Greg Groover and Melinda Groover, as parents and next friends of Lennon Groover, a minor v. William H. Johnston, Jr., M.D., and Birmingham Pediatric Associates, Inc. (Appeal from Jefferson Circuit Court: CV-06-1917). Affirmed. No Opinion.

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REL: 09/30/2009 N o t i c e : T h i s o p i n i o n i s s u b j e c t t o f o r m a l 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 the advance sheets o f S o u t h e r n R e p o r t e r . Readers a r e r e q u e s t e d t o n o t i f y the 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 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 2290649), o f any 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 be made b e f o r e the 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 SPECIAL TERM, 2009 1071143 Greg Groover and Melinda Groover, as parents and next f r i e n d s o f Lennon Groover, a minor V. W i l l i a m H. Johnston, J r . , M.D., and Birmingham P e d i a t r i c A s s o c i a t e s , Inc. Appeal from J e f f e r s o n C i r c u i t Court (CV-06-1917) PER CURIAM. AFFIRMED, See NO O P I N I O N . Rule 53(a)(1) a n d ( a ) ( 2 ) ( E ) , A l a . R. A p p . P. Lyons, Woodall, Stuart, Bolin, Smith, and Parker, J , , concurs s p e c i a l l y . Cobb, G.J., a n d M u r d o c k , J . , d i s s e n t . J J . , concur. 1071143 SMITH, J u s t i c e . I concur affirm without t h e summary j u d g m e n t e n t e r e d i n f a v o r o f D r . opinion H. (concurring specially). in William Johnston, the J r . , and Court's Birmingham {"Birmingham P e d i a t r i c " ) ^ and Melinda Groover, Groover, a minor. decision as Pediatric i n the a c t i o n parents to and A s s o c i a t e s , Inc. filed next by Greg friends As d i s c u s s e d i n P a r t I b e l o w , with issues raised however, Groovers I Rule by write 28 (a) , A l a . Chief R. Justice specially complied w i t h Rule to App. P. Cobb's In light why, a reversal Lennon failure dissenting explain 28 ( a ) , of an o p i n i o n i s not warranted i n t h i s case because of the Groovers' comply Groover of to the opinion, even had of the the summary judgment e n t e r e d a g a i n s t them i s n o t a p p r o p r i a t e . I. The specific the Groovers are breaches of the standard of care a l l e g e d (1) t h a t D r . Johnston negligently r e c o g n i z e Lennon's developmental appropriate Johnston Mussell specialist negligently in a failed " r e g a r d i n g Lennon's manner; communicate condition and and {2) with their that Dr. Dr. Holly respective ^ C o l l e c t i v e l y , Dr. J o h n s t o n and Birmingham P e d i a t r i c r e f e r r e d t o as "the J o h n s t o n d e f e n d a n t s . " 2 to d e l a y s and t o r e f e r him t o an timely to failed by are 1071143 treatment." that those Groovers' alleged brief, breaches p. of 26. The the standard Lennon t o s u f f e r permanent b r a i n i n j u r i e s . trial court, the Groovers Groovers of care contend caused As they d i d i n the on a p p e a l r e l y e x c l u s i v e l y upon t h e d e p o s i t i o n t e s t i m o n y of Dr. D a n i e l A d l e r and t h e a f f i d a v i t Dr. Steven those Shore, the Groovers' expert witnesses, to support allegations. The trial court found that the deposition testimony Dr. A d l e r and t h e a f f i d a v i t o f Dr. Shore were n o t evidence Johnston brain of indicating probably damage. defendants' "Dr. The that caused trial alleged Lennon's substantial negligence injury--i.e., motion the following states: in his affidavit: " ' W i l l i a m H. J o h n s t o n , MD, breached the standard of care by failing to r e c o g n i z e Lennon Groover's developmental d e l a y s and r e f e r t h e c h i l d out t o q u a l i f i e d s p e c i a l i s t s i n a t i m e l y manner. " ' D r . W i l l i a m H, J o h n s t o n ' s d e l a y i n sending the child to a qualified hematologist or other specialist resulted in the child's m a c r o c y t i c anemia being undiagnosed f o r a t l e a s t an a d d i t i o n a l s i x (6) m o n t h s . During that period the c h i l d did not receive the necessary medical 3 of Dr. irreversible court's order granting the summary-judgment Shore avers the of Johnston 1071143 treatment resulting in further deteriorating.' his condition "The C o u r t h a s r e v i e w e d t h e d e p o s i t i o n t e s t i m o n y o f Dr. A d l e r . However, i t a p p e a r s t o the C o u r t t h a t D r . A d l e r , a p e d i a t r i c n e u r o l o g i s t , was d e p o s e d i n order to e l i c i t testimony regarding the standard of c a r e , and t h e b r e a c h of t h e s t a n d a r d o f c a r e i n the t r e a t m e n t p r o v i d e d by Defendant H o l l y M u s s e l l , the pediatric neurologist in this case. Dr. Adler o f f e r e d no o p i n i o n w i t h r e g a r d to the applicable standard o f c a r e t o w h i c h a p e d i a t r i c i a n , s u c h as Dr. J o h n s t o n , i s t o comply, n o r w h e t h e r Dr. J o h n s t o n breached the standard of care i n p r o v i d i n g p e d i a t r i c health services to Plaintiffs' minor, Lennon Groover. Dr. A d l e r , however, d i d o f f e r t e s t i m o n y with regard to the element of causation. S p e c i f i c a l l y , he t e s t i f i e d a s f o l l o w s : " '... I agreed that B-12 deficiency a p p e a r i n g a f t e r b i r t h was a substantive cause of this boy's neurological disability, that the neurological d i s a b i l i t y was permanent, and t h a t there was an o p p o r t u n i t y t o p r e v e n t t h e i n j u r y had the B-12 administration commenced e a r l i e r , c o n s i d e r i n g t h e way t h e boy was being fed.' "Dr. Adler testified that Plaintiffs' minor d e v e l o p e d s y m p t o m s o f B-12 d e f i c i e n c y between 9 to 12 m o n t h s a f t e r h i s b i r t h . He further testified t h a t b y m i d - 2 0 0 1 i t was c l e a r t h a t L e n n o n was not developing w e l 1 and by the summer o f 2 0 01, he r e a c h e d a l e v e l o f B-12 d e f i c i e n c y t o t h e p o i n t t h a t he b e c a m e b r a i n i n j u r e d f r o m i t . D r . A d l e r s t a t e d t h a t t h o u g h P l a i n t i f f s ' m i n o r was n o t B-12 d e f i c i e n t during pregnancy nor during the f i r s t year of h i s l i f e , t h a t t h e c o n d i t i o n d e v e l o p e d o v e r t i m e and the symptoms d i d n o t show s u d d e n l y , [but] through a process of poor developmental evolution of the child. A d l e r t e s t i f i e d t h a t P l a i n t i f f s ' m i n o r had 4 1071143 i r r e v e r s i b l e b r a i n damage f o r 4-6 w e e k s p r i o r t o S e p t e m b e r 7, 2 0 0 1 , t h e d a t e o n w h i c h D r . M u s s e l l b e c a m e a w a r e o f t h e r e s u l t s o f t h e MRI c o n d u c t e d i n A u g u s t o f 2 0 0 1 . He t e s t i f i e d t h a t t h e b r a i n i n j u r y occurred b y m i d - J u l y t o e a r l y A u g u s t 2 0 01, Dr. Adler testified that had P l a i n t i f f s ' minor been d i a g n o s e d a n d t r e a t e d e a r l i e r t h a n he a c t u a l l y was, t h a t he w o u l d have h a d an o p p o r t u n i t y ' t o be b e t t e r t h a n h e i s [. ' ] [H] o w e v e r , w h e n a s k e d t o q u a n t i f y t h a t o p i n i o n , Dr. A d l e r t e s t i f i e d , 'I can't t e l l you how m u c h b e t t e r . ' II "The C o u r t f i n d s t h a t D r . S h o r e i s a q u a l i f i e d similarly situated health care provider with Defendant Johnston. The C o u r t f u r t h e r f i n d s t h a t Dr. Shore's a f f i d a v i t i s sufficient t o create a genuine dispute of m a t e r i a l f a c t with regard t o the issues of the standard of care t o which board c e r t i f i e d p e d i a t r i c i a n s a r e h e l d , and w i t h regard t o the issue of whether o r not Defendant Johnston breached the s a i d standard of care. "However, on t h e i s s u e o f c a u s a t i o n , f o r w h i c h expert testimony i s required i n order t o create a genuine dispute of material fact, Dr. Shore's affidavit states that the delay i n referring P l a i n t i f f s ' minor son t o a s p e c i a l i s t rendered h i s c o n d i t i o n undiagnosed and u n t r e a t e d f o r an extended p e r i o d of time ' r e s u l t i n g i n h i s c o n d i t i o n f u r t h e r deteriorating.' "Dr. Adler's deposition testimony, cited hereinabove, expands on t h i s statement i n a r r i v i n g a t t h e same c o n c l u s i o n t h a t t h e b r a i n d a m a g e h a d commenced p r i o r t o t h e t i m e t h a t i t s h o u l d h a v e b e e n d i s c o v e r e d by Defendant Johnston, and t h a t t h e delay i n t r e a t m e n t and d i a g n o s i s meant t h a t Plaintiffs' minor son s u f f e r e d a f u r t h e r , though u n q u a n t i f i a b l e , d e t e r i o r a t i o n i n h i s h e a l t h as a r e s u l t . " 5 1071143 (Footnotes The omitted.) trial court found this case to be controlled by M c A f e e v . B a p t i s t M e d i c a l C e n t e r , 641 So. 2d 265, 267-68 ( A l a . 1994), McAfee, and the t r i a l including most court's order of the quotes extensively following: " I f , as t h e d e f e n d a n t s s u g g e s t , t h e p l a i n t i f f s are i n f a c t a s k i n g t h i s Court t o abandon Alabama's traditional rules of proximate cause and to r e c o g n i z e t h e ' l o s s o f c h a n c e d o c t r i n e , ' we d e c l i n e to do s o . Alabama law r e q u i r e s t h a t a r e c o v e r y not be b a s e d u p o n a mere p o s s i b i l i t y : "'The rule i n Alabama i n medical malpractice cases i s that to find l i a b i l i t y , t h e r e must be more t h a n a mere p o s s i b i l i t y o r o n e p o s s i b i l i t y among o t h e r s that the negligence complained of caused the i n j u r y . T h e r e must be e v i d e n c e t h a t the negligence probably caused the i n j u r y . P a p p a V . B o n n e r , 268 A l a . 1 8 5 , 105 S o . 2 d 87 ( 1 9 5 8 ) . ' " B a k e r v . C h a s t a i n , 3 8 9 S o . 2 d 9 3 2 , 934 ( A l a . 1980). "The p l a i n t i f f s c i t e u s t o P a r k e r v . C o l l i n s , 6 0 5 S o . 2 d 824 ( A l a . 1 9 9 2 ) , w h e r e i n we s t a t e d : " ' T h i s C o u r t has p r e v i o u s l y h e l d t h a t t h e i s s u e of c a u s a t i o n i n a m a l p r a c t i c e case may p r o p e r l y b e s u b m i t t e d t o t h e j u r y w h e r e t h e r e i s evidence t h a t prompt d i a g n o s i s and treatment would have p l a c e d the p a t i e n t i n a b e t t e r p o s i t i o n t h a n s h e was i n a s a result of i n f e r i o r medical care. Waddell V. J o r d a n , 2 93 A l a . 2 5 6 , 302 S o . 2 d 74 (1974); M u r d o c h v . T h o m a s , 404 S o . 2 d 580 (Ala. 1981) . I t i s not necessary to 6 from 71143 establish that prompt care could have prevented the inj ury or death of the p a t i e n t ; r a t h e r , the p l a i n t i f f must p r o d u c e e v i d e n c e t o show t h a t h e r c o n d i t i o n was adversely affected by the alleged negligence. W a d d e l l ; see a l s o Annot. 54 A . L . R . 