Clifford P. Black, M.D. v. Holley Lynn Comer

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REL: 06/19/2009 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 , A l a b a m a 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 ( ( 3 3 4 ) 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 . SUPREME COURT OF ALABAMA OCTOBER TERM, 2008-2009 1070652 Clifford P. B l a c k , M.D. v. H o l l e y Lynn Comer Appeal SMITH, affirm. Calhoun C i r c u i t (CV-97-144) Court Justice. Clifford against from P. B l a c k , M.D., a p p e a l s h i m i n an a c t i o n filed from a judgment by H o l l e y Lynn entered Comer. We 1070652 Facts This case B l a c k v . Comer, following has and P r o c e d u r a l previously been 920 S o . 2 d 1 0 8 3 f a c t u a l background History before ( A l a . 2005) this Court. ("Black I"). from B l a c k I i s r e l e v a n t The to this appeal: " I n e a r l y 1 9 9 5 C o m e r , who was t h e n 40 y e a r s o l d , sought treatment from h i s p r i m a r y - c a r e p h y s i c i a n f o r n i g h t sweats, w e i g h t l o s s , and ' l a t e d a y ' f e v e r s . Additionally, he had recently experienced an a x i l l a r y ( a r m p i t ) v e i n t h r o m b o s i s . Comer's c l i n i c a l p r e s e n t a t i o n p l a c e d a d i a g n o s i s o f l y m p h o m a (a t u m o r o f t h e l y m p h n o d e s ) h i g h on t h e i n d e x o f s u s p i c i o n . H i s p r i m a r y - c a r e p h y s i c i a n o r d e r e d a CT s c a n o f C o m e r ' s a b d o m e n . ... " C o m e r ' s p r i m a r y - c a r e p h y s i c i a n r e f e r r e d Comer to Dr. B l a c k , a b o a r d - c e r t i f i e d g e n e r a l surgeon, f o r a colonoscopy. Dr. B l a c k performed the colonoscopy and found nothing to explain Comer's symptoms. Because those symptoms continued to suggest a l y m p h o m a o r a t l e a s t some t y p e o f h i d d e n t u m o r , D r . Black recommended a diagnostic abdominal laparoscopy, a procedure i n which the doctor views the abdominal cavity through a laparoscope, an o p t i c a l s u r g i c a l instrument inserted through a small cut i n or near the p a t i e n t ' s n a v e l . I f Dr. Black could not adequately e v a l u a t e Comer's condition u s i n g t h e l a p a r o s c o p e , he w a n t e d t o c o n v e r t t h e p r o c e d u r e t o an e x p l o r a t o r y l a p a r o t o m y , a p r o c e d u r e i n w h i c h t h e surgeon opens t h e p a t i e n t ' s abdomen. He e x p l a i n e d b o t h p r o c e d u r e s t o C o m e r . D r . B l a c k t o l d Comer t h a t he m i g h t ' h a v e t o r e m o v e t i s s u e i n o r d e r t o make a d i a g n o s i s o r t o t r e a t w h a t [ h e ] f o u n d ' a n d t h a t he m i g h t h a v e t o ' d o some p r o c e d u r e ... a p p r o p r i a t e f o r w h a t he f o u n d . ' D r . B l a c k a l s o d i s c u s s e d w i t h Comer ' t h a t i t m i g h t b e c o m e n e c e s s a r y to remove abnormal tissue depending upon the 2 See 1070652 f i n d i n g s o f t h e l a p a r o s c o p y and p o s s i b l e l a p a r o t o m y [ a n d ] Comer d i d c o n s e n t t o t h e r e m o v a l o f a b n o r m a l t i s s u e w h i c h c o u l d be t h e c a u s e o f h i s s y m p t o m s . ' "Comer was admitted to Northeast Alabama Regional Medical Center on May 18, 1995. He a u t h o r i z e d Dr. B l a c k to p e r f o r m the p r o c e d u r e s by s i g n i n g a consent form that read, i n p e r t i n e n t p a r t : " ' I h e r e b y a u t h o r i z e Dr. C l i f f o r d B l a c k and whomsoever he ... may designate as a s s i s t a n t t o p e r f o r m u p o n m y s e l f ... [a] Diagnostic Laparoscopy[,] possible open Laparotomy[,] and such additional o p e r a t i o n s / p r o c e d u r e s d u r i n g the course of t h e a b o v e as a r e c o n s i d e r e d t h e r a p e u t i c a l l y n e c e s s a r y or a d v i s a b l e i n the e x e r c i s e of p r o f e s s i o n a l judgment. "'The nature and purpose of the operation/procedure, the reason i t is considered n e c e s s a r y , the p o s s i b l e risks i n v o l v e d , the p o s s i b i l i t y of complications and a l t e r n a t i v e methods o f t r e a t m e n t have been fully explained to me and to my satisfaction by my physician or his designee. " ' I f u r t h e r a c k n o w l e d g e t h a t no g u a r a n t e e s h a v e b e e n made t o me c o n c e r n i n g t h e r e s u l t s of the operation/procedure. " ' I a u t h o r i z e t h e a b o v e named p h y s i c i a n t o p r o v i d e s u c h a d d i t i o n a l s e r v i c e s as d e e m e d reasonable and necessary according to m e d i c a l judgment i n c l u d i n g , but not l i m i t e d t o , t h e s e r v i c e s o f p a t h o l o g y and r a d i o l o g y and t h e a d m i n i s t r a t i o n and m a i n t e n a n c e o f a n e s t h e s i a w i t h the e x c e p t i o n of none. 3 1070652 " ' I a u t h o r i z e the h o s p i t a l to r e t a i n dispose of any tissue or parts accordance w i t h the customary p r a c t i c e the h o s p i t a l . or in of " ' I h a v e r e a d o r h a v e h a d r e a d t o me the above s t a t e m e n t s and a g r e e w i t h a l l e x c e p t none.' " C o m e r ' s s i g n i n g o f t h e c o n s e n t f o r m was witnessed by a nurse and by R e b e c c a C o m e r , Comer's w i f e . Comer d o e s n o t c h a l l e n g e i n a n y way t h e v a l i d i t y o r e n f o r c e a b i l i t y o f t h e w r i t t e n c o n s e n t ; r a t h e r , he s i m p l y a r g u e s t h a t Dr. B l a c k ' s a c t i o n s e x c e e d e d t h e s c o p e o f h i s c o n s e n t and t h a t t h e w r i t t e n c o n s e n t ' s h o u l d be i n t e r p r e t e d b y t h e c o u r t l i k e a n y other c o n t r a c t ' t o d e t e r m i n e i t s s c o p e . ( C o m e r ' s b r i e f , p. 32.) " D u r i n g t h e l a p a r o s c o p y , D r . B l a c k d i s c o v e r e d 'a hard-feeling t i s s u e ' i n Comer's r e t r o p e r i t o n e u m - ¬ the space between the l i n i n g of the abdominal and p e l v i c c a v i t i e s and t h e m u s c l e s and bones o f the p o s t e r i o r abdominal w a l l . He c o u l d n o t s e e this t i s s u e w i t h the laparoscope because h i s view of the a r e a i n w h i c h t h e t i s s u e l a y was b l o c k e d by the l i n i n g and by a l a y e r o f f a t t y t i s s u e . Dr. Black elected to convert the procedure to an open laparotomy. "When D r . B l a c k p a l p a t e d t h e retroperitoneum t h r o u g h t h e s u r g i c a l o p e n i n g , he f e l t C o m e r ' s r i g h t k i d n e y a n d w h a t he b e l i e v e d t o be t h e l e f t kidney. He a l s o p a l p a t e d t h e h a r d - f e e l i n g t i s s u e m a s s he h a d d e t e c t e d u s i n g the l a p a r o s c o p e , p o s i t i o n e d below h i p l e v e l , a l l t h e way i n the back of the abdomen; i t was s i t t i n g a t t h e m i d - l i n e on t h e l o w e s t p a r t o f the v e r t e b r a l column b e f o r e the s p i n e curves into t h e p e l v i s . The m a s s was l o c a t e d a b o u t 10 inches away f r o m w h e r e a k i d n e y n o r m a l l y w o u l d be s i t u a t e d . 