November 18, 2005. She Davis had testified i n s t r u c t e d her t h a t i f a p a t i e n t ' s Bryant's was hospital that day, the patient INR was as h i g h as was go immediately. Bryant on t h a t Dr. G i l l i s r e t u r n e d t o Dr. G i l l i s ' s 2005, c o m p l a i n i n g t h a t she was office still to to the on November 15, b l e e d i n g from the site where b l o o d h a d b e e n drawn f o r h e r INR t e s t t h e day b e f o r e . She a l s o c o m p l a i n e d another INR t e s t , hospital. 44.77; The however, indicating that o f n a u s e a and a h e a d a c h e . handling town. took ordered and t h e r e s u l t s were f a x e d t o h e r f r o m t h e results there a indicated was a "mixing B r y a n t ' s INR was a c t u a l l y Davis Davis note study" .89. that Bryant attached had been h a d an INR o f to the done results and 1 t h e INR r e p o r t t o Dr. G e o r g e E v a n s , who Dr. G i l l i s ' s that patients while Dr. G i l l i s was was out of Dr. E v a n s t o l d D a v i s t o r e f e r B r y a n t t o a h e m a t o l o g i s t . D a v i s d i d as i n s t r u c t e d , and she a l s o t o l d B r y a n t t h a t i f she 1 term T h e r e i s n o t h i n g i n t h e r e c o r d t h a t e l a b o r a t e s on t h e "mixing study." 8 2100202 had any 16, 2005, B r y a n t was that p r o b l e m s she time, indicated she that bleeding in was the i n t o Shoals nonresponsive. had suffered brain. a Efforts unsuccessful, and Bryant Richard who testified Hays, to the h o s p i t a l . brought was she t o go died on on On Hospital, e i t h e r November 14 subdural to save November behalf have o r November 15, of at testing hematoma, her or life 2005. 17, were Dr. F r a z i e r , and she Dr. treatment w o u l d most likely survived. Dr. Hays i s a f a m i l y p r a c t i t i o n e r who for and, Diagnostic G i l l i s a g r e e d t h a t , had B r y a n t r e c e i v e d a p p r o p r i a t e on November his Bryant. patients He effective testified doses of d r u g i s so diagnosed with atrial p r e s c r i b e s Coumadin fibrillation, t h a t , because of the wide v a r i a n c e Coumadin i n i n d i v i d u a l s , and dangerous, because " i t i s extremely important to t h e p a t i e n t a t t h e s t a r t so t h a t you like in the monitor know t h a t t h e y a r e on the p r o p e r d o s e and make s u r e t h e y g e t s t a b i l i z e d b e c a u s e t h e y may e v e n - - i t may testified change w i t h i n t h e f i r s t s e v e r a l weeks." t h a t the standard of care for monitoring Dr. a patient on Coumadin i s "that sufficient t e s t i n g n e e d s t o be done to d e t e r m i n e t h a t t h e p a t i e n t i s on t h e therapeutic 9 Hays 2100202 dose, as we mentioned, and t h a t their dose s t a b i l i z e s a n d m a i n t a i n s s t a b l e . So t h e s t a n d a r d o f c a r e does n o t s a y y o u have t o n e c e s s a r i l y do i t on a d a y one v e r s u s d a y two o r d a y two v e r s u s d a y three. I t i s n o t a f u n c t i o n o f t e l l i n g e x a c t l y how t o do i t , b u t i t d i c t a t e s t h a t t o meet t h e s t a n d a r d o f c a r e y o u n e e d t o be s u r e t h a t t h e p a t i e n t i s w i t h i n t h a t s a f e t y range. Part of the reason f o r t h a t range i s , and r e p o r t e d i n s t u d i e s , t o p r e v e n t t h e s t r o k e s , b u t i t a l s o i s a s a f e enough r a n g e f o r people t o take that t h e y d i d n o t have other problems. I t w o u l d n o t do us any good t o p r e v e n t s t r o k e s a n d p u t p e o p l e i n d a n g e r s o t h a t i s how t h a t r a n g e was d e t e r m i n e d . " Dr. Hays testified that the standard t h a t l a b o r a t o r y t e s t s be p e r f o r m e d of care t o assure that the p a t i e n t i s t a k i n g t h e p r o p e r dosage and t h a t t h e p a t i e n t ' s w i t h i n the therapeutic range. requires INRs fall He a l s o s a i d t h a t t h e s t a n d a r d o f c a r e c a n n o t be met w i t h o u t p h y s i c i a n involvement and t h a t t h e s t a n d a r d i s b r e a c h e d when t h e p h y s i c i a n h a s no r o l e i n t h e m o n i t o r i n g o f t h e p a t i e n t ' s INRs. his opinion that, He f u r t h e r t e s t i f i e d as t o f o r a l l of the people working physician's supervision, " i t i s the physician's to make sure correctly." as that they are performing Dr. Hays