4 t h 10 § 3 (1987).' " I d . a t 827. We do n o t r e a d P a r k e r a s abrogating the r u l e t h a t the p l a i n t i f f must prove t h a t the p h y s i c i a n ' s negligence p r o b a b l y caused the i n j u r y . In Parker, we reversed a judgment based on a d i r e c t e d v e r d i c t f o r t h e d e f e n d a n t p h y s i c i a n on t h e grounds t h a t the 'medical testimony suggests that Mrs. P a r k e r ' s c o n d i t i o n w o r s e n e d as a d i r e c t r e s u l t of a diagnosis based upon a s u b s t a n d a r d X-ray,' s t a t i n g , ' T h a t e v i d e n c e was s u f f i c i e n t to create a jury question as to proximate cause in this case....' 605 So. 2 d a t 827 (Emphasis added.) In P a r k e r , a c a n c e r s p e c i a l i s t t e s t i f i e d t h a t he was 80% c e r t a i n t h a t t h e c a n c e r had n o t s p r e a d i n t o t h e lymph nodes at the time of the improper d i a g n o s i s . T h u s , t h e r e was e x p e r t t e s t i m o n y f r o m w h i c h t h e j u r y c o u l d i n f e r t h a t the p h y s i c i a n ' s negligence probably caused her i n j u r y . "We h a v e c a r e f u l l y s t u d i e d t h e r e c o r d i n e a c h o f t h e c a s e s b e f o r e u s a n d i n b o t h c a s e s we conclude t h a t t h e d e f e n d a n t s made a p r i m a f a c i e s h o w i n g t h a t t h e y were e n t i t l e d t o a judgment as a m a t t e r o f law on t h e i s s u e o f c a u s a t i o n by p r o d u c i n g e v i d e n c e t h a t t h e i r a c t i o n s d i d not cause the p a t i e n t ' s c o n d i t i o n to worsen. In n e i t h e r case d i d the plaintiffs submit substantial evidence that the patient's c o n d i t i o n w o r s e n e d as a d i r e c t r e s u l t o f t h e a c t i o n s of the defendant p h y s i c i a n s . "In the f i r s t case, the baby, M a r t i n McAfee, c o n t r a c t e d m e n i n g i t i s f r o m b a c t e r i a . He was treated by Dr, Rodney Dorand. Dr. Dorand, a b o a r d c e r t i f i e d neonatologist, s u b m i t t e d an a f f i d a v i t s t a t i n g t h a t he was f a m i l i a r w i t h t h e d e g r e e o f c a r e , s k i l l , and 7 1071143 diligence normally exercised by physicians p r a c t i c i n g neonatology i n 1990, and t h a t , i n h i s o p i n i o n , n o t h i n g he d i d o r d i d n o t do i n h i s c a r e and t r e a t m e n t of M a r t i n McAfee p r o b a b l y caused or c o n t r i b u t e d t o cause any i n j u r y . The a f f i d a v i t o f the p l a i n t i f f s ' e x p e r t , D r . O. C a r t e r Snead I I I , offered a conjectural observation that, generally, the sooner the onset of treatment, the b e t t e r the expected result. T h e r e i s no e v i d e n c e t h a t t h e a c t i o n s of Dr. Dorand o r t h o s e o f Dr. G i l l i s Payne, who f i r s t saw t h e b a b y , p r o b a b l y c a u s e d t h e p o o r outcome. In the second case, the plaintiffs s u b m i t t e d a f f i d a v i t s s t a t i n g , g e n e r a l l y , t h a t 'time i s of the essence' i n t r e a t i n g b r e a s t cancer, and t h a t p a t i e n t s who r e c e i v e e a r l i e r t r e a t m e n t o b t a i n a better result. T h e r e was no e x p e r t t e s t i m o n y t o rebut the testimony s u b m i t t e d by the defendants i n d i c a t i n g t h a t the m e t a s t a s i s t o the lymph nodes p r o b a b l y o c c u r r e d i n the e a r l y stages b e f o r e the c a n c e r c o u l d be d i a g n o s e d . The a f f i d a v i t s o f t h e plaintiffs' e x p e r t s d i d not r i s e t o the l e v e l of substantial evidence that the actions of the defendants probably caused Brenda Roberts's inj uries. "The s u m m a r y j u d g m e n t i n e a c h c a s e i s d u e t o b e a f f i r m e d o n t h e a u t h o r i t y o f M c K i n n o n v . P o l k , 219 Ala. 1 6 7 , 1 2 1 S o . 539 ( 1 9 2 9 ) ; P e d e n v . A s h m o r e , 554 S o , 2 d 1010 ( A l a . 1 9 8 9 ) ; S a s s e r v . C o n n e r y , 565 So. 2 d 50 ( A l a . 1990} ; S m i t h v . M e d i c a l C e n t e r E a s t , 585 S o . 2 d 1325 ( A l a . 1 9 9 1 ) ; P a r k e r v . C o l l i n s . 605 So. 2 d 824 ( A l a . 1 9 9 2 ) ; a n d L e v e s q u e v . R e g i o n a l M e d i c a l C e n t e r , 612 S o . 2 d 445 ( A l a . 1 9 9 3 ) . " M c A f e e , 641 So. 2d a t 267-68 ( f o o t n o t e s o m i t t e d ; some e m p h a s i s added). 8 1071143 The trial offered court i n Dr. concluded Shore's affidavit that the expert testimony and Dr. A d l e r ' s deposition was "not sufficient to create a genuine dispute of material fact that the alleged breach of the standard of care probably caused the i r r e v e r s i b l e b r a i n damage i n [ L e n n o n ] . Parlcer v. C o l l i n s , [605 So. 2 d 824 { A l a . 1992) ] , w h i c h c o u l d serve as authority f o r the proposition that the causation testimony before the Court i s s u b s t a n t i a l evidence c r e a t i n g a genuine d i s p u t e of m a t e r i a l f a c t , has n o t b e e n s o i n t e r p r e t e d by t h e A l a b a m a Supreme C o u r t . " In cite their any analysis though materials authority to this to Court, demonstrate that and c o n c l u s i o n as t o c a u s a t i o n the trial Collins, 605 Johnston defendants brief this to So. court 2d Court, 824 cited the Groovers both the argument court's McAfee and both McAfee the Groovers regarding the and Par]^er i n their of in to this The Groovers' causation i s Causation "Dr. Adler testified that Lennon's B-12 d e f i c i e n c y m o s t l i ] t e l y d e v e l o p e d a r o u n d 12 m o n t h s o f a g e ( A d l e r d e p . 64) . Dr. A d l e r p o i n t e d out t h a t L e n n o n c o u l d s i t u p a t 9 m o n t h s , b u t c o u l d n o t wal]c 9 the their follows: "C. v. and briefs issue Even Parl<:er { A l a . 1992) , i n i t s o r d e r discuss not are incorrect. C o u r t do n o t a d d r e s s e i t h e r McAfee o r P a r l ^ e r . entire trial do as 1071143 u n t i l a f t e r 19 m o n t h s { A d l e r d e p . 64). e x p l a i n e d h i s t i m e l i n e f o r L e n n o n ' s B-12 as f o l l o w s : Dr. Adler deficiency " ' I t h i n k t h a t t h i s b a b y was b o r n w i t h a d e q u a t e s t o r e s o f B-12. He was n o r m a l a t birth. A l l n o t e s about him e a r l y i n l i f e w e r e t h a t he was t h r i v i n g a n d d o i n g w e l l . I think that his nutritional deficiencies--and, again, speaking as a p e d i a t r i c neurologist--were such that from t h e f a c t t h a t he w a s n ' t e a t i n g a n y t h i n g and he was o n l y b e i n g b r e a s t - f e d w e r e n o t o n l y v i t a m i n B-12 d e f i c i e n c y , w h i c h , o f c o u r s e , we learned later, but much e a r l i e r we seemed to have iron deficiency that's described in the records. Iron s u p p l e m e n t a t i o n i s commenced. That's at a b o u t a y e a r o f age. So my f e e l i n g i s t h a t there was more likely than not a combination, and that the problems with B-12 t h a t u l t i m a t e l y p r o d u c e d more, you know, s i g n i f i c a n t problems began really after a few more months of continued v i t a m i n B-12 deficiency.' " ( A d l e r dep. 65-66) . "Dr. A d l e r e x p l a i n e d t h e p r o g r e s s i o n o f L e n n o n ' s i n j u r i e s f r o m t h e B~12 d e f i c i e n c y as f o l l o w s : " ' I t h i n k he h a d a d e g r e e o f w h i t e m a t t e r i n j u r y b a s e d on the i m a g i n g a b n o r m a l i t i e s . That must have been at l e a s t f o u r t o s i x weeks o l d , b e c a u s e he' s t a l k i n g a b o u t a diminution i n the volume of the white matter. So s i n c e B-12 i s involved in myelin production, i t s absence leads to injury i n myelin producing cells. "'So f i r s t y o u g e t i n j u r y . You i t on s p e c i f i c a b n o r m a l i t i e s . 10 would see And then 1071143 whatever those c e l l s are, since they can't s u r v i v e m e t a b o l i c a l l y - - s i n c e t h e y have a metabolic injury, they can't survive. Then they shrink a f t e r a while. And t h a t t a k e s time t o develop. II I II ' T h e r e was a l r e a d y a l o s s o f v o l u m e i n t h e b r a i n t h a t was c a u s e d b y c h r o n i c vitamin B-12 d e f i c i e n c y , s o t h a t t h e i m a g i n g i n A u g u s t [ 2 0 0 1 ] was a b n o r m a l . And I t h i n k e v e n B-12 administration at that point would have s t i l l - - w o u l d not have p e r m i t t e d t h i s b o y t o be n o r m a l . " 'Q. He h a d by that p o i n t i n cause him t o have other issues that correct? "'A. permanent b r a i n i n j u r i e s time t h a t were g o i n g t o d e v e l o p m e n t a l d e l a y s and occur from b r a i n i n j u r y , True. " 'Q. A n d t h a t c o n d i t i o n h a d e x i s t e d , i n y o u r o p i n i o n , a t l e a s t f o u r t o s i x weeks by the time that MRI was performed, correct? "'A. Correct. "'Q.' W h i c h w o u l d p o i n t t h e i n j u r i e s t o these permanent injuries to Lennon occurring by m i d - J u l y to early August, correct? "'A. "(Adler dep. True.' 70-71). "When a s k e d i f a n y o t h e r birth defects or problems c o n t r i b u t e d t o Lennon's i n j u r i e s . Dr. A d l e r 11 1071143 testified, 'there's no other diagnosis in the r e c o r d s t h a t I c a n s e e , o t h e r t h a n B-12 d e f i c i e n c y . ' ( A d l e r dep. 80). Again, Dr. Adler states that Lennon's records s h o w no other causes for his i n j u r i e s o t h e r t h a n t h e B-12 d e f i c i e n c y ( A d l e r d e p . 82-83). Dr. A d l e r d i s m i s s e d Dr. J o h n s t o n ' s earlier reliance on an iron d e f i c i e n c y or iron anemia because the low i r o n would not cause the white b r a i n m a t t e r d e c r e a s e t h a t t h e B-12 d e f i c i e n c y caused i n L e n n o n ( A d l e r d e p . 83) ." (Groovers' brief, Thus, reply the brief portions of Even relied quantify 27-29.) addressing whatsoever. order pp. "how Dr. and the to Johnston's In So. 2d of " [t]he testimony legal of delay of 157 a he deterioration i n treatment the standard authority could not i f he had a c t u a l l y was, the he their (Ala. brief in a 12 cite for medical-malpractice plaintiff the that Groovers 1998), i n Lennon's allegedly of to condition caused by Dr. care. precedes the L o o n e y v. i t s section Davis, recitation a c t i o n and medical and summary-judgment that than brief the e f f e c t of Dr. A d l e r ' s i n a b i l i t y c a u s a t i o n , the 152, elements that the s e c t i o n of addressing no court's treated earlier degree breach a trial Adler' s G r o o v e r s do n o t a d d r e s s allocable the cite initial much b e t t e r " L e n n o n w o u l d have b e e n been diagnosed quantify Groovers' causation though on the i t s malpractice of 721 the statement action 1071143 generally miast introducing establish the expert testimony." prima facie Groovers' elements brief, p. dissent concludes that that lone c i t a t i o n provides legal in justification this case. The on w h i c h dissent to reverse the by 25, The sufficient summary judgment notes: "The G r o o v e r s ' b r i e f i s c e r t a i n l y s u f f i c i e n t t o a p p r i s e the C o u r t o f t h e G r o o v e r s ' argument and t o a l l o w the Court to evaluate the l e g a l m e r i t s of the Groovers' p o s i t i o n . The G r o o v e r s c l e a r l y r e l y o n the w e l l r e c o g n i z e d p r i n c i p l e of law, a l s o relied upon by the Johnston defendants, t h a t c a u s a t i o n i s an element o f a m e d i c a l - m a l p r a c t i c e a c t i o n . The o n l y i s s u e b e f o r e us i s w h e t h e r p r o o f o f c a u s a t i o n exists; therefore, no further citation to legal authority i s necessary. The Groovers also cite l e g a l a u t h o r i t y to the e f f e c t that c a u s a t i o n i s g e n e r a l l y e s t a b l i s h e d by the t e s t i m o n y o f a m e d i c a l expert." Goover v. dissenting). Johnston, 3d at {Cobb, C.J., I disagree. I n H o r n v. 80 So. {Ala. 2007), Fadal Machining this Court C e n t e r s , LLC, 972 So. 2d noted: "Horn c i t e s no legal authority negligent-maintenance theory. relevant to " ' R u l e 2 8 (a) (10) , A l a . R. App. P. , r e q u i r e s t h a t arguments i n an a p p e l l a n t ' s ... b r i e f c o n t a i n " c i t a t i o n s t o t h e c a s e s , s t a t u t e s , o t h e r a u t h o r i t i e s , and p a r t s of t h e r e c o r d r e l i e d on. " The e f f e c t o f a f a i l u r e t o c o m p l y w i t h R u l e 28 (a) (10) i s well established: 13 her 63, 1071143 "'"It i s settled that a failure to comply w i t h the requirements of Rule 28(a) { [10]) requiring citation of authority for arguments p r o v i d e s the Court w i t h a basis for disregarding those arguments: "'"'When an appellant fails to cite any authority for an argument on a particular issue, this Court may a f f i rm the j udgment as to that issue, for i t is neither this Court's duty nor i t s function to p e r f o r m an appellant's legal research. Rule 28 (a) ( [ 1 0 ] ) ; Spradlin V. Birmingham Airport Authority, 613 So. 2d 347 { A l a . 