4 1070652 I t was c o m p o s e d o f s e v e r a l h a r d l o b e s a n d was q u i t e a b i t s m a l l e r than a normal kidney. Dr. Black s u r g i c a l l y entered the r e t r o p e r i t o n e u m to f u r t h e r examine the mass. B e c a u s e i t was e n c a s e d i n f a t t y t i s s u e he c o u l d n o t s e e i t c l e a r l y , b u t n o t h i n g he c o u l d see suggested t o him t h a t t h e m a s s was a kidney. The v a s c u l a t u r e u s u a l l y p r e s e n t t o s e r v e a n o r m a l l y p l a c e d k i d n e y was n o t p r e s e n t . " D r . B l a c k b e l i e v e d t h e i r r e g u l a r m a s s t o be matted together lymph nodes, c h a r a c t e r i s t i c of lymphoma and o t h e r t u m o r s . The l o c a t i o n o f t h e m a s s was typical f o r lymph nodes and atypical for a kidney. Dr. B l a c k d i d n o t c o n s i d e r t h a t t h e mass m i g h t be an e c t o p i c ( m i s p l a c e d ) k i d n e y b e c a u s e he b e l i e v e d t h a t he h a d l o c a t e d b o t h k i d n e y s w h i l e he was p a l p a t i n g t h e o r g a n s . ... " B e c a u s e D r . B l a c k d i d n o t know t h e v a s c u l a r c o m p o s i t i o n o f t h e m a s s , he h a d t o c o n s i d e r w h e t h e r t a k i n g a s m a l l p o r t i o n of i t to send to p a t h o l o g y might cause u n c o n t r o l l a b l e b l e e d i n g . A l s o , he was concerned that i f he took a small portion for a n a l y s i s a n d i t was m a l i g n a n t , he w o u l d r u n t h e r i s k of seeding the abdomen with cancer cells and possibly introducing cancer to other sites. C o n s e q u e n t l y , Dr. B l a c k e l e c t e d t o remove t h e e n t i r e mass. A f t e r he h a d d o n e s o , he c u t a s a m p l e f r o m t h e mass and s e n t i t t o t h e h o s p i t a l ' s p a t h o l o g y department f o r i d e n t i f i c a t i o n . A b o u t 15 minutes l a t e r the pathology department reported that the s a m p l e s e e m e d t o be k i d n e y t i s s u e . The r e m a i n d e r o f t h e m a s s was s u b m i t t e d t o p a t h o l o g y , a n d t h e e x c i s e d m a s s was ultimately determined t o be a 74-gram k i d n e y w i t h a s h o r t segment of u r e t e r attached. A c c o r d i n g t o Dr. B l a c k , a n o r m a l k i d n e y w e i g h s 175 grams. Dr. Black later testified that had he r e a l i z e d d u r i n g t h e s u r g i c a l p r o c e d u r e t h a t t h e mass was an e c t o p i c k i d n e y , he w o u l d n o t h a v e r e m o v e d i t without f i r s t consulting with a urologist. After g e t t i n g t h e i n i t i a l r e p o r t f r o m p a t h o l o g y , Dr. B l a c k 5 1070652 c l o s e d Comer's recovery. surgical incision and sent him to "On the evening o f t h e day of s u r g e r y , Comer began having trouble breathing and started experiencing severe pain. His stomach started s w e l l i n g , a n d h i s r e d b l o o d - c e l l c o u n t d r o p p e d . He was r e t u r n e d t o s u r g e r y , w h e r e i t was discovered t h a t he was b l e e d i n g f r o m two s m a l l a r t e r i e s i n t h e a r e a w h e r e t h e e c t o p i c k i d n e y h a d b e e n r e m o v e d . The bleeding was stopped, and there were no other p o s t s u r g i c a l c o m p l i c a t i o n s . In t h e weeks and months f o l l o w i n g t h e s u r g e r y , Comer g a i n e d w e i g h t , a n d t h e o t h e r symptoms t h a t had l e d him t o s e e k treatment f r o m Dr. B l a c k disappeared. "On F e b r u a r y 14, 1 9 9 7 , Comer s u e d ... D r . B l a c k , ... alleging the 'wrongful t a k i n g ' of his left kidney. Comer a s s e r t e d t h a t D r . B l a c k had been negligent in various specified respects including ' f a i l i n g to o b t a i n consent.' Comer a l s o a s s e r t e d a c l a i m a g a i n s t Dr. B l a c k o f ' [ b ] a t t e r y i n r e m o v i n g a v i a b l e o r g a n w i t h o u t Comer's c o n s e n t . ' Dr. Black a n s w e r e d t h e c o m p l a i n t , d e n y i n g l i a b i l i t y t o Comer on a n y o f t h e a d v a n c e d t h e o r i e s . "On S e p t e m b e r 9, 2 0 0 3 , C o m e r f i l e d a motion r e q u e s t i n g a p a r t i a l summary j u d g m e n t a g a i n s t Dr. Black as to l i a b i l i t y on the failure-to-obtainc o n s e n t and b a t t e r y c l a i m s . 1 fl " A l t h o u g h Comer s t a t e d i n t h e m o t i o n t h a t he s o u g h t a s u m m a r y j u d g m e n t 'as t o l i a b i l i t y on h i s c l a i m s f o r f a i l u r e o f i n f o r m e d c o n s e n t and b a t t e r y ' (emphasis supplied) and although Dr. Black's o p p o s i t i o n to the motion addressed, i n p e r t i n e n t p a r t , the cause of a c t i o n a r i s i n g out of performing a medical procedure without obtaining informed 1 6 1070652 consent from the p a t i e n t , the p a r t i e s subsequently c o n v e r t e d t h e c l a i m t o one a s s e r t i n g s i m p l y a l a c k of consent. S p e c i f i c a l l y , Comer f i l e d a r e s p o n s e t o D r . B l a c k ' s o p p o s i t i o n i n w h i c h Comer e x p l a i n e d that a f t e r he h a d f i l e d h i s m o t i o n , t h i s C o u r t i s s u e d i t s opinion i n C a i n v . H o w o r t h , 877 S o . 2 d 566 ( A l a . 