f u r t h e r e x p l a i n e d under responsibility [their] functions the standard of care follows: "[Y]ou can farm out t h e r e s p o n s i b i l i t y w i t h i n your s t a f f i n many d i f f e r e n t ways a n d many p e o p l e do, b u t i t i s a l l t o meet t h e s t a n d a r d o f c a r e i n c a r i n g 10 a 2100202 for a p a t i e n t with t h i s problem a p h y s i c i a n e n s u r e t h a t t h a t i s b e i n g done c o r r e c t l y . " has t o I n o t h e r w o r d s , D r . Hays s a i d , t h e p h y s i c i a n h a s t h e u l t i m a t e responsibility. Dr. Hays a l s o t e s t i f i e d t h a t , a l t h o u g h p h y s i c i a n s a r e n o t r e q u i r e d t o u s e a s p e c i f i c method t o e n s u r e t h a t p a t i e n t s on Coumadin a r e h a v i n g INR t e s t s p e r f o r m e d r e g u l a r l y , p h y s i c i a n s must keep track of those patients t o ensure that they are a c t u a l l y being monitored. He s t a t e d t h a t numerous f a c t o r s c a n change d u r i n g treatment, a person's s o t h e INR numbers c a n change " s o y o u have t o have some s o r t o f p r o c e s s t o keep t r a c k of people." F o r example, D r . Hays testified, a physician c a n n o t s t o p a t s i m p l y m a k i n g an a p p o i n t m e n t f o r a p a t i e n t e a c h month. He o p i n e d t h a t , i f a p a t i e n t on Coumadin does n o t come i n f o r h i s or her monthly appointment, the p h y s i c i a n ' s office s h o u l d f o l l o w up w i t h t h a t p a t i e n t t o s t r e s s t h e i m p o r t a n c e o f the need f o r f u r t h e r m o n i t o r i n g and t e l l he or she discontinued. does not come i n , the the patient that, i f treatment will be Dr. Hays s a i d t h a t , i n h i s o p i n i o n , a p h y s i c i a n c a n n o t t u r n o v e r t h e r e s p o n s i b i l i t y o f m o n i t o r i n g a Coumadin patient t o someone i n h i s o r h e r o f f i c e and then walk f r o m any f u r t h e r r e s p o n s i b i l i t y . As D r . Hays 11 said: away 2100202 " [ E ] v e r y b o d y [working i n a p h y s i c i a n ' s o f f i c e ] has d i f f e r e n t t r a i n i n g , d i f f e r e n t s k i l l s , but they are s t i l l you a r e t h e p h y s i c i a n , y o u a r e s t i l l t h e d o c t o r i n p r a c t i c e and i t i s s t i l l your p a t i e n t w h e t h e r i t i s t h e p e r s o n c h a n g i n g t h e bandage o r how t h e y draw b l o o d o r w h a t e v e r f u n c t i o n t h e y do i n y o u r o f f i c e , y o u a r e s t i l l t h e one t h a t t h e s t a n d a r d [ o f c a r e ] r e q u i r e s u l t i m a t e l y y o u n e e d t o make s u r e t h a t what i s b e i n g done t o them a n d f o r them i s done a p p r o p r i a t e l y and w i t h i n t h e s t a n d a r d o f c a r e . " Dr. medical Hays t h e n records, standard of care testified that, after reviewing i n h i s o p i n i o n Dr. G i l l i s i n s e v e r a l ways. Bryant's f a i l e d t o meet t h e He s t a t e d t h a t D r . G i l l i s never created a p l a n t o e n s u r e t h a t B r y a n t was p l a c e d correct o f Coumadin; dose Bryant's that dosage, her dosage indication t o Bryant and a v e r y monitored was Further, never adjusted t h e c o r r e c t dosage, o r confirmed medical that serious i n a certain therapeutic Dr. G i l l i s stabilized; i n Bryant's explained drug," confirmed that and records Coumadin there that i s likely and dangerous fashion that t o make drug sure i s no i t was a ever "life-time that that must be i t stays a n d does n o t c a u s e any d a n g e r o u s p r o b l e m s . when asked whether Bryant's proper Coumadin was e v e r d e t e r m i n e d , Dr. Hays r e p l i e d t h a t is on t h e n o t one s i n g l e reading on an INR t h a t was dose of "[t]here w i t h i n the t h e r a p e u t i c r a n g e so I c a n n o t t e l l y o u b e t w e e n A u g u s t 29 when 12 2100202 she was there s t a r t e d and was ever failure, care, Dr. and, Davis's, Dr. November 15 a therapeutic Hays t e s t i f i e d , he s t a t e d , i t was [ s i c ] when she dose falls Dr. established." beneath also testified that B r y a n t ' s INRs were b e i n g b r e a c h of the standard the over Coumadin his standard of not colonoscopy, Dr. to failure Gillis responsibility dosage a to established. ensure that also a care. When a s k e d a b o u t w h e t h e r Dr. turned Such t