1 9 9 3 ) . ' " ' " C i t y of Birmingham v. B u s i n e s s R e a l t y I n v . Co., 722 S o , 2 d 7 4 7 , 752 (Ala. 1998), See also M c L e m o r e v . F l e m i n g , 604 S o . 2d 353 (Ala. 1992} ; Stover v. A l a b a m a F a r m B u r e a u I n s . Co. , 4 6 7 So. 2 d 2 5 1 ( A l a . 1985); and Ex p a r t e R i l e y , 464 S o . 2 d 92 ( A l a . 1985} . " " 'Ex p a r t e S h o w e r s , 812 S o . 2 d 2 7 7 , 2 81 (Ala. 2 0 0 1 ) . " [W]e cannot create legal arguments f o r a p a r t y b a s e d on u n d e l i n e a t e d general propositions unsupported by authority or argument." Spradlin v. S p r a d l i n , 601 S o . 2 d 7 6 , 79 ( A l a . 1 9 9 2 ) , ' 14 1071143 " U n i v e r s i t y of South C o . , 904 S o . 2 d 1 2 4 2 , Alabama v. P r o g r e s s i v e 1247-48 { A l a . 2 0 0 4 ) . Ins. " 'Authority supporting only "general propositions of law" does not constitute a sufficient argument f o r reversal.' Beachcroft P r o p s . , L L P V . C i t y o f A l a b a s t e r , 901 So. 2d 703, 708 { A l a . 2 0 0 4 ) { q u o t i n g Q e i s e n h o f f v . Geisenhoff. 693 So. 2d 489, 491 ( A l a . C i v . App. 1997)) . ' " r w i h e r e no l e g a l a u t h o r i t y i s c i t e d o r a r g u e d , t h e effect i s t h e same a s i f n o a r g u m e n t h a d been made."' S t e e l e v. R o s e n f e l d , L L C , 936 S o . 2 d 4 8 8 , 493 ( A l a . 2005) { q u o t i n g B e n n e t t v . B e n n e t t , 506 So. 2 d 1 0 2 1 , 1023 { A l a , C i v . App. 1987) ( e m p h a s i s i n Steele)). B e c a u s e H o r n h a s c i t e d no l e g a l a u t h o r i t y s p e c i f i c t o h e r n e g l i g e n t - m a i n t e n a n c e c l a i m , she has not p r e s e n t e d an argument s u f f i c i e n t f o r r e v e r s a l o f t h e j udgment on t h a t c l a i m . The j udgment i n f a v o r of Cardinal i s , therefore, affirmed as t o t h e negligent-maintenance claim." Horn. 972 S o . 2 d a t 80 (some e m p h a s i s Under Horn, the e f f e c t added). of the Groovers' any l e g a l a u t h o r i t y s p e c i f i c t o t h e i r t h e o r y the at same a s i f n o a r g u m e n t h a d b e e n made.'" 80 {quoting Steele, 936 S o . 2 d a t 4 9 3 ) . to the issue of causation, failure 2d a t cite of causation " ' i s H o r n , 972 S o . Consequently, the Groovers have "not p r e s e n t e d argument s u f f i c i e n t f o r r e v e r s a l o f t h e judgment." So. to Horn. 2d as an 972 80 ^The d i s s e n t c i t e s E x p a r t e B o r d e n , [Ms. 1 0 5 0 0 4 2 , A u g . 1 7 , 2007] So. 3d ( A l a . 2007) , i n s u p p o r t o f t h e c o n t e n t i o n t h a t t h e G r o o v e r s have p r e s e n t e d s u f f i c i e n t argument r e g a r d i n g causation. I n Ex p a r t e Borden, t h e b r i e f a t i s s u e "included 11 p a g e s o f a r g u m e n t r e g a r d i n g ineffective assistance of 15 1071143 II. For the reasons stated warranted i n the present Groovers' failure warrant i n Part case. to present a reversal, I, a But reversal even sufficient apart legal i s not from the argument to summary j u d g m e n t i n f a v o r o f t h e J o h n s t o n d e f e n d a n t s n e v e r t h e l e s s was p r o p e r o n t h e m e r i t s . Among o t h e r t h i n g s , the Johnston defendants c i t e McAfee, supra, t o support their argument evidence "loss that o f c a u s a t i o n and t h a t o f a chance" As the Groovers noted, the trial court by the Groovers genuine dispute of material was I that fact that caused substantial not r e c o v e r f o r any this outcome.^ case the expert "not s u f f i c i e n t standard of care probably i n [Lennon]." found and c o n c l u d e d offered damage t h e y may to obtain a better medical c o n t r o l l e d by McAfee the d i d not offer to the alleged to be testimony create breach the irreversible a of brain agree. c o u n s e l , i n c l u d i n g some 2 5 c i t a t i o n s t o c a s e l a w , a l o n g w i t h e x p l a n a t i o n s and q u o t a t i o n s from t h e c i t e d cases." So. 3d at . ^The J o h n s t o n d e f e n d a n t s ' b r i e f d i s c u s s e s t h e i s s u e o f c a u s a t i o n a t pages 41-51; t h a t d i s c u s s i o n i n c l u d e s c i t a t i o n s to sufficient legal authority. 16 1071143 According t o the Groovers' expert, Dr. D a n i e l Adler, a p e d i a t r i c n e u r o l o g i s t , a v i t a m i n B-12 d e f i c i e n c y c a u s e d L e n n o n to s u f f e r permanent, or e a r l y A u g u s t 2 0 01. negligence to suffer an The G r o o v e r s the B-12 i s that appropriate deficiency. injuries by mid-July do n o t c o n t e n d that Notably, specialist, however, an e a r l i e r Rather, the "further diagnosis Lennon referral deterioration" have been a v o i d e d o r Dr. Adler's any Groovers' if_ D r . J o h n s t o n h a d made a t i m e l y Lennon's c o n d i t i o n c o u l d that brain by the Johnston defendants probably caused contention to irreversible testimony of lessened. does o f t h e B-12 d e f i c i e n c y not or state earlier r e f e r r a l by Dr. J o h n s t o n o r anyone e l s e would have r e s u l t e d i n a q u a n t i f i a b l y d i f f e r e n t outcome f o r Lennon. the trial court Plaintiffs' actually noted, minor been diagnosed was, ... he w o u l d b e t t e r t h a n h e i s [ . '] opinion, "Dr. Dr. Adler Adler Specifically, testified and t r e a t e d that had earlier t h a n he had an o p p o r t u n i t y have ' t o be [H] o w e v e r , w h e n a s k e d t o q u a n t i f y testified, as 'I can' t tell y o u how that much better.'" Dr. this Adler admitted that the sole basis c a s e was t h e g e n e r a l f o r h i sopinion i n medical premise that 17 the earlier a 1071143 condition he i s treated, the better t h e outcome. Specifically, testified: "Q. Do y o u a g r e e t h a t t h a t o p i n i o n - - t h a t h e w o u l d be b e t t e r w i t h a n e a r l i e r d i a g n o s i s - - k n o w i n g t h a t i t ' s a l r e a d y y o u r o p i n i o n t h a t he w o u l d have a l r e a d y had permanent n e u r o l o g i c a l i n j u r i e s by t h a t t i m e ... r e q u i r e s y o u t o s p e c u l a t e ? "A, I d o n ' t t h i n k i t i s s p e c u l a t i o n t o s a y t h a t when y o u have an o n g o i n g p r o c e s s that produces i n j u r y t o the brain o r leads t o i n j u r y t o the b r a i n and as i t c o n t i n u e s t h a t t h e i n j u r y - - o r t h e e f f e c t s of t h a t i n j u r y worsens. B u t I'm n o t a b l e t o t e l l y o u how m u c h w o r s e i t w o u l d b e , j u s t t h a t h e w o u l d be b e t t e r . "Q. I s t h a t j u s t b a s e d o n some g e n e r a l c o n c e p t of the sooner you t r e a t a c o n d i t i o n , the b e t t e r the outcome, generally? in "A. I m e a n , t h a t ' s medicine. a general and accepted rule II "A. I w o u l d s a y he w o u l d be b e t t e r , t h a t I don't have an o p i n i o n . but after "Q. Y o u j u s t s a y h e w o u l d b e b e t t e r , c a n ' t q u a n t i f y t h a t i n a n y way, c o r r e c t ? "A. Thus, premise Correct." the basis that f o r Dr. Adler's the earlier a condition testimony--the i s treated, the outcome--is i d e n t i c a l t o that of t h e expert insufficient but you i n McAfee. 18 general the better testimony held 1071143 In t h e i r r e p l y b r i e f , testified B-12 the Groovers assert that t h a t Lennon's i n j u r i e s had testimony been to administered which the "Dr. A d l e r c o u l d have been p r e v e n t e d i f earlier." Groovers are Presumably, referring the i s the following: " I a g r e e d t h a t B-12 d e f i c i e n c y a p p e a r i n g a f t e r b i r t h was a s u b s t a n t i v e c a u s e o f t h i s b o y ' s n e u r o l o g i c a l disability, that the neurological d i s a b i l i t y was permanent, and that there was a n o p p o r t u n i t y to prevent t h e i n j u r y h a d t h e B-12 administration commenced e a r l i e r , c o n s i d e r i n g t h e way t h e b o y was being fed." Dr. Adler's specifically that any testimony addressed i n that by the t r i a l regard, court's however, order. was Again, t e s t i m o n y i s s t a t e d g e n e r i c a l l y and does n o t a s s e r t specificity made i n o r d e r court noted how m u c h e a r l i e r the diagnosis t o r e s u l t i n a d i f f e r e n t outcome.^ and as I have noted above, when needed with t o be As t h e t r i a l Dr. A d l e r was ^ A c c o r d i n g t o t h e J o h n s t o n d e f e n d a n t s , D r . A d l e r was n o t q u a l i f i e d t o t e s t i f y s p e c i f i c a l l y t h a t a d i f f e r e n t outcome w o u l d h a v e r e s u l t e d i f D r . J o h n s t o n h a d d i a g n o s e d t h e B-12 deficiency earlier. The J o h n s t o n d e f e n d a n t s p o i n t o u t t h a t "Dr. Adler practices within the s p e c i a l t y of p e d i a t r i c neurology. He i s n o t q u a l i f i e d t o r e n d e r a n o p i n i o n regarding the standard o f care f o ra p e d i a t r i c i a n such as Dr. Johnston, and a g r e e d i n h i s d e p o s i t i o n t h a t he was n o t o f f e r i n g a n y standard o f care opinions regarding Dr. Johnston's care." The J o h n s t o n d e f e n d a n t s ' b r i e f , p. 25. I n t h e i r r e p l y b r i e f , t h e G r o o v e r s do n o t c h a l l e n g e this assertion of the Johnston defendants. 19 1071143 asked t o "quantify h i s opinion" would be i f h i s B-12 d e f i c i e n c y had been t h a n i t was, D r . A d l e r better."^ Under sufficient Dr. Adler's testified, McAfee, t o serve a s t o how m u c h b e t t e r Dr. diagnosed " I can't Adler's tell testimony that earlier y o u how testimony as s u b s t a n t i a l e v i d e n c e of the already Lennon much i s not causation. permanent brain i n j u r y w o r s e n e d i n a n u n q u a n t i f i a b l e w a y a f t e r t h e "summer o f 2001," would as have better basis. nothing as h i s testimony that r e s u l t e d i n "an o p p o r t u n i t y t h a n he i s , ' " i s c o n c l u s o r y , This more sufficient and well Court than has held that speculation, i s equally existence o r nonexistence earlier diagnosis [ f o r Lennon] ' t o be s p e c u l a t i v e , and without "evidence affords conjecture, t o warrant the submission i f the "evidence an which o r guess" i s not o f an i s s u e t o t h e j u r y , consistent of negligence, with e i t h e r the the issue should not ^ A d d i t i o n a l l y , D r . A d l e r was n o t s p e c i f i c i n h i s t e s t i m o n y a s t o w h e n L e n n o n ' s s y m p t o m s o f B-12 d e f i c i e n c y h a d p r o g r e s s e d to t h e p o i n t t h a t they would have been r e c o g n i z e d by an appropriate specialist. As t h e t r i a l c o u r t n o t e d : "Dr. A d l e r s t a t e d t h a t t h o u g h [ L e n n o n ] was n o t B-12 d e f i c i e n t during pregnancy nor during the f i r s t year of h i s l i f e , that the c o n d i t i o n d e v e l o p e d o v e r t i m e a n d t h e symptoms d i d n o t show suddenly, [but] through a process of poor developmental evolution of the child." 20 1071143 be submitted 180, 183, In offered 61 to the So. 2d addition an jury." 690, to 692 Dr. affidavit Watterson Adler's the certainly that in [Lennon's] ' r e s u l t [ed] i.e.. that Lennon's So. 3d at c o n c l u d e s t h a t Dr. sufficiently in dissent Dr. condition injuries would have been i n the testimony, Steven Regarding that a f f i d a v i t , testify 258 Ala. C. J . , the Groovers Shore, a pediatrician. asserts that "Dr. Johnston's Shore negligence further deteriorating'-- were worse a b s e n c e o f Dr. (Cobb, Conwell, (1952). f r o m Dr. did v. than they Johnston's dissenting) . otherwise negligence." The dissent S h o r e ' s a f f i d a v i t t e s t i m o n y makes t h i s analogous to the following situation recognized McAfee: " ' T h i s C o u r t has p r e v i o u s l y h e l d t h a t the i s s u e o f c a u s a t i o n i n a m a l p r a c t i c e c a s e may p r o p e r l y be s u b m i t t e d t o the j u r y where t h e r e i s e v i d e n c e t h a t prompt d i a g n o s i s and t r e a t m e n t w o u l d have p l a c e d t h e p a t i e n t i n a b e t t e r p o s i t i o n t h a n s h e was i n as a r e s u l t of i n f e r i o r medical care. W a d d e l l v. J o r d a n , 293 A l a . 