2003), d i s t i n g u i s h i n g between a c l a i m of a l a c k of consent to the performance of a medical procedure and a c l a i m o f a ' l a c k o f i n f o r m e d c o n s e n t . ' Comer a d v i s e d t h a t t h e c l a i m he h a d p l e a d e d a s ' n e g l i g e n c e in failing to obtain consent' should now be understood as one 'alleg[ing] failure to obtain consent (rather than informed consent).' Dr. B l a c k accepted that r e c a s t i n g of the claim, c h a r a c t e r i z i n g the c l a i m i n h i s subsequent s u b m i s s i o n t o t h e t r i a l court a s o n e o f ' l a c k o f c o n s e n t , ' a n d he d o e s likewise throughout his briefs to this Court. Accordingly, we a d d r e s s o n l y a claim of lack of c o n s e n t , as o p p o s e d t o a c l a i m o f l a c k o f i n f o r m e d consent." 920 So. 2d a t 1084-88. The partial summary on h i s lack-of-consent claim. Comer l a t e r v o l u n t a r i l y d i s m i s s e d h i s remaining claims against judgment Dr. court i n favor Black, judgment of trial the e f f e c t before damages of of "thereby liability." tried i n Black Comer I giving entered the of a f i n a l jury; court's partial summary j u d g m e n t 920 S o . 2 d a t 1 0 8 8 . a a "the j u r y $15 0 , 0 0 0 - - $ 1 0 0 , 0 0 0 The i s s u e awarded on t h e 920 S o . 2 d a t 1 0 8 8 . 7 was compensatory past pain s u f f e r i n g and m e n t a l a n g u i s h and $50,000 f o r h i s f u t u r e anguish." issue o f damages Comer f o r Comer's summary and mental 1070652 This that Court i n Black jury verdict. We I r e v e r s e d t h e judgment noted the following e n t e r e d on arguments of the parties: "Comer made t h e f o l l o w i n g a r g u m e n t c o n c e r n i n g the i s s u e of consent i n h i s motion f o r a p a r t i a l summary j u d g m e n t : "'[Comer] agreed t o t h e removal o f a tumor. I t i s u n d i s p u t e d t h a t no t u m o r was f o u n d a t t h e t i m e o f t h e s u r g e r y o r s i n c e . The f a c t that Dr. B l a c k negligently failed to i d e n t i f y an o r g a n b e f o r e r e m o v i n g i t , does not then extend consent t o t h e w r o n g f u l r e m o v a l o f an o r g a n , s i m p l y b e c a u s e D r . B l a c k f a i l e d t o i d e n t i f y t h e known p a r t o f the body, and m i s t o o k t h e k i d n e y f o r a t u m o r . ... ' " I n o p p o s i t i o n t o Comer's m o t i o n f o r a p a r t i a l summary judgment, D r . B l a c k made the following argument c o n c e r n i n g t h e scope o f t h e consent g i v e n by Comer: "'Dr. Black had [Comer's] consent to p e r f o r m t h e open l a p a r o t o m y , to perform "such additional operations/procedures during t h e c o u r s e o f t h e above as a r e considered therapeutically necessary or advisable i n the exercise of professional judgment" [and] ["]to provide such a d d i t i o n a l s e r v i c e s as deemed r e a s o n a b l e and necessary according to medical j u d g m e n t " and t o remove t i s s u e t h a t Dr. B l a c k b e l i e v e d t o be a b n o r m a l o r c a n c e r o u s . At the very l e a s t , v i e w i n g the evidence i n the l i g h t most f a v o r a b l e t o Dr. B l a c k , g e n u i n e i s s u e s o f m a t e r i a l f a c t e x i s t as t o whether Dr. B l a c k had [ C o m e r ' s ] consent t o r e m o v e t h e e c t o p i c k i d n e y w h i c h he b e l i e v e d 8 1070652 t o be abnormal cancerous.'" 920 So. 2d at We then tissue that was possibly 1090. stated: "As d e m o n s t r a t e d b y t h e a r g u m e n t s t h e p a r t i e s made t o t h e t r i a l c o u r t , t h e r e i s a d i s p u t e i n t h i s c a s e as t o t h e p a r a m e t e r s o f t h e c o n s e n t C o m e r g a v e Dr. B l a c k f o r t h e o p e r a t i o n . fl "... [T]he p i v o t a l i s s u e i n the t r i a l c o u r t and on a p p e a l i s t h e s c o p e o f t h e c o n s e n t . We agree w i t h Dr. B l a c k t h a t t h e l a n g u a g e o f t h e c o n s e n t does n o t s a y t h a t he h a d t h e a u t h o r i t y t o p e r f o r m o n l y t h o s e a d d i t i o n a l o p e r a t i o n s or p r o c e d u r e s t h a t were in fact t h e r a p e u t i c a l l y necessary or advisable; r a t h e r , t h e c o n s e n t p e r m i t t e d Dr. B l a c k t o p e r f o r m a d d i t i o n a l o p e r a t i o n s a n d p r o c e d u r e s he considered therapeutically necessary or advisable in the exercise of his professional judgment. Comer u n d e r s t o o d t h a t n e i t h e r the l a p a r o s c o p y nor the potential laparotomy was intended to target a particular organ or to accomplish a particular t h e r a p e u t i c r e s u l t ; the p r o c e d u r e s were ' d i a g n o s t i c ' and exploratory i n nature and could involve the removal of tissue, depending upon Dr. Black's f i n d i n g s d u r i n g the p r o c e d u r e s . C o m e r ' s c o n s e n t was b r o a d and e s s e n t i a l l y 'open-ended,' q u a l i f i e d and conditioned only by the limitation that any a d d i t i o n a l o p e r a t i o n s o r p r o c e d u r e s Dr. B l a c k m i g h t p e r f o r m m u s t be t h o s e ' c o n s i d e r e d t h e r a p e u t i c a l l y necessary or advisable in the exercise of p r o f e s s i o n a l judgment.' S u c h an a u t h o r i z a t i o n d o e s not r e p r e s e n t u n l i m i t e d ' c a r t e b l a n c h e , ' h o w e v e r ; i t a p p l i e s o n l y t o t h o s e o p e r a t i o n s and p r o c e d u r e s t h a t m i g h t be considered t h e r a p e u t i c a l l y necessary or a d v i s a b l e i n the e x e r c i s e of p r o f e s s i o n a l judgment. T h i s l a n g u a g e d i d not a u t h o r i z e Dr. B l a c k t o a c t i n 9 1070652 whatever fashion he might subjectively think appropriate i n the exercise of h i s p r o f e s s i o n a l j u d g m e n t , r e g a r d l e s s o f how m e d i c a l l y a b e r r a n t that judgment might be. R a t h e r , t h i s language a u t h o r i z e d o n l y a d d i t i o n a l o p e r a t i o n s and p r o c e d u r e s considered t h e r a p e u t i c a l l y necessary or advisable under the objective standard of care that controls the e x e r c i s e of p r o f e s s i o n a l judgment. "'Initially, we note that the l e g i s l a t u r e has c o d i f i e d t h