e s t e d i n a t i m e l y manner was of that responsibility, Gillis's the t o e n s u r e t h a t t h e t h e r a p e u t i c dose was Hays passed the for physician Hays s a i d t h a t c o u l d have monitoring who properly Bryant's performed a gastroenterologist the is not the proper p h y s i c i a n t o m o n i t o r a p a t i e n t ' s Coumadin d o s a g e . He the also before stated a that procedure p h y s i c i a n who physician such who handles a the Coumadin t r e a t m e n t , w i t h from the g a s t r o e n t e r o l o g i s t i f n e c e s s a r y . that, again, because there Dr. Gillis were no Coumadin as reinitiates colonoscopy the failed INR c o l o n o s c o p y on S e p t e m b e r 13, t o meet t h e tests done on should Dr. Hays the input testified standard Bryant be of care after 2005, and no t e s t s done on h e r O c t o b e r 2005. 13 the in 2100202 Similarly, Dr. Hays noted c a r d i o l o g i s t on O c t o b e r 6, Gillis, too blood. He can physician patient's to "So, determine t h a t concerned t h a t her h e a r t r a t e Hays claimed ensure at h i s 2005, further on did not not r e l i e v e d of Hays also of care office when or she Coumadin i t has by receive testified not sent that, called her should not of care the his even on Dr. a new Coumadin, recheck the changed. you He need t o r e - therapeutic." though Dr. Gillis the c a r d i o l o g i s t ' s report, his obligation p r o p e r and that ensuring to with a s t a b l e dose and testified p o s s i b l e b r u i s i n g on energy. However, l e v e l o f Coumadin i n one's t o meet t h e s t a n d a r d B r y a n t ' s Coumadin d o s a g e was standard Digoxin. t h e body d e a l s that was Dr. with the he Gillis was change how they are the Dr. a f f e c t the monitoring INR testified: Dr. saw s t a t e d t h a t , anytime a p a t i e n t i s p l a c e d m e d i c a t i o n t h a t can the Bryant r e f e r r e d by began t r e a t i n g her Hays s a i d , D i g o x i n when 2005, a f t e r b e i n g t h e c a r d i o l o g i s t was f a s t and that, Dr. office t h i g h and 14 ensure to Gillis breached room on complain shoulder Gillis's that stabilized. t h a t B r y a n t was emergency When B r y a n t came t o Dr. to Dr. and the e i t h e r seen November 9, about the her o f f i c e on lack of November 2100202 14, 2005, Dr. Hays patients being that Davis, as someone who t r e a t e d w i t h Coumadin, s h o u l d Bryant's emergency." said, INR He constituted s a i d : "[The "absolute an recognized critical d i d not respond i n f a c t t h a t she those p a t i e n t s . " Dr. with have t h a t f a s h i o n c a l l s i n t o q u e s t i o n w h e t h e r she was t o be h a n d l i n g deals truly capable Hays t h e n t e s t i f i e d that " w i t h i n the p h y s i c i a n ' s o f f i c e you can delegate a n y d i f f e r e n t r e s p o n s i b i l i t i e s t o p e o p l e b a s e d on t h e i r t r a i n i n g and t h e i r a b i l i t i e s , b u t i t i s s t i l l the p h y s i c i a n ' s u l t i m a t e r e s p o n s i b i l i t y . I t i s your patient. You a r e t h e one t h a t i s r e s p o n s i b l e f o r what e v e r y b o d y t h a t t r e a t s t h e p a t i e n t u n d e r y o u r c a r e does f o r t h a t p a t i e n t . So, t h i s i s s t i l l s o l e l y Dr. G i l l i s ' s r e s p o n s i b i l i t y w h e t h e r o r n o t he was p r e s e n t o r n o t . " Dr. Hays Bryant also said a f t e r Dr. breached the that, Gillis standard given placed of care the her lack on of monitoring Coumadin, Dr. required to properly of Gillis supervise Davis. Dr. degree Hays of standard d e a t h was not said medical that, in his opinion, to Dr. Gillis's breaches certainty, of care caused Bryant's death. "absolutely" irreversible as avoidable late as B r y a n t ' s INRs were e x t r e m e l y and November high. 15 a reasonable of He t e s t i f i e d t h a t t h a t her 14 and condition 15, the her was 2005, when 2100202 At the close o f F r a z i e r ' s case, judgment as a m a t t e r negligence o f l a w on t h e g r o u n d t h a t was n o t t h e p r o x i m a t e Specifically, Dr. G i l l i s cause h i s alleged of Bryant's he a r g u e d t h a t t h e d e f i c i e n t m e d i c a l B r y a n t r e c e i v e d a t t h e hands o f o t h e r h e a l t h - c a r e November moved f o r a 14 a n d 15, 2005, was t h e p r o x i m a t e death. treatment p r o v i d e r