256, 302 So. 2d 74 (1974) ; M u r d o c h v. T h o m a s , 404 So. 2 d 580 ( A l a . 1981} . It is not n e c e s s a r y t o e s t a b l i s h t h a t prompt care c o u l d have prevented the i n j u r y or death of the patient; r a t h e r , t h e p l a i n t i f f must p r o d u c e e v i d e n c e t o show t h a t h e r c o n d i t i o n was adversely a f f e c t e d by the alleged negligence. W a d d e l l ; see a l s o A n n o t . 54 A . L . R , 4 t h 10 § 3 ( 1 9 8 7 } . ' " 21 case 1071143 M c A f e e , 641 So. 2d (Ala. 824, 827 Dr. 2d Shore's a t 267 injuries been the however, were worse absence Shore's a f f i d a v i t Parker v. Collins, 605 So. 1992)}. affidavit, Lennon's in (quoting of than Dr. states does they state otherwise Johnston' s specifically not "that would have negligence. " Dr. that: "4. W i l l i a m H. J o h n s t o n , M.D., breached the standard of care by failing to recognize Lennon G r o o v e r ' s d e v e l o p m e n t a l d e l a y s and r e f e r the child out t o q u a l i f i e d s p e c i a l i s t s i n a t i m e l y manner. "5. D r . W i l l i a m H. J o h n s t o n ' s d e l a y i n s e n d i n g the child to a qualified hematologist or other s p e c i a l i s t r e s u l t e d i n the c h i l d ' s macrocytic anemia b e i n g u n d i a g n o s e d f o r a t l e a s t a n a d d i t i o n a l s i x (6) months. During that period the child did not r e c e i v e the necessary medical treatment r e s u l t i n g i n his condition further deteriorating." Thus, Dr. should did have and r e f e r r e d Lennon t o (2) medical Shore's a f f i d a v i t a s s e r t s that treatment deteriorating. provide i f failure resulted However, a basis w o r d s , Dr. that Lennon's for inferring Johnston s p e c i a l i s t - - i . e . , i f Dr. had to his (1) affidavit caused no made timely J o h n s t o n had 22 the than not (2). basis for further does In not other inferring referral acted he necessary condition provides a Johnston earlier receive Shore's that t h a t Dr. specialist in Dr. Shore's a f f i d a v i t Dr. a (1) to a negligently-- 1071143 Lennon probably treatment" The would to which the r e c e i v e d "the Dr. Shore finds dissent because, have Dr. Shore's asserts, Dr. dissent necessary referred. affidavit Shore sufficient "opines purportedly negligent delay i n treatment a c t u a l l y in' a real physical condition'" So. emphasis added). B-12 Dr. deficiency injury: 'the d e t e r i o r a t i o n 3d a t (Cobb, C . J . , However, as n o t e d , was medical the cause that the 'result[ed] of [Lennon's] dissenting) (first i t i s undisputed that of Lennon's i n j u r i e s . Neither Shore n o r Dr. A d l e r t e s t i f i e d t h a t Dr. J o h n s t o n had a to diagnose asserted a n d t r e a t t h e B-12 t h a t Dr. Johnston deficiency.^ "breached the the R a t h e r , Dr. standard of duty Shore care f a i l i n g t o r e c o g n i z e Lennon Groover's developmental d e l a y s refer the manner" set out (emphasis Thus, care child qualified specialists in a and timely added), f o r Dr. forth to by by Johnston Dr. to Shore, comply Dr. with Johnston the standard needed to of (1) ^As t h e d i s s e n t p o i n t s o u t i n i t s r e c i t a t i o n o f t h e f a c t s , M e l i n d a G r o o v e r on s e v e r a l o c c a s i o n s i n d i c a t e d t o Dr. J o h n s t o n t h a t s h e t h o u g h t L e n n o n h a d a B-12 d e f i c i e n c y . So. 3d a t (Cobb, C . J . , d i s s e n t i n g ) . H o w e v e r , t h e r e was n o e x p e r t testimony indicating that, i n view of that evidence, the a p p r o p r i a t e s t a n d a r d of c a r e r e q u i r e d Dr. J o h n s t o n t o d i a g n o s e L e n n o n ' s B-12 deficiency. 23 1071143 r e c o g n i z e Lennon's developmental 12 deficiency) "qualified Dr. at an earlier specialists" Johnston had possibilities: time (not t r e a t done (1) those the two l e s s e n i n g any additional (2) t h e "qualified treated the would injury to diagnosis, treatment, been, specialists" Dr. Lennon. and Shore's and there result that the and i n Dr. Shore's the B-12 the Groovers do n o t c i t e any deficiency an stating such assumes treatment earlier would to support reduced who that the probable referral would "qualified t r e a t e d the have B- prevented But t h e r e i s that any o t h e r e v i d e n c e 24 and i n an e a r l i e r d i a g n o s i s have d i a g n o s e d and affidavit have have d i a g n o s e d Without opinion two Lennon s u s t a i n e d ; o r Lennon's c o n d i t i o n from " f u r t h e r d e t e r i o r a t i n g . " nothing are thereby preventing I n o t h e r words, of to If would s h o u l d have been o r what the p r o b a b l y would deficiency then not thus Lennon, specialists" 12 would and deficiency). specialists" that Lennon c o u l d have p o s s i b l y p r e v e n t e d o r "qualified have things, c o u l d have p o s s i b l y r e s u l t e d additional refer t h e B-12 injury deficiency, treatment, which (2) deficiency, specialists" continue to injure referral and B-12 {not r e c o g n i z e t h e and "qualified d i a g n o s e d a n d t r e a t e d t h e B-12 or delays conclusion, i n the record 1071143 to support referral it.'^ Thus, Dr. Shore's assumption to a "qualified specialist" lessened the "further deterioration" conclusory, See Bradley which this c r e a t e a genuine v. M i l l e r . Court earlier would have p r e v e n t e d or o f Lennon's c o n d i t i o n i s s p e c u l a t i v e , and without f o u n d a t i o n and cannot t h a t an a proper evidentiary issue of material 878 S o . 2 d 2 6 2 , 2 6 6 fact. ( A l a . 2003), i n noted: " 'To prove causation i n a medical m a l p r a c t i c e c a s e , t h e p l a i n t i f f must p r o v e , through expert medical testimony, that the a l l e g e d n e g l i g e n c e p r o b a b l y caused, r a t h e r than o n l y p o s s i b l y caused, t h e p l a i n t i f f ' s injury.' " U n i v e r s i t y o f A l a b a m a H e a l t h S e r v s . v . B u s h , 638 S o . 2 d 7 9 4 , 802 ( A l a . 1 9 9 4 ) . ' [T]he o p i n i o n s o f a n expert may not rest on "mere s p e c u l a t i o n and conjecture." Townsend v . G e n e r a l M o t o r s C o r p . . 642 S o . 2 d 4 1 1 , 4 2 3 ( A l a . 1994) . ' Dixon v. Board o f W a t e r & S e w e r Comm'rs o f M o b i l e , 8 6 5 S o . 2 d 1 1 6 1 , 1166 ( A l a . 2003). '[A]s a t h e o r y o f c a u s a t i o n , a c o n j e c t u r e i s s i m p l y an e x p l a n a t i o n c o n s i s t e n t w i t h known f a c t s o r c o n d i t i o n s , b u t n o t d e d u c i b l e from them a s a r e a s o n a b l e i n f e r e n c e . See, e.g.. G r i f f i n L u m b e r C o . v . H a r p e r , 2 4 7 A l a . 6 1 6 , 25 S o . 2 d 5 0 5 (1946).' A l a b a m a P o w e r Co. v . R o b i n s o n . 4 4 7 S o . 2 d 14 8, 153-54 ( A l a . 1983). An e x p e r t witness's o p i n i o n t h a t i sconclusory, s p e c u l a t i v e , and without ''Indeed, t h e o n l y o t h e r e x p e r t t e s t i m o n y w a s f r o m D r . A d l e r , a p e d i a t r i c n e u r o l o g i s t (and presumably a s i m i l a r l y s i t u a t e d " q u a l i f i e d s p e c i a l i s t " l i k e t h o s e t o whom D r . S h o r e referred). However, as I have n o t e d , Dr. A d l e r ' s o p i n i o n t h a t e a r l i e r treatment o f t h e B-12 d e f i c i e n c y w o u l d h a v e made L e n n o n " b e t t e r " was i n s u f f i c i e n t u n d e r M c A f e e . 25 1071143 a proper evidentiary f o u n d a t i o n cannot create a genuine issue of material fact. Becton v. R h o n e - P o u l e n c , I n c . . 706 S o . 2 d 1 1 3 4 , 1 1 4 1 - 4 2 ( A l a . 1997) . " As n o t e d , t h e d i s s e n t c o n c l u d e s t h a t McAfee i s i n a p p o s i t e and, presumably, supra. that This case this case i s more a n a l o g o u s i s distinguishable from Parker, P a r k e r i n v o l v e d a c l a i m t h a t i n J a n u a r y 1988 Collins, a upon Mrs. P a r k e r and test radiologist, results diagnosed t o be t h a t he presented indicating that "'grossly technically the X-ray and that standard of radiology 605 Dr. Wyatt a i n December So. 2d at 826. failure to testimony film used 1988; 605 by . Dr. and Dr. violated Collins by from inadequate Parker So. to that was time 2d a t 826. two experts Collins suboptimal the was for accepted diagnose, testimony about "Dr. N i c h o l a s R o b e r t , a c a n c e r s p e c i a l i s t , t e s t i f i e d ¢ . . as t o t h e e f f e c t o f t h e d e l a y i n d i a g n o s i n g Mrs. Parker's condition. B a s e d on t h e e v i d e n c e r e g a r d i n g t h e s i z e o f t h e lump d i s c o v e r e d b y Mrs. P a r k e r i n J a n u a r y , as w e l l as t h e m e d i c a l e v i d e n c e s u r r o u n d i n g 26 the that c a r e by b a s i n g h i s d i a g n o s i s upon In addition E, mammogram then n e g l i g e n t l y interpreted spread t o her lymph nodes. Parkers interpretation' performed Parker, however. negative" f o r breast cancer. with breast cancer the c a n c e r had The "negligently to it." the 1071143 t h e s u b s e q u e n t g r o w t h o f t h e lump. Dr. R o b e r t s a i d t h a t h e was 80% c e r t a i n t h a t t h e c a n c e r had not s p r e a d i n t o Mrs. P a r k e r ' s lymph nodes as o f J a n u a r y . Dr. Sanchez, Mrs. P a r k e r ' s surgeon, t h e n t e s t i f i e d t h a t Mrs. P a r k e r ' s mastectomy and t h e c o u r s e of chemotherapy and r a d i a t i o n t r e a t m e n t s t h a t f o l l o w e d were n e c e s s a r y , because the c a n c e r had spread i n t o her l y m p h n o d e s . He also testified that breast c a n c e r has a h i g h e r r a t e o f r e c u r r e n c e once i t has s p r e a d i n t o the lymph g l a n d s . " 605 So. 2 d a t 826 Thus, unlike (emphasis Dr. added) Shore's opinion in this case regarding the e f f e c t o f the a l l e g e d n e g l i g e n t f a i l u r e o f Dr. J o h n s t o n timely refer Lennon to a qualified specialist, there p r o p e r e x p e r t t e s t i m o n y i n P a r k e r as t o the p r o b a b l e e f f e c t the f a i l u r e to diagnose: probably caused treatments--a f o r example, the f a i l u r e t o Parker mastectomy to and undergo the course additional of to was of diagnose medical chemotherapy and ^In v i e w of t h a t evidence, t h i s Court i n P a r k e r c o n c l u d e d : " W h i l e t h e f a c t s do n o t e s t a b l i s h t h a t M r s . P a r k e r ' s c a n c e r c o u l d have been p r e v e n t e d a l t o g e t h e r i f Dr. C o l l i n s had r e n d e r e d a prompt d i a g n o s i s b a s e d on a c l e a r e r X-ray, m e d i c a l t e s t i m o n y s u g g e s t s t h a t Mrs. P a r k e r ' s c o n d i t i o n w o r s e n e d as a d i r e c t r e s u l t o f a diagnosis based upon a substandard X-ray. That e v i d e n c e was s u f f i c i e n t t o c r e a t e a j u r y q u e s t i o n a s t o proximate cause i n t h i s case; a c c o r d i n g l y , we r e v e r s e t h a t p o r t i o n o f t h e judgment b a s e d on t h e d i r e c t e d v e r d i c t f o r Dr. C o l l i n s . " 605 So. 2d a t 827 (emphasis added). 27 1071143 r a d i a t i o n treatments--and injury of having a caused higher her to s u f f e r the chance of reocurrence c a n c e r t h a n she o t h e r w i s e w o u l d h a v e had. plaintiffs with probably unlike is p h y s i c i a n had the As had case, not acted a better there In o t h e r words, indicating negligently, outcome.^ was breast that the the expert i f the patient Consequently, substantial evidence of i n Parker. (1) developmental (3) t h e have present noted, that Johnston evidentiary foundation would causation of i n P a r k e r p r e s e n t e d t e s t i m o n y by a q u a l i f i e d a proper defendant additional had the Groovers' i f Dr. delays theory of causation i n t h i s Johnston at an had earlier recognized stage and {2) Lennon's i f r e f e r r e d Lennon t o " q u a l i f i e d s p e c i a l i s t s , " "qualified s p e c i a l i s t s " would have p r o p e r l y case Dr. then diagnosed ^Two recent d e c i s i o n s of t h i s Court i l l u s t r a t i n g this p r i n c i p l e i n c l u d e M o b i l e I n f i r m a r y A s s ' n v . T y l e r , 9 8 1 So. 2 d 1077, 1102 ( A l a . 