e s t a n d a r d of c a r e t o be e x e r c i s e d by p h y s i c i a n s i n t h i s state. [Ala.] Code 1975, § 6-5-484, p r o v i d e s as f o l l o w s : "'"(a) In performing professional services for a patient, a physician's, surgeon's, or d e n t i s t ' s duty to t h e p a t i e n t s h a l l be t o e x e r c i s e such reasonable care, diligence and skill as physicians, surgeons, and d e n t i s t s i n the same g e n e r a l n e i g h b o r h o o d , a n d i n the same general line of practice, ordinarily have and exercise i n a l i k e case. In the case of a hospital rendering services to a patient, the h o s p i t a l must u s e t h a t d e g r e e o f c a r e , s k i l l and d i l i g e n c e used by hospitals generally in the community. "'"(b) Neither a physician, a surgeon, a dentist nor a h o s p i t a l s h a l l be c o n s i d e r e d an insurer of the successful issue of t r e a t m e n t or s e r v i c e . " ' " S h u m a k e r v . J o h n s o n , 571 S o . 2 d 991 , 993 ( A l a . 1990) (declaring jury charge in a medical10 1070652 m a l p r a c t i c e case t h a t a p h y s i c i a n i s not l i a b l e ' f o r an h o n e s t m i s t a k e o r an h o n e s t e r r o r o r j u d g m e n t ' t o be r e v e r s i b l e e r r o r because § 6-5-484 'clearly s t a t e s an o b j e c t i v e s t a n d a r d f o r t h e p e r f o r m a n c e o f p r o f e s s i o n a l d u t i e s by p h y s i c i a n s ' ) . "Dr. B l a c k e x p l a i n e d i n h i s d e p o s i t i o n t e s t i m o n y the convergence of signs, symptoms, diagnostic possibilities, intraoperative findings, and the therapeutic options available under the circumstances t h a t c a u s e d him t o c o n s i d e r the c o u r s e o f c o n d u c t he t o o k t o be t h e r a p e u t i c a l l y n e c e s s a r y or a d v i s a b l e i n the e x e r c i s e of h i s p r o f e s s i o n a l judgment. "'(a) I n any action for i n j u r y or damages or wrongful death, whether in c o n t r a c t or i n t o r t , a g a i n s t a h e a l t h care provider f o r b r e a c h of the standard of c a r e , the p l a i n t i f f s h a l l have the b u r d e n o f p r o v i n g by s u b s t a n t i a l e v i d e n c e t h a t t h e h e a l t h care provider f a i l e d to exercise s u c h r e a s o n a b l e c a r e , s k i l l , and d i l i g e n c e as o t h e r similarly situated health care providers i n the same g e n e r a l line of p r a c t i c e o r d i n a r i l y have and e x e r c i s e i n a l i k e case.' "Ala. Code 1975, § 6-5-548. "When t h e trial judge entered the partial summary j u d g m e n t i n f a v o r o f Comer, c o n c l u d i n g that Dr. Black did not have medically and legally efficacious consent to remove the tissue mass u l t i m a t e l y d e t e r m i n e d t o be a k i d n e y , i t had been n e i t h e r proven nor disproven t h a t Dr. Black had e x e r c i s e d t h a t l e v e l of reasonable care, s k i l l , and d i l i g e n c e as a n o t h e r b o a r d - c e r t i f i e d s u r g e o n w o u l d have e x e r c i s e d i n a l i k e c a s e , g i v e n a l l of the f a c t s t h e n a v a i l a b l e to Dr. Black. Whether Dr. B l a c k f a i l e d to s a t i s f y the 'relative standard of c a r e ' i n t h a t r e g a r d (§ 6 - 5 - 5 4 8 ( e ) , A l a . C o d e 1975) 11 1070652 r e q u i r e s p r o o f , one way o r t h e o t h e r , by expert testimony. I t c o u l d n o t be r e s o l v e d m e r e l y on t h e b a s i s of a l a y u n d e r s t a n d i n g , which r e q u i r e s o n l y common k n o w l e d g e and experience. See Ex parte H e a l t h S o u t h C o r p . , 851 So. 2 d 33 ( A l a . 2 0 0 2 ) . T h u s , a genuine i s s u e of m a t e r i a l f a c t e x i s t e d i n t h a t r e g a r d , p r e c l u d i n g a s u m m a r y j u d g m e n t on t h e i s s u e of l i a b i l i t y . " 920 So. 2d at 1090-92. On remand, Dr. Black moved t h e h e a r i n g on t h a t m o t i o n , deny the motion. and the case Dr. Black No a the t r i a l o r d e r was ultimately for was moved f o r a j u d g m e n t as The the verdict jury returned a trial on t h e m o t i o n , however, a a matter jury. of At law trial, ("JML") again at the Comer's favor, at conclusion court denied both motions, in At i t would before t h e c l o s e o f Comer's c a s e - i n - c h i e f and of a l l the evidence. judgment. court indicated entered tried summary awarding and him $350,000 i n c o m p e n s a t o r y damages, i n c l u d i n g damages f o r m e n t a l anguish. Dr. The trial Black alternatively, court entered filed a f o r a new a j u d g m e n t on renewed trial. Dr. motion that for a JML or, B l a c k a r g u e d , among other t h i n g s , t h a t Comer h a d n o t o f f e r e d e x p e r t t e s t i m o n y that Dr. Black A l t e r n a t i v e l y , Dr. had exceeded the scope of indicating the B l a c k moved f o r a r e m i t t i t u r o f t h e 12 verdict. consent. damages 1070652 award. The motion, and trial Dr. court Black denied Dr. Black's postjudgment appeals. Standard of Review "We apply the same s t a n d a r d of review to a r u l i n g on a m o t i o n f o r a JML a s t h e t r i a l c o u r t u s e d in i n i t i a l l y d e c i d i n g the motion. This standard i s ' i n d i s t i n g u i s h a b l e f r o m t h e s t a n d a r d by w h i c h we r e v i e w a summary j u d g m e n t . ' H a t h c o c k v . Wood, 815 So. 2 d 5 0 2 , 506 ( A l a . 2 0 0 1 ) . We m u s t d e c i d e w h e t h e r t h e r e was s u b s t a n t i a l e v i d e n c e , when v i e w e d i n t h e l i g h t most f a v o r a b l e to the p l a i n t i f f , t o w a r r a n t a jury determination. City of Birmingham v. Sutherland, 834 So. 2d 755 (Ala. 2002). In F l e e t w o o d E n t e r s . , I n c . v . H u t c h e s o n , 791 So. 2d 920, 923 (Ala. 2000), this Court stated that ' " [ s ] u b s t a n t i a l evidence i s evidence of such weight and q u a l i t y t h a t f a i r - m i n d e d p e r s o n s i n t h e e x e r c i s e of impartial judgment can reasonably infer the e x i s t e n c e o f t h e f a c t s o u g h t t o be p r o v e d . " ' 791 So. 2d at 923 (quoting West v. Founders Life A s s u r a n c e Co. o f F l o r i d a , 547 So. 2d 8 7 0 , 871 ( A l a . 