s on cause of her death, and t h a t , b u t f o r t h a t i n t e r v e n i n g cause, B r y a n t would have s u r v i v e d . The t r i a l court agreed, saying: " I f t h i s was a b o r d e r l i n e [ c a s e ] , I w o u l d l e t i t go t o t h e j u r y . T h a t i s j u s t b e c a u s e t h a t i s my philosophy. I kept e x p e c t i n g your expert t o say t h a t even i f Dr. Evans had s e n t h e r t o t h e h o s p i t a l t h a t because o f t h e t h i n g s t h a t had happened b e f o r e , b e c a u s e h e r l e v e l n e v e r h a d b e e n s t a b i l i z e d t h a t she m i g h t n o t have l i v e d . Or I e x p e c t e d h i m t o s a y t h a t Dr. E v a n s m i g h t n o t have known t o s e n d h e r t o t h e h o s p i t a l b e c a u s e s h e was n o t h i s p a t i e n t , a n d he d i d n o t know how h e r l e v e l s f l u c t u a t e d . I expected t h o s e t h i n g s a n d t h a t i s t h e o n l y way i t c o u l d have gone t o t h e j u r y . "MR. DOUGLAS heard b r i e f l y ? [Frazier's a t t o r n e y ] : May I be "THE COURT: I have h e a r d i t , I have l o o k e d a t i t , I have m u l l e d o v e r i t , a n d t h o s e t h i n g s were n o t there. A n d b e c a u s e t h e y were n o t t h e r e , a s much a s I h a t e i t I b e l i e v e t h a t B r y a n t s h o u l d n o t have d i e d , a n d I t h i n k t h a t i s a c r y i n g shame, a n d my s y m p a t h y i s c o m p l e t e l y a n d t o t a l l y w i t h Mr. F r a z i e r . My h e a r t b r e a k s f o r h i m . I am so s o r r y f o r h i s loss. I have l o s t b o t h o f my p a r e n t s a n d i f I t h o u g h t t h e i r d e a t h s s h o u l d have b e e n p r e v e n t e d , I d o n ' t know how y o u l i v e w i t h i t , b u t s h e s h o u l d n o t 16 2100202 have d i e d , b u t i t was n o t Dr. G i l l i s ' s fault. You c o u l d n o t p r o v e d i d n o t p r o v e y o u r c a s e so I am g o i n g t o e n t e r a j u d g m e n t as a m a t t e r o f l a w i n f a v o r o f Dr. G i l l i s . "MR. DOUGLAS: May I be h e a r d , Y o u r Honor? "THE COURT: T h a t i s i t , n o . " On O c t o b e r judgment 2 1 , 2010, t h e t r i a l i n favor o f Dr. G i l l i s . A l a b a m a Supreme C o u r t , w h i c h court entered a written Frazier transferred appealed to the the appeal t o t h i s c o u r t p u r s u a n t t o § 1 2 - 2 - 7 ( 6 ) , A l a . Code 1975. Frazier Dr. G i l l i s ' s contends t h a t the t r i a l court erred i n granting m o t i o n f o r a j u d g m e n t as a m a t t e r o f l a w . i n i t i a l m a t t e r , we n o t e t h a t Dr. G i l l i s waived h i s right because, he s a y s , r a i s e s on a p p e a l . opposing law, contends t h a t to challenge the t r i a l Frazier failed Specifically, Dr. G i l l i s ' s motion court's As an Frazier judgment to preserve the issue Dr. G i l l i s he contends t h a t , i n f o r a j u d g m e n t as a m a t t e r o f F r a z i e r f a i l e d t o argue t h a t n e g l i g e n t subsequent m e d i c a l care i s f o r e s e e a b l e and, t h e r e f o r e , t h a t he c a n n o t now r a i s e t h a t argument on a p p e a l . We "will record disagree with not place a t r i a l reveals Dr. G i l l i s ' s court i tneither assertion. This court ' " i n e r r o r on m a t t e r s w h i c h t h e ruled 17 upon n o r was p r e s e n t e d t h e 2100202 o p p o r t u n i t y t o r u l e upon."' Res., 668 So. 2d 813, J.K. v . L e e C o u n t y Dep't o f Human 817 ( A l a . C i v . App. 1 9 9 5 ) ( q u o t i n g v. S t a t e Dep't o f Human Res., App. 1988)) (emphasis added).'" 52 So. 3d 484, was entitled 527 So. 2 d 1322, 491 ( A l a . 2 0 1 0 ) . t o a judgment Wilson 1324 ( A l a . C i v . Hamm v . N o r f o l k S. Ry. Co., However, i n a s s e r t i n g t h a t he as a m a t t e r o f l a w , Dr. argued that the a l l e g e d d e f i c i e n t medical care Bryant Gillis received f r o m o t h e r h e a l t h - c a r e p r o v i d e r s on November 14 a n d 15, 2005, was an i n t e r v e n i n g liability. judgment trial cause The t r i a l court on t h e g r o u n d court considered that absolved Dr. G i l l i s o f any agreed w i t h him and e n t e r e d t h e argued b y Dr. G i l l i s . and r u l e d upon Because t h e the very issue b e f o r e us, t h i s c o u r t w i l l review t h e p r o p r i e t y o f t h a t and t h e s u b s e q u e n t e n t r y o f a j u d g m e n t b a s e d on t h a t Our standard of review of a t r i a l judgment as a m a t t e r o f l a w i s w e l l "In Decamps, Inc. vibrant, court's ruling ruling. entry of a settled. 