2 007) (finding substantial evidence of c a u s a t i o n where e x p e r t t e s t i m o n y e s t a b l i s h e d t h a t a n u r s e ' s negligent failure to adequately communicate the symptoms s u f f e r e d by the p a t i e n t p r e v e n t e d the p a t i e n t "from r e c e i v i n g the medical c a r e t h a t p r o b a b l y would have p r e v e n t e d her d e a t h " ) ; a n d L a w s o n v . M o o r e . [Ms. 1 0 7 0 6 3 4 , D e c , 3 1 , 2 0 0 8 ] So, 3d ( A l a . 2 0 08) (finding substantial evidence of causation where expert testimony established that the defendant doctor " a c t e d n e g l i g e n t l y and that his alleged negligence terminated a viable intrauterine pregnancy" (emphasis added)). 28 1071143 and treated condition reasons in Lennon's would not of are "further testimony their theory as Groovers have not theory have described avoid being deficiency, expert s t a t e d , the support B-12 cited (4) Lennon's deteriorated." o f f e r e d by causation was mere c o n j e c t u r e . For the the Groovers insufficient to A d d i t i o n a l l y , the legal authority suggesting that their the evidence o f f e r e d i n support o f c a u s a t i o n and sufficient of and of i t to warrant a r e v e r s a l of the summary j u d g m e n t . Ill. In l i g h t of the foregoing d i s c u s s i o n about the Groovers' f a i l u r e t o o f f e r s u b s t a n t i a l evidence of c a u s a t i o n , i t should be noted court that the e r r e d by Groovers entering completed discovery scheduling order." argument in Groovers contend depose their that the court that on the in compliance regard that were Shore. c a u s a t i o n was that not 29 given the Groovers court's The Groovers' First, enough for the a the time Groovers properly before motion trial the parts. Second, not "[t]he trial the p . 15 . two defendants' j udgment. with brief, includes they Dr. Johnston appeal summary j u d g m e n t b e f o r e Groovers' expert, i s s u e of argue on to argue trial summary 1071143 When the Groovers 2006, t h e y order, also filed requesting, filed their a motion among complaint f o r the entry other things, on March of a 31, scheduling the following: (1) that a l l fact witnesses b e d e p o s e d w i t h i n 90 d a y s o f t h e d a t e of answer; filing of the last experts be i d e n t i f i e d answer filed and (2) t h a t a l lthe Groovers' w i t h i n 90 d a y s o f t h e d a t e o f t h e l a s t that a l l of those experts would be made a v a i l a b l e f o r d e p o s i t i o n w i t h i n 120 d a y s o f t h e d a t e o f f i l i n g of the last conference answer; 2007, those a n s w e r was September scheduling 31, order. 1, the court a pretrial filed. 2006, the trial court experts; until depositions. trial on October 1, 2 0 0 7 . filed curriculum vitae March The o r d e r a number of a January 30, 2007, to put J u l y 31, 2007, t o s e t the case f o r On J a n u a r y 3 1 , 2 0 07, of entered gave t h e Groovers u n t i l up f o r d e p o s i t i o n ; and u n t i l a l l other hold f o r t r i a l w i t h i n 200 d a y s o f t h e That order to identify experts complete [3) t h a t and s e t t h e case date the l a s t On and the Groovers purported experts, i n c l u d i n g Dr. Shore and Dr. A d l e r . On February scheduling order 22, 2007, to extend the trial several 30 court amended i t s deadlines, including 1071143 e x t e n d i n g t h e d e a d l i n e f o rdeposing the Groovers' e x p e r t s March Dr. 30, 2007, u n t i l A d l e r i n New On June withdraw granted from York 1, The d e f e n d a n t s counsel f o r the Groovers representing the Groovers. and a l l o w e d 2 0 0 7 , t o s e c u r e new affidavit 31, 2007. moved counsel. for a summary asserts standard of care i n h i s treatment act or h i s part based moved trial until 13, 2007, judgment the on The the Groovers On J u l y o f Dr. Johnston which omission deposed on March 23, 2007. 2007, the motion defendants May from court July 23, the Johnston on: (l) the t h a t Dr, Johnston o f Lennon and t h a t "proximately to caused harm met no to L e n n o n " ; a n d (2) t h e f a c t t h a t t h e May 3 1 , 2 0 0 7 , d e a d l i n e h a d passed without deposition the Groovers' any s i m i l a r l y s i t u a t e d Johnston breached At appeared conduct a status conference f o r the Groovers discovery Groovers expert to t e s t i f y up f o r t h a t Dr. t h e s t a n d a r d of care i n h i s care o f Lennon, judgment motion. the i d e n t i f y i n g and p u t t i n g and i d e n t i f y and submit July 23, and r e q u e s t e d to respond The t r i a l additional on to 2007, new additional the pending counsel time to summary- c o u r t e n t e r e d an order g r a n t i n g time--until October 1, 2007--to a f f i d a v i t s from any expert w i t n e s s needed 31 1071143 to respond t o the pending set summary-judgment motion. The order t h e c a s e f o r a n o t h e r s t a t u s c o n f e r e n c e o n O c t o b e r 1, 2 0 0 7 . The trial October court 3, entered 2007, summary-j udgment an additional continuing the mot i o n u n t i 1 hearing January 10, a l s o gave t h e J o h n s t o n d e f e n d a n t s u n t i l file scheduling order on the 2008. on pending The court December 31, 2008, t o a d d i t i o n a l e v i d e n t i a r y s u b m i s s i o n s and gave t h e Groovers until January 8, 2008, to file additional evidentiary file additional evidentiary submissions. The Groovers did not s u b m i s s i o n s b y t h e J a n u a r y 8, 2 0 0 8 , d e a d l i n e . 2008, the Johnston stating that evidence by Groovers The the the in Groovers January filed had 8, not trial court held 2 00 8, the a supplemental submitted deadline had not submitted s u f f i c i e n t summary-judgment the defendants On J a n u a r y evidence of scheduled m o t i o n on J a n u a r y 10, 2008. further that to f i l e defendants' Following a reply brief i n response supplemental brief filed the hearing, the Groovers 32 on filed the causation. hearing on the At that hearing, G r o o v e r s r e q u e s t e d and were g r a n t e d an a d d i t i o n a l which brief any and 10, to the 10 d a y s Johnston January 10, 2008. a motion to strike 1071143 the Johnston defendants defendants' responded supplemental b r i e f the January 8 submissions argued that contended, filed i n a written passed brief, with the Groovers. causation i t had been was not raised a no substantial of care As given evidence by Dr. the after evidentiary also because, they Johnston's affidavit original summary- court denied the Groovers' and t h e c o u r t g r a n t e d f o r a summary j u d g m e n t . that the Groovers indicating Johnston was that the the proximate The had not alleged cause of injuries. to their enough Groovers inform motion order s p e c i f i c a l l y stated Lennon's that motion. the Johnston defendants' breach Johnston defendants issue defendants' motion t o s t r i k e the supplemental b r i e f , offered further new i n Dr. On J a n u a r y 2 9 , 2 0 0 8 , t h e t r i a l court's The arguing The J o h n s t o n along with the Johnston judgment brief. c o u l d not have been s u b m i t t e d u n t i l deadline from supplemental argument time d i d not the t r i a l to this t o depose raise court their this that Court expert, argument they depose t h e i r e x p e r t , Dr. Shore. 33 that they Dr. below; needed were n o t Shore, they additional the d i d not time to The J o h n s t o n d e f e n d a n t s p o i n t 1071143 out t h a t a f t e r July o f t h e i r summary-judgment m o t i o n 2007, t h e G r o o v e r s were g i v e n an a d d i t i o n a l until January submissions defendants need to trial and the f i l i n g 8, in support also assert depose Dr. court since could opinions in the sufficient the court's not order he did Lennon Groover," on the issue of that Shore Groovers' opinions before the to their they expert forth they brief, were argument deemed pp. 37-38. not allowed that the court, and held issue the Dr. Johnston's or did not do Thus, of proof which harm to the c o n t r a r y to the that to Groovers Groovers' contention, the Johnston defendants d i d not wait u n t i l 34 the asserting "proximately caused the burden causation. affidavit of trial that 2007 summary-judgment m o t i o n , by his i s without merit. p r o p e r l y before the t r i a l shifted own setting detail argument that Johnston not him of The did access from evidentiary "certainly defendants' argument addressed accompanied nothing direct his s i x months-- file Groovers amount Johnston defendants' July was to claims. place t o depose Dr. Regarding c a u s a t i o n was to Johnston Groovers' time the affidavit whatever The their that Shore an which of they had obtain appropriate." Thus, 2008--in in January 1071143 2008 to Indeed, raise the issue the Groovers' judgment motion of causation f o r the argument d i d not raise c o n t r a d i c t e d by the Groovers' S e p t e m b e r 28, 2007, "have b e e n that i n which the J u l y the issue response These regarding the experts cause (emphasis added). and offer extent of Consequently, raise the issue Finally, erred in the Groovers' brief argued that the i s Johnston defendants' 2008, filed asserted that they expect additional the to evidence child's the Groovers' they injuries" argument that motion d i d of causation i s without merit. permitting supplemental summary- causation i s t h e J o h n s t o n d e f e n d a n t s ' J u l y 2007 summary-judgment not time. t o that motion, the Groovers will 2007 of i n c o n t a c t w i t h o t h e r e x p e r t s who identify. first argument Johnston also had the trial defendants without supplemental Groovers that merit. brief failed to court file a Although filed the on J a n u a r y 10, to offer substantial e v i d e n c e o f c a u s a t i o n b y t h e J a n u a r y 8, 2 0 0 8 , d e a d l i n e f o r t h e Groovers to defendants' provided brief, 10 submit evidence i n opposition summary-judgment additional and t h e Groovers days motion, the to respond i n fact 35 filed to a Johnston Groovers to that reply. the were supplemental 1071143 COBB, C h i e f I affirm Justice respectfully the (dissenting). dissent from summary j u d g m e n t the in this majority's decision to case. Facts'" Greg youngest and of Although According whom, he subsequent Melinda was Groover Lennon, have was born developmentally development soon she to had him months o l d w h i l e diet with children. diet with solid 18 food, as she However, when M e l i n d a solid food, he was his done unable to his mother. breast- supplementing with attempted 1999.'^ breast-feed s i x months o l d , t h e n had the birth, planned to feed was 29, at concern he he children, October Lennon e x c l u s i v e l y u n t i l until was on normal began t o Lennon's mother, three her two his older to supplement his swallow i t . '°In s e t t i n g f o r t h these facts, I understand that, i n r e v i e w i n g a t r i a l c o u r t ' s r u l i n g on a summary-judgment m o t i o n , "' [ t ] h e c o u r t m u s t a c c e p t t h e t e n d e n c i e s o f t h e e v i d e n c e m o s t favorable to the nonmoving party and must resolve a l l reasonable doubts [regarding the facts] i n f a v o r of the nonmoving p a r t y . ' " R i c h a r d s o n v . T e r r y . 893 S o . 2 d 2 7 7 , 281 ( A l a . 2 0 0 4 ) ( q u o t i n g B r u c e v . C o l e , 854 So. 2 d 4 7 , 54 ( A l a . 2003)) . '^The Groovers are vegetarians. Dr. Johnston, a pediatrician who practices with Birmingham Pediatric A s s o c i a t e s , Inc. , had been the G r o o v e r f a m i l y p e d i a t r i c i a n f o r 2 0 y e a r s a n d was v e r y a w a r e t h a t t h e G r o o v e r s a r e v e g e t a r i a n s . 