19 8 9 ) ) . " Alabama Power Co. v. Aldridge, 854 So. 2d 554 , 560 (Ala. 2002). Discussion Dr. support issue Black t h a t he of t h a t a r g u m e n t , Dr. before judgment argues f i r s t on Black the Court in Black the consent/battery 13 was entitled t o a JML. contends that I was claim the and In "[t]he only p r o p r i e t y of the the only issue 1070652 properly He before contends the court on retrial was the consent claim." that "the o n l y breach of the standard of care t h a t was p r o p e r l y a t i s s u e on r e m a n d i n t h i s c a s e was Dr. B l a c k ' s a l l e g e d breach r e l a t e d to the consent--that i s , w h e t h e r Dr. B l a c k b r e a c h e d t h e s t a n d a r d of c a r e in determining, i n h i s p r o f e s s i o n a l judgment and b a s e d on t h e i n f o r m a t i o n t h e n a v a i l a b l e t o h i m , t h a t r e m o v a l o f t h e m a s s was t h e r a p e u t i c a l l y n e c e s s a r y o r advisable. The o n l y b r e a c h o f t h e s t a n d a r d o f c a r e that would support [Comer's] l a c k of c o n s e n t claim was a b r e a c h by Dr. B l a c k i n d e t e r m i n i n g , i n h i s p r o f e s s i o n a l j u d g m e n t , t h a t r e m o v a l o f t h e m a s s was t h e r a p e u t i c a l l y n e c e s s a r y o r a d v i s a b l e , and [Comer] was r e q u i r e d t o o f f e r e x p e r t t e s t i m o n y as t o t h a t s p e c i f i c b r e a c h t o meet h i s b u r d e n o f p r o o f . Black I , 920 So. 2 d a t 1 0 9 2 . The e x p e r t t e s t i m o n y h a d t o be s p e c i f i c a l l y t a i l o r e d t o t h a t p a r t i c u l a r breach of the standard of care because a l l other breaches of the s t a n d a r d of c a r e t h a t were or c o u l d have been plead[ed] were p r e c l u d e d by [Comer's] voluntary dismissal of a l l other claims and the judgment appealed i n Black I . " Dr. Black's We brief, agree pp. Dr. with only claim before this Court 30-31. Black the in Black trial that the c o u r t on consent remand. c l a i m was As noted above, I explained: "[T]the consent permitted Dr. Black to perform a d d i t i o n a l o p e r a t i o n s and p r o c e d u r e s he considered therapeutically necessary or advisable in the e x e r c i s e o f h i s p r o f e s s i o n a l j u d g m e n t . ... C o m e r ' s consent was broad and essentially 'open-ended,' q u a l i f i e d and c o n d i t i o n e d o n l y by t h e limitation t h a t any a d d i t i o n a l o p e r a t i o n s or procedures Dr. Black might perform must be those 'considered 14 the 1070652 therapeutically necessary or advisable i n the exercise o f p r o f e s s i o n a l judgment.' Such an a u t h o r i z a t i o n does n o t r e p r e s e n t u n l i m i t e d ' c a r t e blanche,' however; i t applies only to those o p e r a t i o n s and procedures t h a t m i g h t be c o n s i d e r e d therapeutically necessary or advisable i n the e x e r c i s e o f p r o f e s s i o n a l judgment. This language did not a u t h o r i z e Dr. B l a c k t o a c t i n whatever f a s h i o n he m i g h t s u b j e c t i v e l y t h i n k a p p r o p r i a t e i n the exercise of his professional judgment, r e g a r d l e s s o f how m e d i c a l l y a b e r r a n t t h a t j u d g m e n t m i g h t be . Rather, t h i s language a u t h o r i z e d only additional operations and procedures considered t h e r a p e u t i c a l l y necessary or a d v i s a b l e under t h e objective standard of care that controls the e x e r c i s e of p r o f e s s i o n a l judgment." 920 I So. 2d a t 1091 (emphasis a d d e d ) . that expert Black's testimony We a l s o s t a t e d i n B l a c k was r e q u i r e d t o d e t e r m i n e d e c i s i o n t o remove t h e mass f e l l objective standard whether Dr. below the a p p l i c a b l e of care: "When t h e t r i a l judge entered the p a r t i a l summary j u d g m e n t i n f a v o r o f Comer, c o n c l u d i n g t h a t Dr. Black d i d n o t have medically and legally efficacious consent t o remove the tissue mass u l t i m a t e l y determined t o be a k i d n e y , i t h a d been neither proven nor disproven t h a t Dr. B l a c k had e x e r c i s e d t h a t l e v e l o f r e a s o n a b l e c a r e , s k i l l , and d i l i g e n c e as a n o t h e r b o a r d - c e r t i f i e d s u r g e o n w o u l d have e x e r c i s e d i n a l i k e case, g i v e n a l l o f t h e f a c t s then a v a i l a b l e t o Dr. B l a c k . Whether Dr. Black f a i l e d to satisfy the 'relative standard of c a r e ' i n t h a t r e g a r d (§ 6 - 5 - 5 4 8 ( e ) , A l a . C o d e 1 9 7 5 ) r e q u i r e s p r o o f , o n e way o r t h e o t h e r , b y e x p e r t testimony. I t c o u l d n o t b e r e s o l v e d m e r e l y on t h e basis of a l a y understanding, which requires only common knowledge and e x p e r i e n c e . See Ex parte H e a l t h S o u t h C o r p . , 851 S o . 2 d 33 ( A l a . 2 0 0 2 ) . " 15 1070652 920 So. 2d at At t r i a l , 1092. Comer o f f e r e d t h e t e s t i m o n y a board-certified Black. Voeller's Dr. general Black's testimony as surgeon, brief to stating o f D r . Guy similarly this that Court there Voeller, situated to summarizes Dr. Dr. were " o n l y two i n s t a n c e s i n w h i c h D r . B l a c k d e v i a t e d f r o m the a p p l i c a b l e s t a n d a r d of c a r e . First, according to Voeller, Dr. B l a c k s h o u l d have suspended the o p e r a t i o n w h i c h was u n d e r w a y a t t h e p o i n t i n t i m e when he e n c o u n t e r e d t h e m a s s t h a t was n o t i d e n t i f i e d in t h e r a d i o l o g y r e p o r t o f Dr. [ D a n i e l Sherman] Foeckle. S e c o n d , i f Dr. B l a c k s u s p e c t e d t h a t t h e m a s s u n d e r i n v e s t i g a t i o n was a lymphoma t h e n the entire mass should not have been removed, but r a t h e r , o n l y a s m a l l p o r t i o n o b t a i n e d (a b i o p s y ) f o r submission to pathology." [ 1 ] Dr. Black's brief, pp. Specifically, Dr. 14-15 (emphasis Voeller testified added). as f o l l o w s on direct examination: "Q. D r . V o e l l e r , ... do y o u h a v e an o p i n i o n i n t h i s c a s e b a s e d on t h e m a t e r i a l s y o u h a v e r e v i e w e d a b o u t t h e m e d i c a l c a r e r e n d e r e d t o Mr. C o m e r b y D r . Black? "A. I do. "Q. What i s t h a t opinion? "A. That below i t fell the standard of care. Dr. Foeckle was originally named a s a defendant in Comer's complaint; on Comer's motion, the trial court d i s m i s s e d D r . F o e c k l e a s a d e f e n d a n t on F e b r u a r y 1 1 , 2 0 0 3 . 