738 So. 2d 824 ruling (Ala. on a "'When r e v i e w i n g a r u l i n g on a m o t i o n for a [judgment as a m a t t e r of law ( " J C L " ) ] , t h i s C o u r t u s e s t h e same s t a n d a r d the t r i a l c o u r t used i n i t i a l l y i n g r a n t i n g o r d e n y i n g a JML. P a l m H a r b o r Homes, I n c . 18 now 2100202 v. C r a w f o r d , 689 So. 2d 3 ( A l a . 1 9 9 7 ) . Regarding q u e s t i o n s of f a c t , the u l t i m a t e question i s w h e t h e r t h e nonmovant has presented s u f f i c i e n t evidence to a l l o w the c a s e o r t h e i s s u e t o be s u b m i t t e d t o t h e jury for a factual resolution. C a r t e r v. H e n d e r s o n , 598 So. 2d 1350 ( A l a . 1992) . F o r a c t i o n s f i l e d a f t e r June 11, 1987, the nonmovant must present "substantial evidence" i n order to w i t h s t a n d a motion f o r a JML. See § 12-21-12, A l a . Code 1975; West v. F o u n d e r s L i f e A s s u r a n c e Co. of F l o r i d a , 547 So. 2d 870, 871 ( A l a . 1 9 8 9 ) . A r e v i e w i n g c o u r t must d e t e r m i n e w h e t h e r t h e p a r t y who b e a r s t h e b u r d e n o f p r o o f has produced s u b s t a n t i a l evidence c r e a t i n g a f a c t u a l d i s p u t e r e q u i r i n g r e s o l u t i o n by t h e j u r y . C a r t e r , 598 So. 2d a t 1353. In r e v i e w i n g a r u l i n g on a m o t i o n f o r a JML, t h i s Court views the evidence i n the l i g h t most favorable to the nonmovant and e n t e r t a i n s s u c h r e a s o n a b l e i n f e r e n c e s as t h e j u r y w o u l d have b e e n f r e e t o draw. M o t i o n I n d u s t r i e s , I n c . v. P a t e , 678 So. 2d 724 ( A l a . 1 9 9 6 ) . R e g a r d i n g a q u e s t i o n o f law, however, this Court indulges no p r e s u m p t i o n o f c o r r e c t n e s s as t o t h e t r i a l c o u r t ' s r u l i n g . R i c w i l , I n c . v. S.L. Pappas & Co., 599 So. 2d 1126 ( A l a . 1 9 9 2 ) . ' "738 So. 2d a t 830-31." L e o n a r d v. Cunningham, 4 So. 3d a t 1184. F r a z i e r a s s e r t s t h a t he p r e s e n t e d s u b s t a n t i a l e v i d e n c e o f each of the elements required to sustain a c l a i m of m e d i c a l m a l p r a c t i c e a g a i n s t Dr. G i l l i s p u r s u a n t t o t h e A l a b a m a M e d i c a l 19 2100202 L i a b i l i t y A c t ("the AMLA"), § 6-5-480 e t s e q . a n d § 6-5-540 e t seq., A l a . Code 1975. M e d i c a l - m a l p r a c t i c e a c t i o n s a r e g e n e r a l l y governed by the AMLA. See Mock v. A l l e n , 783 So. 2d 828, 832 ( A l a . 2000) ( n o t i n g t h a t t h e AMLA " a p p l i e s ' [ i ] n any a c t i o n f o r i n j u r y o r damages or wrongful death, whether i n c o n t r a c t a g a i n s t a h e a l t h care p r o v i d e r care.'" or i n t o r t , f o r breach of the standard ( q u o t i n g § 6 - 5 - 5 4 8 ( a ) , A l a . Code of 1975)). "'To p r e v a i l on a m e d i c a l - m a l p r a c t i c e claim, a p l a i n t i f f must p r o v e "'1) t h e a p p r o p r i a t e standard o f c a r e , 2) t h e [ h e a l t h - c a r e p r o v i d e r ' s ] d e v i a t i o n from t h a t standard, a n d 3) a p r o x i m a t e causal c o n n e c t i o n between t h e [ h e a l t h - c a r e p r o v i d e r ' s ] a c t or o m i s s i o n c o n s t i t u t i n g t h e b r e a c h and t h e i n j u r y s u s t a i n e d by t h e p l a i n t i f f . ' " ' G i l e s v. B r o o k w o o d H e a l t h S e r v s . , I n c . , 5 So. 3d 533, 549 ( A l a . 2008) ( q u o t i n g P r u i t t v. Z e i g e r , 590 So. 2d 236, 238 ( A l a . 1 9 9 1 ) , q u o t i n g i n t u r n B r a d f o r d v. McGee, 534 So. 2d 1076, 1079 ( A l a . 