36 1071143 By the time unable to without support this swallow time, routine she Lennon solid Johnston nine food; months he was o l d , he not was able to Lennon's mother took him t o Dr. s i t up Lennon's mother introduce formula into asked Johnston Dr. Lennon's diet, but for Dr. Johnston a child food u p t o t h e a g e o f 18 m o n t h s . because he had a birth defect commonly known as b e i n g "tongue-tied." Lennon's when mother that, Lennon would need Lennon in swallowing his Dr. Johnston reached the t o undergo a procedure further tongue informed age of After this mother breast-feed Lennon in appointment, b a s e d on Dr. J o h n s t o n ' s d i d not Lennon "solid" food introduce exclusively. formula She a d d i t i o n t o b r e a s t m i l k , b u t s h e was the food. 37 solid advice, continued a l s o attempted (such as mashed p o t a t o e s Lennon c o u l d not swallow but 18 to correct t h e d e f e c t a n d a t t h a t p o i n t he w o u l d be a b l e t o s w a l l o w Lennon's Dr. nutrition" informed Lennon's mother t h a t Lennon had d i f f i c u l t y food. i f a d v i s e d h e r t h a t i t was n o t a g o o d i d e a t o i n t r o d u c e "complete months, At for a Johnston f o r m u l a and t h a t b r e a s t - f e e d i n g p r o v i d e s solid still o r t o c r a w l , a n d he d i d n o t s a y a n y w o r d s . appointment. should was and a p p l e unsuccessful to to feed sauce) because 1071143 In O c t o b e r 2000, a t t h e age had not begun t o c r a w l . could walk only hands. of 12 m o n t h s , Lennon still He r a r e l y t u r n e d o v e r o n h i s own. i f an a d u l t assisted He him by h o l d i n g b o t h h i s Lennon's mother a g a i n took him t o Dr. J o h n s t o n . J o h n s t o n drew b l o o d t o t e s t Lennon f o r m i c r o c y t i c anemia Dr. {iron d e f i c i e n c y ) and s e t up a n a p p o i n t m e n t f o r L e n n o n t o r e t u r n weeks l a t e r At f o r f o l l o w - u p on t h e r e s u l t s the Johnston follow-up informed deficiency. could have At a Lennon's this B-12 appointment time, mother L e n n o n c o u l d n o t h a v e a B-12 test revealed indicative In that February than Lennon mother Dr. small test. November 2 0 0 0, had asked Johnston deficiency, Lennon had o f an i r o n in Lennon's deficiency. of the an replied cells, Dr. iron i f Lennon and t h a t blood two that t h e anemia w h i c h were deficiency. 2 001, when L e n n o n was about 15 m o n t h s , h i s m o t h e r n o t i c e d t h a t h e was p u l l i n g o n h i s f i n g e r s a n d touching his Lennon's lips. I n reading about i r o n d e f i c i e n c y f o l l o w i n g diagnosis, she had d i s c o v e r e d l i t e r a t u r e indicating 12 d e f i c i e n c y c a u s e s t i n g l i n g i n t h e f i n g e r s . t h a t a B~ She t o o k Lennon t o Dr. J o h n s t o n f o r a n o t h e r a p p o i n t m e n t , and she i n f o r m e d Dr. Johnston about Lennon's habit of p u l l i n g 38 on h i s f i n g e r s and 1071143 touching his lips. She expressed Lennon's f i n g e r s were t i n g l i n g a B-12 and d e f i c i e n c y t h a t was touch doing have his lips. i t now." a B-12 He Dr. told deficiency concern that and asked i f Lennon m i g h t have c a u s i n g him t o p u l l Johnston replied, Lennon's mother and perhaps that on h i s f i n g e r s "Well, that the t e s t he's Lennon results not d i d not indicated t h a t Lennon's b l o o d c e l l s were l a r g e r t h a n b e f o r e , w h i c h , Dr. Johnston was informed recovering At Dr. the from the i r o n Johnston was t h a t h e was s t i l l mother asked t h a t Dr. Johnston therapy. do w i t h indicated still unconcerned He e x p l a i n e d about months, Lennon's t h a t L e n n o n was a b i g b a b y weak f r o m t h e i r o n d e f i c i e n c y . Lennon's he b e r e f e r r e d t o a p h y s i c a l t h e r a p i s t , b u t told her that Lennon d i d not need physical H o w e v e r , h e g a v e L e n n o n ' s m o t h e r some e x e r c i s e s to Lennon, w h i c h she d i d . took continued "It's Lennon deficiency. I n A u g u s t 2 0 0 1 , w h e n L e n n o n was again that t h e t i m e o f L e n n o n ' s c h e c k u p a t t h e a g e o f 15 developmental delays. and mother, him to Dr. developmental g o t t o b e B~12 21 m o n t h s o l d , h i s m o t h e r Johnston. delays, anemia." she Referring said to to Dr. Lennon' s Johnston, D r . J o h n s t o n r e s p o n d e d , "Nobody 39 1071143 gets B-12 breast anemia. milk." Lennon Dr. i s getting Johnston put enough Lennon B-12 on He then referred further evaluation Lennon to Dr. Lennon's records from Dr, Johnston. medical record, Lennon's mother n o t i c e d normal blood-test Mussell In that Children's sample. that the medical unable Dr. to after five Johnston hematologist to she for Lennon's at the had not 12 m o n t h s o l d . She that a mother blood was so looked Lennon B-12 test, and Dr. to Dr. thick a consult that were a t Dr. to obtain "smear" with of him to sample Lennon's about test the at obtain c l o t t e d so Johnston's a B-12 technicians unable h e m a t o l o g i s t c o n f i r m e d t h a t L e n n o n h a d a B-12 40 Lennon f o r the so t h i c k and technicians attempts took drawn i n Birmingham b l o o d was took When schedule the have blood Hospital Lennon's Mussell and test. 2 0 01, office Lennon's acid, obtained r e s u l t s s i n c e h e was Mussell ordered the Johnston' s because Dr. December Holly mother medical requested folic a of Lennon's m u s c u l a r weakness. I n November 2001, had your Poly-Vi-Sol, v i t a m i n s u p p l e m e n t , w h i c h p r o v i d e d some i r o n , B-12. from a quickly office were for testing. blood to test. deficiency. a The Dr. 1071143 Johnston q u i c k l y b e g a n t r e a t i n g L e n n o n w i t h B-12 s h o t s . After L e n n o n b e g a n t a k i n g B-12 s h o t s , a c c o r d i n g t o L e n n o n ' s m o t h e r , L e n n o n ' s c o n d i t i o n b e g a n t o i m p r o v e " r i g h t away." noted i m p r o v e m e n t when he t r e a t e d L e n n o n a t h i s n e x t February It that as of a result Lennon the s u f f e r e d permanent prolonged B-12 A c c o r d i n g t o Dr. Steven Shore, t h e Groovers' who i s a p e d i a t r i c i a n , Dr. Johnston by failing developmental hematologist affidavit Lennon to Lennon's office on 1, 2 0 0 2 . i s undisputed damage care Dr. Johnson t o recognize delays specialist. t h a t , because of a qualified macrocytic Dr. anemia (i.e., of him t o a Shore Dr. Johnston's hematologist witnesses, the standard of the significance and t o t i m e l y r e f e r or other deficiency. expert breached or Lennon's qualified testified delay other B-12 brain by i n sending specialist, deficiency) was undiagnosed f o r a t l e a s t an a d d i t i o n a l s i x months. opined Lennon d i d n o t r e c e i v e that, during those the necessary medical deterioration Lennon years s i x months, treatment, Dr. Shore which r e s u l t e d i n the f u r t h e r of h i scondition. could o l d , and not walk when he unti 1 could 41 he walk was then two and only one-half with the 1071143 assistance of deposition was grade. At a walker. taken that At i n this time, the time Lennon's case, Lennon had selective Lennon was mother's i n the mutism, was s p e c i a l - e d u c a t i o n and o c c u p a t i o n a l - t h e r a p y c l a s s e s a t and c o u l d not test indicate The Pediatric or write t h a t Lennon has Groovers Associates, summary speak w e l l sued Inc., judgment and in Dr, an IQ of Johnston, others. favor well. of A s s o c i a t e s , I n c . , and The The results in school, of an IQ 60. Birmingham trial court Johnston Dr. first and the Groovers Pediatric entered a Birmingham appealed. Analysis I. The Merits As e v i d e n c e t h a t Dr. J o h n s t o n ' s alleged failure to timely r e f e r Lennon t o a h e m a t o l o g i s t o r o t h e r s p e c i a l i s t p r o x i m a t e l y and p r o b a b l y c a u s e d i n j u r y t o Lennon, the Groovers affidavit of from pediatrician. one Dr. their Shore expert testified w i t n e s s e s , Dr. in that r e l y on an Shore, a affidavit follows: " W i l l i a m H. J o h n s t o n , M.D,, d i d not comply w i t h the a p p l i c a b l e standard of care f o r a board certified p e d i a t r i c i a n w i t h r e s p e c t t o t h e c a r e and t r e a t m e n t rendered t o Lennon Groover. 42 as 1071143 " W i l l i a m H. J o h n s t o n , M.D., b r e a c h e d t h e s t a n d a r d o f care by f a i l i n g t o r e c o g n i z e Lennon G r o o v e r [ ' ] s developmental delays and r e f e r t h e c h i l d out t o q u a l i f i e d s p e c i a l i s t s i n a t i m e l y manner. "Dr. W i l l i a m H. J o h n s t o n ' s delay i n sending the child to a qualified hematologist or other s p e c i a l i s t r e s u l t e d i n the c h i l d ' s m a c r o c y t i c anemia n. e. . B-12 d e f i c i e n c y ] b e i n g u n d i a g n o s e d f o r a t l e a s t a n a d d i t i o n a l s i x (6) m o n t h s . During that period the c h i l d d i d not receive the necessary medical treatment r e s u l t i n g i n h i s c o n d i t i o n f u r t h e r deteriorating." The Center, trial relied 641 So. 2 d 265 affidavit material delay court was on McAfee { A l a . 1994), insufficient to Baptist Medical t o h o l d t h a t Dr. Shore's create a f a c t as t o whether Dr. Johnston i n Lennon's diagnosis v. genuine issue n e g l i g e n t l y caused a and treatment, which, i n turn, c a u s e d L e n n o n ' s c o n d i t i o n t o d e t e r i o r a t e . F i n d i n g no of causation summary judgment Associates, The in i n light o f McAfee, f o r Dr. Johnston the t r i a l court evidence entered and Birmingham a Pediatric Inc . fundamental flaw i n the t r i a l court's logic e n t e r i n g t h e summary j u d g m e n t , t h e t r i a l c h a r a c t e r i z e d the Groovers' as a n a t t e m p t of court i s that, incorrectly r e l i a n c e on Dr. Shore's affidavit t o r e l y on t h e " l o s s - o f - c h a n c e " d o c t r i n e , which '^A s u m m a r y j u d g e m e n t h a d e a r l i e r o t h e r defendants on another ground. 43 been entered f o r the 1071143 this Court expressly loss-of-chance and doctrine soundly rejected in McAfee. i s the p r o p o s i t i o n that "the chance (to achieve a b e t t e r medical outcome)" i s a injury i n a medical-malpractice 267 n.2. case. Thus, i n accordance w i t h McAfee, The loss-of- compensable So. 2d r e j e c t i o n of the 641 at the loss- of-chance d o c t r i n e i n McAfee, Alabama e v i d e n c e i n d i c a t i n g t h a t a delay i n medical condition to treatment worsen i s not b a s e d on m e d i c a l n e g l i g e n c e condition probably did could sufficient v. Williams, in 12 caused to a sustain fact So. worsen See 3d a action patient's probable and g e n e r a l l y M c A f e e ; see also 631 as patient's an absent evidence that the proximate r e s u l t of the delay. Crutcher have ( A l a . 2009) (relying McAfee t o h o l d t h a t evidence i n d i c a t i n g t h a t d e l a y e d treatment merely caused l o s s of chance to p r e v e n t f u r t h e r i n j u r y d i d satisfy the i n c u r r e d an the delay plaintiff's burden i n j u r y t h a t was to prove p r o b a b l y and i n treatment) . T h i s that she proximately i s because on not actually caused evidence that by an ^^I a u t h o r e d C r u t c h e r , w h i c h a p p l i e d M c A f e e t o o v e r t u r n a j ury v e r d i c t f o r a p l a i n t i f f i n a medical-malpractice case. In Crutcher, the p l a i n t i f f , l o l a W i l l i a m s , presented evidence a t t r i a l t h a t an emergency-room d o c t o r ' s f a i l u r e t o t r e a t h e r dangerous b r a i n c o n d i t i o n or to t r a n s f e r her to U n i v e r s i t y of Alabama a t B i r m i n g h a m H o s p i t a l by emergency v e h i c l e c a u s e d a d e l a y i n t r e a t m e n t a n d a l a c k o f e m e r g e n c y c a r e w h e n i t was needed. W i l l i a m s ' s m e d i c a l expert t e s t i f i e d t h a t , g e n e r a l l y . 