1 16 1070652 "Q. A r e t h e c i r c u m s t a n c e s u n d e r w h i c h D r . B l a c k cared f o r L y n n Comer circumstances t h a t you a r e familiar with and are within your surgical specialty? "A. Yes, s i r , they a r e . "Q. C o u l d you t e l l u s , g e n e r a l l y s p e a k i n g , what those c i r c u m s t a n c e s were w i t h r e g a r d t o Lynn Comer? "A. W e l l , t h e p a t i e n t had been h a v i n g some n i g h t sweats and w e i g h t l o s s . I t h i n k t h e r e was a b l o o d c l o t i n t h e v e i n and t h e arm. And t h e y r e a l l y d i d n ' t know w h a t was g o i n g on w i t h t h e p a t i e n t . " T h e r e was some, I t h i n k , a h i s t o r y o f C r o h n ' s disease, which i s a disease of the i n t e s t i n e . And so t h e p r i m a r y c a r e p h y s i c i a n was d o i n g a w o r k - u p trying to figure out and t r y i n g to e x p l a i n the s y m p t o m s o f t h e p a t i e n t a n d h a d o r d e r e d CAT scans and o t h e r t e s t s and r e a l l y s t i l l c o u l d n ' t e x p l a i n t h e symptoms o f t h e p a t i e n t and r e f e r r e d t h e p a t i e n t t o D r . B l a c k f o r e v a l u a t i o n i n h o p e s t h e y m i g h t be a b l e t o come up w i t h a d i a g n o s i s . And Dr. B l a c k offered the option o f what we call diagnostic laparoscopy which i s where you p u t t h e little t e l e s c o p e i n t o t h e a b d o m i n a l c a v i t y and you l o o k a r o u n d t o s e e i f y o u c a n make a d i a g n o s i s t o t r y t o e x p l a i n t h e n i g h t sweats and weight l o s s and f e v e r a n d w h a t e v e r o t h e r s y m p t o m s M r . Comer was h a v i n g . "Q. A l l r i g h t . L e t ' s t a l k about Dr. B l a c k ' s basic knowledge a t t h a t p o i n t i n t i m e . You had mentioned t h a t t h e r e was a CAT scan performed; correct, sir? "A. Yes, s i r . 17 1070652 "Q. And Dr. r e p o r t o f t h a t CAT "A. said seen B l a c k had scan? available to him the He d i d . "Q. A n d do y o u r e c a l l t h a t i n p a r t t h e CAT s c a n t h a t t h e r e was no r e t r o p e r i t o n e a l a d e n o p a t h y a t t h e t i m e o f t h e CAT scan? "A. Yes, s i r . "Q. What d o e s that mean? "A. A d e n o p a t h y means s w o l l e n l y m p h n o d e s a n d l a r g e l y m p h n o d e s . So t h e y a r e j u s t s a y i n g i n t h e a r e a where these lymph nodes r u n , t h e r e were no a b n o r m a l l y e n l a r g e d lymph nodes. fl "Q. D i d y o u s e e , as y o u s a i d , planned the d i a g n o s t i c laparoscopy worrisome f o r lymphoma? "A. I d i d see "Q. where Dr. B l a c k b e c a u s e he was that. What i s l y m p h o m a ? "A. Lymphoma i s a t u m o r o f t h e l y m p h glands. There are v a r i o u s k i n d s o f lymphoma and I don't p r e t e n d t o know a l l t h e d i f f e r e n t k i n d s , b u t i t ' s s i m p l y a tumor i n t h e lymph s y s t e m . "Q. I n t e r m s o f t a k i n g a l o o k a r o u n d as you h a v e d e s c r i b e d , do y o u a g r e e w i t h t h a t a p p r o a c h ? "A. I a g r e e w i t h t h e a p p r o a c h as f a r a s t h e d i a g n o s t i c l a p a r o s c o p y l o o k i n g f o r lymphoma, I a g r e e w i t h t h e a p p r o a c h . I d o n ' t know t h a t I w o u l d h a v e d o n e i t w i t h a n o r m a l CAT scan, but I certainly agree w i t h the approach. 18 1070652 "Q. ... D i d y o u s e e r e v i e w e d t h a t Dr. B l a c k "A. Yes, i n t h e r e c o r d s t h a t you have d i c t a t e d an o p e r a t i v e n o t e ? sir. fl "Q. ... Do y o u r e c a l l i n h i s d i c t a t i o n t h a t D r . Black said that he found something that was u n e x p e c t e d i n t h e a r e a o f t h e d i s t a l s m a l l b o w e l ; do you r e c a l l t h a t ? "A. I remember w o r d s - - I d o n ' t remember exact words, but words to something l i k e t h a t . the fl "Q. In his attempt to do a thorough exploration, do you understand that Dr. Black i n d i c a t e d t h a t he f o u n d s o m e t h i n g t h a t was either a b n o r m a l l y l o c a t e d or something t h a t shouldn't have been t h e r e ? "A. Yes, "Q. Why sir. do you say that? "A. W e l l , he d e s c r i b e d t h i s m a s s t h a t we h a v e been t a l k i n g about t h a t the CAT scan certainly d i d n ' t d e s c r i b e , so he w a s n ' t p r e p a r e d t o s e e w h a t he saw t h r o u g h t h e l a p a r o s c o p e b e c a u s e he h a d a CAT scan not m e n t i o n i n g t h a t . "Q. A t t h a t p r e c i s e moment, a t t h e moment t h a t he realizes t h a t he sees something t h a t is not m e n t i o n e d on t h e r e p o r t o f t h e CAT scan, what does the standard of care r e q u i r e of the g e n e r a l surgeon l i k e D r . B l a c k i n 1995 t o do a t t h a t moment? "A. To go g e t t h e CAT s c a n a n d p r e f e r a b l y g e t w i t h t h e r a d i o l o g i s t t o go o v e r t h e CAT s c a n a t t h a t t i m e i n t h e o p e r a t i n g room or i n r a d i o l o g y . 