1 9 8 8 ) ) . " M o s l e y v. B r o o k w o o d H e a l t h (Ala. Serve., I n c . , 24 So. 3d 430, 433 2009). I n m o v i n g f o r a j u d g m e n t as a m a t t e r o f l a w a t t h e c l o s e of F r a z i e r ' s case, failed to present standards those of care standards Dr. G i l l i s d i d n o t a s s e r t t h a t F r a z i e r h a d s u b s t a n t i a l evidence or evidence of care. that of the Dr. G i l l i s appropriate had breached At the close of F r a z i e r ' s case-in- 20 2100202 c h i e f , Dr. G i l l i s matter of law, asked the c o u r t to determine the subsequent i n t e r v e n i n g a l l e g e d n e g l i g e n c e o f Dr. E v a n s and Davis the November hospital w h e t h e r , as a on in failing 14 or t o have B r y a n t 15, admitted 2005, when h e r INR to was d a n g e r o u s l y e l e v a t e d , r e l i e v e d Dr. G i l l i s o f any l i a b i l i t y f o r her death. If i t did, Dr. Gillis argued, q u e s t i o n of f a c t f o r the j u r y to decide, t o a j u d g m e n t as a m a t t e r o f l a w . Dr. Gillis, On appeal, determine trial and the i s whether, intervening liability. In 2d 152 d e n t i s t who ("Eva"). sought issue at this this court stage asserting that In is called i n the t h a t , as negligence ( A l a . 1998). with the that litigation, a matter absolved of the court law, the of erred on L o o n e y v . D a v i s , case, Dr. Looney extraction. Looney, two 721 hospitals in So. 2d at the days 154-55. was a Davis after and the Health-care p r o v i d e r s i n t h e e m e r g e n c y rooms a t b o t h h o s p i t a l s a d v i s e d 21 in 721 A f t e r w a r d s , Eva c o n t i n u e d t o b l e e d f r o m t h e s i t e at to Gillis Dr. trial upon e x t r a c t e d a t o o t h o f h i s p a t i e n t , Eva Winn treatment no entitled t r i a l court agreed e n t e r i n g the judgment, F r a z i e r r e l i e s So. and he was was i t e n t e r e d the judgment a c c o r d i n g l y . court erred i n finding alleged The there Eva 2100202 to apply pressure to the extraction d e n t i s t ; they then r e l e a s e d her. the extraction, room. The Eva was again d o c t o r on c a l l site Id. taken and a larger to a h o s p i t a l r e c o g n i z e d t h a t Eva was coagulopathy, hospital, an where inability sepsis, respond to treatment and she anemia. in critical diagnosed to c l o t , with because I d . a t 156. died that night. the h o s p i t a l s who extraction, medical alleging care n e g l i g e n c e had named t o Eva had provided that and each Eva that their d i d not reached to Dr. Looney, to concurring Id. S e v e r a l of agreements with trial. Three A jury defendants Eva's estate. reached Dr. pro Looney t h i n g s , t h a t the t r i a l tanto settlement appealed, c o u r t had 22 Eva's returned Two agreements arguing, e r r e d i n denying the defendants, v e r d i c t a g a i n s t a l l t h r e e i n t h e amount o f $3 m i l l i o n . the the c o m b i n e d and settlement went after substandard e s t a t e o r were d i s m i s s e d f r o m t h e a c t i o n . including her Looney provided r e s u l t e d i n Eva's death. defendants of Id. care had after emergency E v a ' s h u s b a n d , on b e h a l f o f E v a ' s e s t a t e , s u e d Dr. and her then t r a n s p o r t e d was of her b l o o d l i v e r d i s e a s e , and visit On t h e f o u r t h day c o n d i t i o n and o r d e r e d a t r a n s f u s i o n . Eva was to to among a of with other h i s motion 2100202 f o r a judgment n o t w i t h s t a n d i n g t h e v e r d i c t 2 b e c a u s e , he said, t h e r e was no e v i d e n c e i n d i c a t i n g t h a t h i s a l l e g e d n e g l i g e n c e had the proximate been Instead, he argued, cause the of Eva's negligent death. care Id. at provided 158. by her s u b s e q u e n t h e a l t h - c a r e p r o v i d e r s was a s u p e r s e d i n g i n t e r v e n i n g cause of her d e a t h . He a l s o a r g u e d t h a t p r o x i m a t e c a u s e not in his be established "simply unforeseeable that case he said, i t was [Eva] w o u l d d i e as t h e r e s u l t o f an improper tooth e x t r a c t i o n . " In r e j e c t i n g because, could Id. at Dr. L o o n e y ' s 159. assertions, o u r supreme court s t a t e d t h a t "a p a r t i c u l a r d e f e n d a n t ' s n e g l i g e n c e need n o t be t h e s o l e c a u s e o f i n j u r y i n o r d e r f o r an a c t i o n t o l i e a g a i n s t the defendant; i t i s s u f f i c i e n t t h a t the n e g l i g e n c e concurred w i t h the o t h e r causes t o produce injury." I d . a t 158. The c o u r t went on t o e x p l a i n : " ' I n Alabama, the i s s u e of p r o x i m a t e causation hinges on foreseeability and is intertwined, analytically, with the concept of intervening cause.' S p r i n g e r v. J e f f e r s o n C o u n t y , 595 So. 2d 1381, 1384 ( A l a . 