44 1071143 injury could warrant the 641 So. the at that better 2 6 7. the treatment of i s not condition. plaintiffs that [the p l a i n t i f f s ' ] delay Thus, alleged another the way, sufficient under sufficient See McAfee, failed to 641 to prove mere treatment, So. that 2d at a delay caused a worsening of 641 "submit So. 2d at to McAfee, McAfee, onset of r e s u l t , " McAfee, 268 in that 267 (holding substantial evidence c o n d i t i o n s w o r s e n e d as a d i r e c t r e s u l t " i n treatment McAfee i s not sooner the a particular patient the the Put expected that of as t h a t i t p r o b a b l y d i d so o c c u r . "generally, (emphasis added), patient's occurred conclusion 2d evidence have simply in their applied A l a b a m a t h a t , t o p r e v a i l on p a r t i c u l a r cases). the long-standing a medical-malpractice rule claim in based a delay i n treatment of a p a t i e n t w i t h a c o n d i t i o n li'ke Williams's c o u l d cause the p a t i e n t ' s c o n d i t i o n t o further deteriorate. Cf. McAfee (holding that evidence that " g e n e r a l l y . . . ' t i m e i s o f t h e e s s e n c e ' i n t r e a t [ment] " o r t h a t " g e n e r a l l y , t h e s o o n e r t h e ... t r e a t m e n t , t h e b e t t e r t h e e x p e c t e d r e s u l t , " 641 So. 2 d a t 2 68, was not s u f f i c i e n t to e s t a b l i s h causation i n a p a r t i c u l a r case). However, v i e w i n g the e v i d e n c e i n the l i g h t most f a v o r a b l e t o W i l l i a m s , the C o u r t f o u n d no e v i d e n c e o f a p r o b a b i l i t y t h a t a n y legally cognizable injury to Williams a c t u a l l y r e s u l t e d from the emergency-room doctor's alleged negligence in placing W i l l i a m s a t r i s l ^ t h a t an i n j u r y c o u l d o c c u r . See C r u t c h e r , 12 So. 3 d a t 64 8. Therefore, we reversed the j udgment f o r Williams and rendered a judgment f o r the emergency-room doctor. Id, 45 1071143 on a d e l a y i n p r o v i d i n g m e d i c a l prove that a breach i n treatment, more others See M c A f e e than that of the standard a mere (Ala, the negligence (quoting 1980))). decades." of care, i.e., must the delay or one complained [T]here p o s s i b i 1i t y of caused the must among injury. that the negligence probably caused the Baker "This 2 d a t 267 has v. Chastain, been 389 So. the standard 2d 932, 934 i n Alabama f o r 6 4 1 S o . 2 d a t 267.'* However, make 641 So. possibility There must be e v i d e n c e injury.'" the p l a i n t i f f p r o x i m a t e l y and p r o b a b l y caused a c t u a l i n j u r y t o the p l a i n t i f f . be treatment, t h e McAfee c o u r t went i t abundantly summary j u d g m e n t clear that i t was f o r the defendant plaintiff presented evidence condition probably worsened diagnosis and treatment. to considerable effort not was See a that the direct McAfee, that a a p p r o p r i a t e when t h e indicating as holding to result 641 So. plaintiff's of 2d delay at i n 267-68 '^Because c a u s a t i o n i s an e s s e n t i a l e l e m e n t o f a m e d i c a l m a l p r a c t i c e a c t i o n , I h a v e n o t s h i e d f r o m u p h o l d i n g summary j u d g m e n t s i n m e d i c a l - m a l p r a c t i c e c a s e s when t h e p l a i n t i f f ' s e v i d e n c e was n o t s u f f i c i e n t t o c r e a t e a g e n u i n e i s s u e o f m a t e r i a l f a c t as t o whether a p h y s i c i a n ' s breach of the s t a n d a r d o f c a r e a c t u a l l y c a u s e d damage t o t h e p l a i n t i f f . See, e . g . , 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 5 3 3 ( A l a . 2 0 0 8 ) ; c f . C r u t c h e r v . W i l l i a m s , 12 S o . 3 d 6 3 1 ( A l a . 2009) ( r e l y i n g on McAfee) . However, t h i s i s n o t s u c h a c a s e . 46 1071143 (discussing of this point at length and r e a f f i r m i n g the v a l i d i t y P a r k e r v . C o l l i n s , 605 S o . 2 d 824 Unlike the p l a i n t i f f s (Ala. 1992)). i n McAfee, t h e G r o o v e r s do n o t t a k e the p o s i t i o n that t h e y s h o u l d be compensated f o r t h e mere of prevent a chance to Rather, they i n j ury: the further which, they are further seeking damages deteriorat ion allege, was brain caused damage f o r an to actual, Lennon. physical o f Lennon's b r a i n by Dr. Johnston's loss i n j ury, failure to r e f e r Lennon t o a hematologist o r o t h e r q u a l i f i e d s p e c i a l i s t . Dr. Shore's "chance" affidavit to prevent Lennon's c o n d i t i o n . delay i n treatment goes beyond suggesting or further reduce He o p i n e s t h a t actually "result[ed] "the d e t e r i o r a t i o n of McAfee, 641 evidence that a t 267 a plaintiff's result' " of a delay [Lennon's] condition i n treatment j u r y q u e s t i o n as t o p r o b a b l e cause at 827 (emphasis chance case, omitted))). and McAfee of negligent physical condition." Cf. the p r i n c i p l e that "'worsened as a d i r e c t i s s u f f i c i e n t to create (quoting This i s therefore 47 of a deterioration i n "a real (reaffirming 2d loss the purportedly injury: So. mere Parker, 605 So. 2 d i s simply not a inapposite. a loss-of- 1071143 Moreover, under the p l a i n l a n g u a g e o f M c A f e e , i t was n o t n e c e s s a r y f o rDr. Shore t o t e s t i f y suffered care. irreversible brain injury T h e r e c a n be d i f f e r e n t damage. Under McAfee, t h a t Lennon would n o t have i f he h a d r e c e i v e d prompt degrees of i r r e v e r s i b l e i t i s sufficient that Dr. brain Shore's t e s t i m o n y s h o w s t h a t L e n n o n ' s p e r m a n e n t b r a i n i n j u r y was w o r s e than i t otherwise Johnston's certainly would be negligence. as a Although does n o t exclude probable Dr. result Shore's the p o s s i b i l i t y that of affidavit Lennon would h a v e h a d i r r e v e r s i b l e b r a i n damage e v e n h a d D r . J o h n s t o n sooner, Dr. Shore c e r t a i n l y negligence " r e s u l t [ed] deteriorating" they -- i . e . , otherwise Johnston's would negligence. did testify i n that [Lennon's] Dr. Dr. acted Johnston's condition further t h a t Lennon's i n j u r i e s were worse t h a n have been'^ Thus, Dr. i n the Shore's absence of Dr. affidavit does exclude t h e p o s s i b i l i t y t h a t t h e e x t e n t o f t h a t Lennon's brain d a m a g e w o u l d h a v e b e e n t h e same a b s e n t a d e l y i n t h e d i a g n o s i s and treatment sufficient. of h i s disease. This Court Under McAfee, t h i s stated i s clearly i n McAfee: '^I r e s p e c t f u l l y d i s a g r e e w i t h J u s t i c e S m i t h ' s s u g g e s t i o n t h a t c a u s i n g Lennon's c o n d i t i o n t o d e t e r i o r a t e f u r t h e r i s n o t t h e same t h i n g a s c a u s i n g L e n n o n ' s c o n d i t i o n t o b e w o r s e t h a t i t o t h e r w i s e w o u l d have been. 48 1071143 [T] h e i s s u e o f c a u s a t i o n i n a m a l p r a c t i c e c a s e may p r o p e r l y be s u b m i t t e d t o t h e j u r y w h e r e t h e r e i s e v i d e n c e t h a t prompt d i a g n o s i s and t r e a t m e n t w o u l d have p l a c e d the p a t i e n t i n a b e t t e r p o s i t i o n than s h e was i n as a r e s u l t of i n f e r i o r m e d i c a l c a r e . W a d d e l l v . J o r d a n , 293 A l a . 2 5 6 , 302 So. 2d 74 ( 1 9 7 4 ) ; M u r d o c h v . T h o m a s , 404 S o . 2 d 580 (Ala. 1981) . I t i s n o t n e c e s s a r y t o e s t a b l i s h t h a t p r o m p t care c o u l d have prevented the i n j u r y o r death of the p a t i e n t ; r a t h e r , t h e p l a i n t i f f must produce e v i d e n c e t o s h o w t h a t h e r c o n d i t i o n was a d v e r s e l y a f f e c t e d b y t h e a l l e g e d n e g l i g e n c e . W a d d e l l ; see a l s o Annot. 54 A . L . R . 4 t h 10 § 3 ( 1 9 8 7 ) . " McAfee. 641 (emphasis In So. a t 227 ( q u o t i n g P a r k e r , 605 the trial court i t s e l f f i n d i n g that the Groovers which one delay So. 2d a t 827 added)). fact, trouble 2d could reasonably in treatment Lennon's condition been. (See. e.g., caused was had by that, Dr. than trial t o have had submitted evidence conclude worse the appeared as a Johnston's result would finding Groovers' expert medical witnesses t e s t i f i e d , from of a negligence, i t otherwise court's no have that the i n essence, that " L e n n o n ' s b r a i n damage h a d commenced p r i o r t o t h e t i m e t h a t i t should have been d i s c o v e r e d by [Dr. J o h n s t o n ] , and d e l a y i n t r e a t m e n t and d i a g n o s i s meant t h a t a further, though '^The lack quantifying the u n q u a n t i f i a b l e , ^^ '^ that [Lennon] deterioration of commentary i n Dr. Shore's probable extent to which Dr. the suffered of his affidavit Johnston's 1071143 health.") Logically, causation, and this i t ought finding to lead amounts to a reversal judgment on t h e G r o o v e r s ' c l a i m t h a t Dr. caused to further Lennon's c o n d i t i o n The before Groovers this d i d not Court. to of the from the i n a p p o s i t e where, a delay in plaintiff. address I cannot of proximately necessarily the means we that i t indicating injury Groovers' must McAfee Because i t i s McAfee caused that arguments to address there i s evidence conclude summary negligently in their failure language as h e r e , treatment McAfee facilitate plain of deteriorate. d o e s n o t make t h e i r c a s e a l o s s - o f - c h a n c e c a s e . apparent finding Johnston d i s c u s s McAfee However, t h e i r a to failure approve is that the to of or i t s m i s a p p l i c a t i o n i n t h i s case a t Dr. J o h n s t o n and Birmingham P e d i a t r i c A s s o c i a t e s , Inc.'s u r g i n g . In conclusion, a decision of t h i s I have n e v e r more s t r o n g l y d i s a g r e e d w i t h Court than I do with i t s decision in this a l l e g e d breach of the s t a n d a r d of c a r e c o n t r i b u t e d t o Lennon's b r a i n i n j u r y o v e r a n d a b o v e w h a t he o t h e r w i s e w o u l d have s u s t a i n e d w o u l d be r e l e v a n t t o t h e e x t e n t o f L e n n o n ' s damages a t t r i b u t a b l e t o Dr. J o h n s t o n , but i t does not negate the e x i s t e n c e o f e v i d e n c e i n d i c a t i n g t h a t Dr. J o h n s t o n p r o b a b l y c a u s e d L e n n o n a c t u a l damage ( f u r t h e r d e t e r i o r a t i o n o f h i s c o n d i t i o n ) by b r e a c h i n g the s t a n d a r d of c a r e . The l a c k o f commentary as t o t h e e x t e n t r a t h e r t h a n the cause of Lennon's damage i s n o t t h e b a s i s u p o n w h i c h t h e t r i a l c o u r t e n t e r e d t h e s u m m a r y j u d g m e n t now a t i s s u e . 