19 1070652 "Q. I n f a i r n e s s t o D r . B l a c k , t h e r e p o r t b y t h e r a d i o l o g i s t does n o t m e n t i o n t h e e c t o p i c l o c a t i o n o f the l e f t k i d n e y , does i t ? "A. I t does n o t . fl "Q. Would t h e s t a n d a r d o f care e x i s t i n g a t t h e t i m e i n 1995 r e q u i r e D r . B l a c k , i f u n s u r e a b o u t h i s own i n t e r p r e t a t i o n o f t h e CAT s c a n , t o g e t w i t h o r consult with the radiologist about his i n t e r p r e t a t i o n o f t h e CAT s c a n ? "A. Y e s , s i r , and because we have the d i s c r e p a n c y . I mean we h a v e a CAT s c a n t h a t ' s n o r m a l s u p p o s e d l y a n d we p u t o u r t e l e s c o p e i n a n d we s e e s o m e t h i n g t h a t h a s n o t b e e n on t h e r e p o r t , on t h e CAT s c a n r e p o r t , a n d y o u h a v e t o t r y t o f i g u r e o u t what's g o i n g on. S o y o u h a v e t o go g e t t h e f i l m s , you have t o l o o k a t i t a n d t r y t o p u t t h e p u z z l e together. fl "Q. ... [ B ] a s e d on e v e r y t h i n g y o u h a v e s e e n , e v e r y t h i n g y o u know f r o m t h e c h a r t , d i d D r . B l a c k know w h a t he was r e v i e w i n g a t t h e t i m e t h a t he c u t t h e mass o u t ? fl "A. I can promise d o i n g , he w o u l d n ' t h a v e "Q. Why i s that y o u i f he knew w h a t removed i t . he was the case? "A. S e v e r a l r e a s o n s . A g a i n , we g e t b a c k t o t h e s i t u a t i o n t h a t we h a v e a n o r m a l CAT s c a n r e p o r t . We 20 1070652 p u t o u r t e l e s c o p e i n a n d we s e e t h i s b i g t h i n g t h e r e t h a t ' s n o t on t h e r e p o r t , so t h a t ' s t h e f i r s t t h i n g . All right. So l e t ' s p r e t e n d t h a t we d o n ' t h a v e t h e CAT s c a n r e p o r t , h y p o t h e t i c a l o r w h a t e v e r you want to c a l l i t , and you are t h i n k i n g i t ' s lymphoma, w h i c h i s w h a t D r . B l a c k was t h i n k i n g , y o u know, we a r e h a v i n g t h e s e s y m p t o m s , c o u l d i t be lymphoma. A g a i n , t h e CAT scan doesn't even t a l k about lymph n o d e s a n d i f I h a d a n o r m a l CAT s c a n I w o u l d n ' t e v e n p u t a l a p a r o s c o p e i n . Say you p u t t h e l a p a r o s c o p e i n and you a r e l o o k i n g f o r l y m p h n o d e s and you see t h i s b i g mass t h e r e , w e l l , i f you t h i n k i t ' s lymphoma, you b i o p s y i t , you p u t a n e e d l e i n t h e r e , you take a p i e c e o f i t ; and t h e n t h e t r e a t m e n t o f t h a t i s n o t r e m o v a l , you d o n ' t remove t h i s . So e v e n i f i t was lymphoma, this patient didn't need this thing removed. The patient needed a d i a g n o s i s i f we thought i t was lymphoma; that's what they needed--but the treatment of lymphoma is c h e m o t h e r a p y and r a d i a t i o n t h e r a p y b a s e d on the t y p e s of lymphoma. Removal of t h i s mass, even i f i t was l y m p h o m a , was n o t n e c e s s a r y . " On cross-examination, Dr. Voeller testified: "Q. ... I s y o u r o p i n i o n ... [ t ] h a t a t t h e t i m e he saw w h a t he t h o u g h t was a mass, i t i s at that p o i n t t h a t he s h o u l d h a v e s t o p p e d t h e s u r g e r y and g o n e up a n d l o o k e d a t t h e f i l m ? "A. Yes, "Q. Or "A. Yes, had "Q. And deviated from about t h a t ? that s i r ; or the had the f i l m brought f i l m brought to him; to him. correct? sir. that i s your only o p i n i o n that he the standard o f c a r e ; am I correct "A. W e l l , I t h i n k a l s o what I m e n t i o n e d e a r l i e r l e t ' s g i v e him t h e b e n e f i t o f t h e d o u b t and say 21 1070652 o k a y , I t h i n k i t ' s a l y m p h o m a ; e v e n t h a t , i f he t h i n k s i t ' s a lymphoma, you d o n ' t open t h e p a t i e n t and remove a lymphoma. "Q. I want t o a s k you about "A. So I t h i n k "Q. So t w o d e v i a t i o n s "A. Yes, s i r . that will that i n a minute. be a d e v i a t i o n , then; also. correct? "Q. One, s h o u l d h a v e g o n e up a n d l o o k e d f i l m when he saw t h e m a s s ? at the "A. A n d t h a t w o u l d n o t - - h a d he d o n e that, nothing e l s e would have o c c u r r e d . But l e t ' s give him this misinterpretation or the not complete r e p o r t b y t h e r a d i o l o g i s t a n d he s t i l l t h i n k s he i s d e a l i n g w i t h a lymphoma, w h i c h i s n ' t t h e c a s e , t h e n y o u d o n ' t p r o c e e d t o o p e n t h e p a t i e n t up a n d r e m o v e it. [ 2 ] "Q. A l lright. you s a y he d e v i a t e d removing i t ? "A. Dr. expert in So e v e n i f i t was a l y m p h o m a , from the standard of care i n Yes, s i r . " Black argues testimony that determining, to this Dr. B l a c k Court that Comer "offered no breached the standard of care i n h i s p r o f e s s i o n a l judgment, that removal of I n h i s m a t e r i a l s t o t h i s C o u r t , Dr. B l a c k p l a c e s great e m p h a s i s on C o m e r ' s v o l u n t a r y d i s m i s s a l o f a l l e g a t i o n s i n h i s c o m p l a i n t t h a t Dr. B l a c k ' s f a i l u r e t o r e v i e w t h e CAT s c a n s f e l l below the standard of care. However, Dr. V o e l l e r ' s t e s t i m o n y was t h a t , e v e n i f t h e r e h a d b e e n no CAT s c a n , D r . B l a c k ' s d e c i s i o n t o remove t h e mass s t i l l d e v i a t e d f r o m t h e applicable standard of care. 2 22 1070652 the m a s s was therapeutically more g e n e r a l t e s t i m o n y care by brief, exceeding We Dr. or a d v i s a b l e , or even t h a t Dr. B l a c k breached t h e s t a n d a r d o f the scope pp. 31-32. Although necessary of the consent." Dr. Black's disagree. Black presented expert testimony that i n d i c a t e d h i s d e c i s i o n t o r e m o v e t h e m a s s was a p p r o p r i a t e , D r . Voeller the testified mass care. that deviated Thus, language from t h a t Dr. B l a c k ' s d e c i s i o n t o remove the a p p l i c a b l e o b j e c t i v e standard Comer p r e s e n t e d Dr. B l a c k ' s [or] clearly substantial procedure[]" or judgment." decision that advisable was in an "additional "considered the exercise I n o t h e r words, by d e m o n s t r a t i n g t o remove t h e mass deviated from c a r e , Comer p r e s e n t e d s u b s t a n t i a l evidence removal was of advisable Dr. indicating d e c i s i o n t o r e m o v e t h e m a s s was n o t , i n t h e of the w r i t t e n consent, necessary evidence t h e mass not operation[] therapeutically of professional t h a t Dr. B l a c k ' s the standard "therapeutically necessary B l a c k t h e r e f o r e exceeded the scope of t h e w r i t t e n consent Dr. Black was not claim. 23 entitled of i n d i c a t i n g that the i n the e x e r c i s e of p r o f e s s i o n a l judgment" Accordingly, of to a JML or and t h a t consent. on the 1070652 Dr. Black insufficient $350,000, p. 32. 1033, next to warrant 1044 compensatory review damages "[t]he i s required." v. East ( A l a . 