1992). I n d e e d , t h i s C o u r t has stated: A motion now known as a R u l e 50, A l a . P l u m b i n g , LLC, 2 f o r a judgment n o t w i t h s t a n d i n g t h e v e r d i c t i s m o t i o n f o r a j u d g m e n t as a m a t t e r o f l a w . See R. C i v . P., and R o b e r t s o n v. Gaddy E l e c . & 53 So. 3d 75, 79 ( A l a . 2 0 1 0 ) . 23 2100202 " ' [ F J o r e s e e a b i l i t y i s the cornerstone of p r o x i m a t e c a u s e , A l a b a m a Power Company v. Taylor, 293 A l a . 484, 306 So. 2d 236 (1975). As a r e s u l t , one i s h e l d l e g a l l y r e s p o n s i b l e f o r a l l consequences which a prudent and e x p e r i e n c e d person, fully acquainted with a l l the circumstances, at t h e t i m e o f h i s n e g l i g e n t a c t , w o u l d have thought reasonably p o s s i b l e t o f o l l o w t h a t act, P r e s c o t t v . M a r t i n , 331 So. 2d 240 (Ala. 1976), i n c l u d i n g t h e n e g l i g e n c e o f o t h e r s , W i l l i a m s v. Woodman, 424 So. 2d 611 (Ala. 1982). ' " G e n e r a l M o t o r s C o r p . v . E d w a r d s , 482 So. 2d 1176, 1194 ( A l a . 1 9 8 5 ) . T h i s Court has f u r t h e r e x p l a i n e d , " ' I t i s an a c c e p t e d p r i n c i p l e t h a t a defendant i s l i a b l e f o r a l l the f o r e s e e a b l e i n j u r i e s caused by h i s n e g l i g e n c e . W i l l i a m s [v. Woodman, 424 So. 2d 611 ( A l a . 1 9 8 2 ) ] ; M c C l e n d o n v . C i t y o f B o a z , 395 So. 2d 21 (Ala. 1 9 8 1 ) ; O'Quinn v. A l s t o n , 213 A l a . 346, 104 So. 653 ( 1 9 2 5 ) . T h a t an i n j u r e d p a r t y w i l l r e c e i v e n e g l i g e n t medical care i s always foreseeable. T h i s Court has accepted t h i s presumption, h o l d i n g : " ' " [ W ] h e r e one i s i n j u r e d b y t h e negligent or wrongful act of another, and uses o r d i n a r y care i n e n d e a v o r i n g t o be h e a l e d , a n d i n t h e s e l e c t i o n o f m e d i c a l and surgical help, but h i s injury i s aggravated by t h e n e g l i g e n c e or u n s k i l l f u l n e s s of the l a t t e r , the party causing the o r i g i n a l injury will be responsible f o r the r e s u l t i n g damages t o i t s f u l l extent." 24 2100202 " ' W i l l i a m s v . Woodman, s u p r a , a t 613, c i t i n g O'Quinn v. A l s t o n , s u p r a . ' "Ex p a r t e R u d o l p h , 515 So. 2d 704, 707-08 ( A l a . 1987) ( e m p h a s i s on " a l l " i n o r i g i n a l ) . " L o o n e y , 721 So. 2d a t 159 (some e m p h a s i s Based Davis Gillis find on t h e h o l d i n g i n L o o n e y , e v e n i f D r . E v a n s a n d acted November added). negligently i n their 14 a n d 15, t h e i r treatment negligence of Bryant would n o t r e l i e v e Dr. o f r e s p o n s i b i l i t y f o r B r y a n t ' s d e a t h i f a j u r y were t o t h a t he a c t e d n e g l i g e n t l y i n treating Bryant t h a t n e g l i g e n c e c a u s e d h e r t o have a d a n g e r o u s l y in the f i r s t In case, Dr. on e l e v a t e d INR place. attempting Dr. G i l l i s Evans and t h a t argues and unforeseeable. to distinguish Davis Looney from the present t h a t t h e n e g l i g e n t care rendered by was so egregious that i t was However, o u r r e s e a r c h h a s r e v e a l e d no A l a b a m a a u t h o r i t y f o r the p r o p o s i t i o n t h a t there a r e d i f f e r e n t degrees of negligent medical foreseeable c a r e so as t o make some n e g l i g e n t c a r e and o t h e r negligent care supreme c o u r t s t a t e d i n L o o n e y , s u p r a , t h a t "an i n j u r e d p a r t y w i l l always f o r e s e e a b l e . " unforeseeable. Our that the p o s s i b i l i t y r e c e i v e n e g l i g e n t medical care i s I n r e a c h i n g t h a t c o n c l u s i o n , t h e supreme 25 2100202 court d i d not i n d i c a t e that the extent medical negligence i s a consideration. of the intervening I t stated: "'"'"As r e g a r d s p r o x i m a t e c a u s e ... i t i s not necessary t o a defendant's liability, a f t e r h i s n e g l i g e n c e has been e s t a b l i s h e d , to show, i n a d d i t i o n t h e r e t o , t h a t t h e p a r t i c u l a r consequences o f h i s n e g l i g e n c e c o u l d have b e e n f o r e s e e n b y h i m ; i t i s sufficient that the i n j u r i e s are the n a t u r a l , a l t h o u g h n o t t h e n e c e s s a r y and i n e v i t a b l e , r e s u l t of the negligent f a u l t - ¬ s u c h i n j u r i e s as a r e l i k e l y , i n o r d i n a r y c i r c u m s t a n c e s , t o ensue from t h e a c t o r o m i s s i o n i n q u e s t i o n . " 38 Am. J u r . , § 62, p. 714.'"' "Lawson v . G e n e r a l T e l . Co. o f A l a b a m a , 289 A l a . 