1999), our that evidence [was] c o m p e n s a t o r y damages i n t h e amount o f and a r e m i t t i t u r In Daniels regarding contends Alabama this for Paving, Court I n c . , 740 stated excessiveness f o r mental Dr. B l a c k ' s of the an brief, So. 2d following award anguish: "We r e c e n t l y , i n K m a r t C o r p . v . K y l e s , 723 S o . 2 d 572 ( A l a . 1 9 9 8 ) , m o d i f i e d t h e r e v i e w procedure e s t a b l i s h e d i n Hammond [ v . C i t y o f G a d s d e n , 493 S o . 2 d 1374 ( A l a . 1 98 6 ) ] , t o a d d an a d d i t i o n a l b a s i s u p o n w h i c h a j u r y v e r d i c t may b e f l a w e d . We h e l d i n Kmart t h a t damages a w a r d e d f o r m e n t a l a n g u i s h were s u b j e c t t o s t r i c t s c r u t i n y i f t h e p l a i n t i f f had not s u f f e r e d any p h y s i c a l i n j u r y and o f f e r e d l i t t l e o r no d i r e c t e v i d e n c e c o n c e r n i n g t h e d e g r e e o f m e n t a l s u f f e r i n g he o r s h e h a d e x p e r i e n c e d . That p r i n c i p l e e s t a b l i s h e d i n Kmart does n o t a p p l y i n t h i s case, because the Danielses each suffered physical i n j u r i e s and e x p e r i e n c e d v a r y i n g degrees o f p a i n and suffering. Moreover, each plaintiff presented e x t e n s i v e d i r e c t evidence r e g a r d i n g the degree of mental a n g u i s h he o r s h e h a d e x p e r i e n c e d , either through h i s o r h e r own t e s t i m o n y o r t h r o u g h t h e t e s t i m o n y o f p h y s i c i a n s a n d o t h e r s who h a d k n o w l e d g e of t h e i r s u f f e r i n g and a n g u i s h . "Under normal circumstances, when a court determines that a p a r t i c u l a r v e r d i c t i s excessive, the c o u r t n e c e s s a r i l y concludes that the v e r d i c t resulted from some bias, prejudice, passion, c o r r u p t i o n , o r i m p r o p e r m o t i v e on t h e p a r t o f t h e jury. The c o u r t i s then faced with ordering a remittitur, a n d t h e q u e s t i o n b e c o m e s 'How much?' There i s no y a r d s t i c k f o r measuring the proper 24 of 1070652 r e d u c t i o n . In t h i s s i t u a t i o n , the c o u r t o f t e n to a c o m p a r i s o n of j u r y v e r d i c t s i n s i m i l a r f o r some g u i d a n c e . turns cases "In the absence of a f l a w e d v e r d i c t , however, a comparison of j u r y v e r d i c t s i n s i m i l a r cases i s not the standard f o r d e t e r m i n i n g whether a j u r y v e r d i c t should be reduced. The trial court must first determine t h a t t h e v e r d i c t was flawed. As this C o u r t s t a t e d i n P i t t v . C e n t u r y I I , I n c . , [631 So. 2d 235, 239 (Ala. 1 993)], 'a r e v i e w of a jury v e r d i c t f o r c o m p e n s a t o r y d a m a g e s on t h e g r o u n d o f excessiveness must focus on the plaintiff (as v i c t i m ) and ask what t h e e v i d e n c e s u p p o r t s i n t e r m s of damages s u f f e r e d by the plaintiff.' In the a b s e n c e o f a f l a w e d v e r d i c t , ' t h e r e i s no s t a t u t o r y a u t h o r i t y to invade the p r o v i n c e of the j u r y i n a w a r d i n g c o m p e n s a t o r y damages.' I d . a t 240. " T h i s C o u r t h a s l o n g h e l d t h a t ' [ t ] h e r e i s no fixed standard for ascertainment of compensatory d a m a g e s r e c o v e r a b l e ... f o r p h y s i c a l p a i n a n d m e n t a l s u f f e r i n g ' a n d t h a t ' t h e a m o u n t o f s u c h [an] a w a r d i s l e f t to the sound d i s c r e t i o n of the j u r y , s u b j e c t o n l y t o c o r r e c t i o n by t h e c o u r t f o r c l e a r abuse o r p a s s i o n a t e e x e r c i s e of t h a t d i s c r e t i o n . ' Alabama P o w e r Co. v . M o s l e y , 294 A l a . 3 9 4 , 4 0 1 , 318 So. 2d 2 6 0 , 266 (1975). T h i s C o u r t has c o n s i s t e n t l y h e l d that a t r i a l court cannot i n t e r f e r e w i t h a jury v e r d i c t m e r e l y because i t b e l i e v e s the j u r y gave too l i t t l e o r t o o much. W i l l i s t o n v . A r d , 611 So. 2d 274 ( A l a . 1 9 9 2 ) ; O l y m p i a Spa v . J o h n s o n , 547 So. 2 d 80 ( A l a . 1 9 8 9 ) ; a n d V e s t v . Gay, 275 A l a . 2 8 6 , 154 So. 2 d 297 (Ala. 1963)." In and this mental damages case, anguish. award heightened there in the i s evidence Thus, in present of both physical reviewing the case, do we injury compensatorynot apply s c r u t i n y s e t f o r t h i n K m a r t C o r p . v . K y l e s , 723 25 the So. 1070652 2d 572 ( A l a . 1998), we review the determining ("There discussed i n Daniels, supra. award i n t h i s case Daniels, Inc. i s no v. 740 So. Bryant, fixed 738 standard of the discretion, of that 2d 1044. 824, subject to is review by left the to also (Ala. 1999) the the court See 837 award f o r mental award abused i t s amount anguish. jury's of The sound for a clear abuse discretion."). his kidney. and the He mental kidney. anguish emergency been [he] was medical evidence removal to and gone, by of two removed. pain" i n c l u d e the caused from surgery "incredible incurred the bleeding had injuries presented After internal "that clearly at Rather, only whether i n for determining damages Comer's p h y s i c a l kidney 2d So. c o m p e n s a t o r y d a m a g e s a j u r y may amount to determine t h e amount o f damages t h e j u r y discretion. Delchamps, as Black's kidney, in the testified the of he] was $10,465.65. 26 to loss area of his suffered where his before the he and of suffering removal that, bleeding, going and Comer trouble breathing [that expenses Dr. arteries stop had of h i s p a i n his Comer permanent suffered he die." thought He also 1070652 Dr. that cases Comer c i t e s the several cases compensatory-damages are inapposite, i n support award which the p l a i n t i f f Under also the circumstances d a m a g e s a w a r d was not excessive. h o w e v e r , b e c a u s e none o f them the review of a compensatory-damages in was of h i s argument suffered of t h i s award f o r mental a physical case, Those involved anguish injury. the compensatory- excessive. Conclusion The judgment i s affirmed. AFFIRMED. Cobb, C . J . , and W o o d a l l , P a r k e r , a n d Shaw, J J . , c o n c u r . 27

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