283, 289, 267 So. 2d 132, 138 ( 1 9 7 2 ) , q u o t i n g S u l l i v a n v . A l a b a m a Power Co., 246 A l a . 262, 268, 20 So. 2d 224, 228 ( 1 9 4 4 ) . I t has a l s o been s i m i l a r l y s a i d that ' i ti s not necessary that every d e t a i l of damage w h i c h i s t h e o r d i n a r y a n d n a t u r a l r e s u l t [ o f one's n e g l i g e n c e ] be c o n t e m p l a t e d . ' Sloss-Sheffield S t e e l & I r o n Co. v. W i l k e s , 236 A l a . 173, 178, 181 So. 276, 279 ( 1 9 3 8 ) . "Thus, g e n e r a l l y a d e f e n d a n t may be f o u n d l i a b l e i f some p h y s i c a l i n j u r y o f t h e g e n e r a l t y p e t h e p l a i n t i f f s u s t a i n e d was a f o r e s e e a b l e c o n s e q u e n c e o f the d e f e n d a n t ' s n e g l i g e n t conduct, even though t h e e x t e n t o f t h e p h y s i c a l i n j u r i e s may have b e e n q u i t e u n f o r e s e e a b l e . I n d e e d , i t h a s b e e n n o t e d , 'There i s a l m o s t u n i v e r s a l a g r e e m e n t upon l i a b i l i t y b e y o n d t h e r i s k , f o r q u i t e u n f o r e s e e a b l e consequences, when they f o l l o w an i m p a c t upon t h e p e r s o n of the plaintiff.' W. Page K e e t o n e t a l . , P r o s s e r a n d K e e t o n on t h e Law o f T o r t s § 43, a t 291 ( 5 t h e d . 1984) (footnote omitted). See a l s o 65 C.J.S. N e g l i g e n c e § 109 ( 1 9 6 6 ) . F o r example, i n Armstrong v. Montgomery S t r e e t Ry. Co., 123 A l a . 233, 26 So. 26 2100202 349 (1899), the Court h e l d that negligence that c a u s e d an i n j u r y t o one's f i n g e r , w h i c h injury p r o d u c e d b l o o d p o i s o n i n g t h a t c a u s e d d e a t h , was t h e p r o x i m a t e cause o f t h e death: "'The fall produced the i n j u r i e s ; the i n j u r i e s p r o d u c e d b l o o d p o i s o n i n g , and t h e b l o o d p o i s o n i n g p r o d u c e d d e a t h . T h e r e was no b r e a k i n t h e c h a i n o f c a u s a t i o n f r o m t h e a l l e g e d n e g l i g e n t a c t t o the death of [the] intestate. The b l o o d p o i s o n i n g was n o t an independent cause. I t was not a s u p e r s e d i n g c a u s e . I t was i t s e l f a r e s u l t , or, perhaps more accurately, a mere development o f t h e i n j u r i e s . I t i s n o t an i m p o r t a n t c o n s i d e r a t i o n , e v e n i f i t be a fact, that blood poisoning i s not a usual and ordinary result or development o f wounds o f t h e c h a r a c t e r i n f l i c t e d upon t h e intestate.' "Id., a t 249, 26 So. a t 3 5 3 . " L o o n e y , 721 So. 2d a t 162. Here, his i f a jury finds that treatment of Bryant, elevated, Dr. G i l l i s was n e g l i g e n t i n c a u s i n g h e r INR t o become d a n g e r o u s l y then i t can a l s o f i n d t h a t h i s n e g l i g e n c e began t h e chain of events that u l t i m a t e l y r e s u l t e d i n Bryant's As matter a negligence of law, the a l l e g e d superseding o f Dr. E v a n s a n d D a v i s does n o t a b s o l v e death. intervening Dr. G i l l i s o f l i a b i l i t y i f t h e j u r y f i n d s t h a t he, t o o , was n e g l i g e n t i n t r e a t i n g B r y a n t and t h a t h i s n e g l i g e n c e t h a t p u t h e r h e a l t h a t such extreme 27 created the condition risk. 2100202 For the reasons set forth above, we conclude that the t r i a l c o u r t e r r e d i n e n t e r i n g a j u d g m e n t as a m a t t e r o f l a w i n favor o f Dr. Gillis based on i t s determination that the s u p e r s e d i n g i n t e r v e n i n g n e g l i g e n c e o f Dr. E v a n s a n d D a v i s i n t r e a t i n g B r y a n t a b s o l v e d Dr. G i l l i s o f l i a b i l i t y . In reaching t h i s h o l d i n g , we e x p r e s s no o p i n i o n as t o w h e t h e r Dr. G i l l i s was i n fact n e g l i g e n t i n the care he rendered to Bryant. A c c o r d i n g l y , we r e v e r s e t h e j u d g m e n t o f t h e t r i a l c o u r t , a n d we remand t h e c a u s e this f o r further proceedings consistent with opinion. REVERSED AND REMANDED. P i t t m a n , B r y a n , a n d Thomas, J J . , c o n c u r . Moore, J . , concurs i n the 28 result, without writing.

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