50 1071143 case. not B y i t s own e x p r e s s a n d c a r e f u l l a n g u a g e , M c A f e e be more c l e a r o r e x p l i c i t there i s no evidence that that i tapplies the loss of a i n cases chance to could where prevent i n j u r y e v e r a c t u a l l y o r p r o b a b l y r e s u l t e d i n an i n j u r y t o t h e plaintiff. evidence but that i t does n o t b a r r e c o v e r y i n d i c a t i n g that a d i r e c t r e s u l t of a delay the trial court sufficient i s as i n treatment. recognizes evidence there c o n d i t i o n worsened a plaintiff's that to create Dr. where B y i t s own f i n d i n g s , Shore's a genuine issue affidavit i s as t o whether some p o r t i o n o f L e n n o n ' s b r a i n d a m a g e w a s c a u s e d b y a d e l a y i n treatment caused by negligence Therefore, is simply this on t h e p a r t i s n o t a mere l o s s - o f - c h a n c e inapposite. Accordingly, of Dr. Johnston, case, and McAfee the t r i a l court erred by e n t e r i n g a summary j u d g m e n t f o r t h e d e f e n d a n t s i n r e l i a n c e on McAfee. II. Dr. Shore ¢s I in the Affidavit r e s p e c t f u l l y disagree with J u s t i c e Smith's h e r s p e c i a l w r i t i n g that Dr. Shore's a f f i d a v i t possibility specialists that might Lennon's c o n d i t i o n . timely n o t have referral l e d t o an Dr. Shore s t a t e d 51 to the earlier assertions leaves open appropriate diagnosis i n his affidavit: of "Dr. 1071143 William H. qualified child's Johnston[']s hematologist macrocytic delay i n sending or other anemia specialist [i.e., B-12 undiagnosed f o ra t l e a s t an a d d i t i o n a l hard to imagine indicated caused how Dr, Shore (1) t h a t D r . J o h n s t o n ' s ("resulted in") the child resulted to a i n the deficiency] being s i x (6) m o n t h s . " I ti s could have more clearly negligent delay i n referral (2) a s i x - m o n t h delay i n diagnosis of L e n n o n ' s B-12 d e f i c i e n c y . A d m i t t e d l y , D r . S h o r e d i d n o t i n s o many w o r d s s t a t e t h a t (1) the six-month deficiency, medical Instead, delay "caused" treatment i n diagnosis of Lennon's (2) L e n n o n n o t t o r e c e i v e t h e f o r a B-12 deficiency during that B-12 necessary period. Dr. Shore s t a t e d : " D r . W i l l i a m H. J o h n s t o n [ ' ] s d e l a y i n s e n d i n g t h e child to a qualified hematologist or other s p e c i a l i s t r e s u l t e d i n the c h i l d ' s m a c r o c y t i c anemia [ i . e . , B-12 d e f i c i e n c y ] b e i n g u n d i a g n o s e d f o r a t l e a s t a n a d d i t i o n a l s i x (6) m o n t h s . During that period the child d i d not receive the necessary medical treatment r e s u l t i n g i n h i s c o n d i t i o n f u r t h e r deteriorating." As Justice technically Dr. to suggests. Dr. Shore's wording l e a v e s open a remote t h e o r e t i c a l p o s s i b i l i t y Johnston failed Smith o r some provide other p h y s i c i a n might "the necessary 52 medical that have n e g l i g e n t l y treatment" for 1071143 L e n n o n ' s B~12 deficiency t i m e l y diagnosed. not concerned even i f Lennon's c o n d i t i o n had As M c A f e e makes c l e a r , with what is been however, c o u r t s "possible," only with are what is " p r o b a b l e , " i . e . , more l i k e l y t h a n n o t t o o c c u r i n a g i v e n s e t of circumstances. juror could Lennon's Even w i t h o u t reasonably "the condition. See So. 2d evidence that c o n d i t i o n would probably receiving 547 infer further medical necessary West v. 870, of 871 a have medical such weight and diagnosis l e d t o Lennon treatment" Founders L i f e ( A l a . 1989) timely testimony, Assurance (" [ S ] u b s t a n t i a l quality that of F l a . , evidence that fair-minded the fact Additionally, [the six-month caused the in" Dr. delay Shore medical negligence] treatment deteriorating." Lennon's necessarily condition caused o t h e r w i s e would have I f the Lennon's "During Lennon's 53 B-12 period deficiency i n his condition delay i n treatment deteriorating, " condition to been. that the c h i l d d i d not r e c e i v e resulting "further the proved."). concluded: i n diagnosing by Dr. J o h n s t o n ' s necessary further s o u g h t t o be is persons i n the e x e r c i s e of i m p a r t i a l judgment can r e a s o n a b l y i n f e r existence of of timely for Go. a be worse "resulted then i t than i t 1071143 Thus, a r e a s o n a b l e p e r s o n c o u l d f a i r l y Shore's affidavit treatment issue affidavit taking fairly Ala. cause. an overly t o draw support have been. condition T h e r e f o r e , Dr. One c a n c o n c l u d e technical from view i t those the Groovers' v. Coleman, 1 1 5 F. {"'Summary j u d g m e n t p r o c e d u r e take unwary trial, litigants i t i s a liberal arriving at the truth. off their from evidence which test this determining 852 Lennon's from Dr. right of the a f f i d a v i t reasonable out, So. 2 d 7 0 5 , 708 into i t s toils measure, See R u l e 56, (quoting (5thC i r . 1940)} by and d e p r i v e them o f liberally of evidence ( A l a . 2002) 54 designed for i s not t o cut l i t i g a n t s jury i f they o f f e r on a t r i a l , advance such that i snot a catch-penny c o n t r i v a n c e of t r i a l i n whether 2 d 3 0 5 , 307 only and by inferences causation theory. I t spurpose they w i l l factual otherwise R. C i v . P. ( C o m m i t t e e C o m m e n t s o n 1 9 7 3 A d o p t i o n ) Whitaker to the delay i n i s s u f f i c i e n t t o e s t a b l i s h a genuine as t o probable failing opinion, negligence) p r o x i m a t e l y caused be worse t h a t i t o t h e r w i s e would Shore's by i n Dr. Shore's from Dr. (caused by a d e l a y i n d i a g n o s i s r e s u l t i n g Johnston's to that, conclude trial have i ti s t o carefully by exists."); (noting really that, inquiring Ex p a r t e and Wood, i n reviewing a 1071143 summary j u d g m e n t , t h e a p p e l l a t e c o u r t the light most favorable to the nonmoving p a r t y a l l reasonable evidence, and nonmoving p a r t y , favorable resolve a l l reasonable p a r t y " ) ; S w e n d s e n v. Gross, "must v i e w t h e r e c o r d 530 So. inferences in deterioration Johnston's of affidavit Lennon's 2d 764 proximately treatment, which, the The amount The opinion negligence Lennon, Under disagree. expert in the turn, a damage does not make t h e probable affidavit from which not the circumstances, I provides that delay proximately resulting Shore d i d to Dr. in the Johnston's caused delay " s p e c u l a t i v e " as clear, diagnosis a b s e n c e o f more d e t a i l e d l a n g u a g e of moving Dr. affidavit caused the attributable to the testimony the ( A l a . 1988) . degree c o n d i t i o n was negligence. respectfully unambiguous his from doubts against the J u s t i c e S m i t h f i n d s i t s i g n i f i c a n t t h a t Dr. "quantify" accord in damage in to "quantifying" in to the diagnosis issue of cause. ^''An a b s e n c e o f p r o o f o f t h e e x t e n t o r a m o u n t o f damage a t t r i b u t a b l e t o t h e d e l a y i n d i a g n o s i s and t r e a t m e n t does not r e a s o n a b l y a p p e a r t o be t h e b a s i s o f t h e m o t i o n f o r s u m m a r y judgment. T h a t i s s u e a l s o was n o t t h e b a s i s o f t h e trial court's ruling or the issue on appeal. Under the circumstances, i t w o u l d be e r r o r t o a f f i r m t h e j u d g m e n t on grounds t h a t the G r o o v e r s d i d not submit e v i d e n c e as t o the q u a n t i t y o f t h e i r damages. 55 1071143 I recognize "An expert and without witness's issue 2d 262, 266 So. 2d of ( A l a . 2003) However, e v e n i f Dr. as "conclusory" that evidentiary material 1134, Shore's a f f i d a v i t opinion a proper genuine 706 t h a t Dr. fact." i s not i s conclusory, elaborate. speculative, foundation cannot Bradley Miller, v. create 878 a So. ( c i t i n g B e c t o n v. R h o n e - P o u l e n c , I n c . , 1141-42 (Ala. 1997) (emphasis S h o r e ' s t e s t i m o n y c o u l d be merely because i t i s simple I and added)). characterized direct, i t is r e c o g n i z e t h a t "we w i l l a f f i r m a s u m m a r y j u d g m e n t i f t h a t judgment i s p r o p e r f o r any r e a s o n s u p p o r t e d by the r e c o r d , e v e n i f t h e b a s i s f o r o u r a f f i r m a n c e was n o t t h e b a s i s o f t h e d e c i s i o n b e l o w and e v e n i f t h e b a s i s f o r o u r affirmance was n o t a r g u e d b e l o w . " D e F r i e c e v . M c C o r q u o d a l e , 998 S o . 2d 4 6 5 , 470 ( A l a . 2008} ( e m p h a s i s added) ( c i t i n g S m i t h v . Equifax S e r v s . , I n c . , 537 So. 2 d 4 6 3 , 465 (Ala. 1988)). However, i t i s n e v e r a p p r o p r i a t e t o a f f i r m a summary j u d g m e n t on an i s s u e n o t a r g u e d b e l o w when (as h e r e ) a f f i r m a n c e w o u l d p r e j u d i c i a l l y d e p r i v e t h e nonmovant of n o t i c e and an o p p o r t u n i t y t o supply the record with e v i d e n c e on that issue. Cf. Giles 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. 3 d 5 3 3 , 555 ( A l a . 2008} ( d i s c u s s i n g t h e l i m i t a t i o n s on a t r i a l c o u r t ' s a b i l i t y t o s u a s p o n t e e n t e r a summary j u d g m e n t ) . The m o t i o n f o r a summary judgment does not r e a s o n a b l y a p p e a r t o be b a s e d on the contention that the extent o f damages r e s u l t i n g f r o m Dr. Johnston's negligence was speculative. Thus, the Groovers were n o t r e a s o n a b l y p l a c e d on n o t i c e t h a t , t o overcome t h e summary-j udgment motion, they were required to present evidence that t h e i r damages were " q u a n t i f i a b l e . " Dow v. A l a b a m a D e m o c r a t i c P a r t y . 897 So. 2 d 1 0 3 5 , 1038 ( A l a . 2004) ("Once t h e m o v a n t m a k e s a p r i m a f a c i e s h o w i n g t h a t t h e r e i s n o genuine i s s u e of m a t e r i a l f a c t , the burden then s h i f t s t o the nonmovant to produce 'substantial evidence' as to the e x i s t e n c e of a genuine i s s u e of m a t e r i a l f a c t . " (emphasis added)). 56 1071143 not "speculative" or "without proper evidentiary as t o the i s s u e o f c a u s a t i o n upon which its that summary j u d g m e n t . the t r i a l I t i s c l e a r from Dr. h i s c o n c l u s i o n s are based on foundation" court Shore's h i s knowledge, based affidavit experience, and t r a i n i n g as a p e d i a t r i c i a n , h i s e x a m i n a t i o n o f Lennon, h i s review of familiarity Johnston. detail in Dr. Johnston's with The his the fact standard that affidavit o p i n i o n s does not medical records, of Dr. Shore about the mean t h e y a r e care did and his applicable not reasons go into expert to Dr. great underlying his "speculative."'^ '^I n o t e t h a t Dr. Johnston' s a f f i d a v i t was no more d e t a i l e d t h a n i s Dr. Shore's. Dr. J o h n s t o n ' s a f f i d a v i t was t h e s o l e e v i d e n c e p r e s e n t e d i n s u p p o r t o f t h e summary-judgment motion. I n h i s a f f i d a v i t , Dr. J o h n s t o n s t a t e d h i s o p i n i o n as follows: "I complied w i t h the a p p l i c a b l e standard of care f o r a board c e r t i f i e d p e d i a t r i c i a n with respect to a l l of t h e c a r e and treatment I rendered to Lennon G r o o v e r a t a l l t i m e s . N o t h i n g d o n e b y me, or not d o n e b y me, c o n s t i t u t e d a breach of the a p p l i c a b l e s t a n d a r d o f c a r e w h i c h p r o x i m a t e l y caused harm t o Lennon Groover." I f D r . J o h n s t o n ' s a f f i d a v i t was s u f f i c i e n t t o s u p p o r t t h e m o t i o n f o r a summary j u d g m e n t , t h e n Dr. S h o r e ' s affidavit was s u f f i c i e n t t o o v e r c o m e i t . C f . S w e n d s e n , 530 S o . 2 d a t 769 (" [ W ] h i l e t h e d e f e n d a n t s ' c o n c l u s o r y a f f i d a v i t s shifted the burden of proof to the p l a i n t i f f to produce counter expert e v i d e n c e , t h e s t a n d a r d b y w h i c h t h e two s i d e s a r e t o be j u d g e d r e m a i n s t h e s a m e . . . . We h o l d , t h e r e f o r e , t h a t , f o r s u m m a r y j u d g m e n t p u r p o s e s , [ t h e p l a i n t i f f ' s e x p e r t ' s ] a f f i d a v i t , when 57 1071143 Finally, the summary Daniel judgment Adler, inference general I that "general Dr. i t do is not rely improper Adler's "the outcome." and I on f o r my the r e s p e c t f u l l y disagree premise that b e t t e r the that although Dr. testimony with t e s t i m o n y was the Justice that of Dr. Smith's on the earlier a condition i s treated, the Adler based agreed that the accepted r u l e i n medicine," but was conclusion sole basis of he his solely p r e m i s e was d i d not a agree opinion. j u d g e d b y t h e same s t a n d a r d a s t h a t b y w h i c h [ t h e d e f e n d a n t p h y s i c i a n ' s i a f f i d a v i t i s judged, r a i s e s t r i a b l e issues of f a c t as t o b o t h the p l a i n t i f f ' s a l l e g a t i o n s of [medical] n e g l i g e n c e a n d h e r c l a i m s o f p r o x i m a t e c a u s e ; t h u s , we reverse t h e summary j u d g m e n t s a p p e a l e d f r o m and remand t h e c a u s e f o r t r i a l , " ( e m p h a s i s a d d e d ) ) ; c f . a l s o G i l e s v. BrooJcwood H e a l t h S e r v s ¢ , I n c . , 5 So. 3 d a t 54 9 ( n o t i n g t h e s u f f i c i e n c y o f a d e f e n d a n t p h y s i c i a n ' s a f f i d a v i t s i m i l a r t o Dr. Johnston's). '^The follows: relevant portion of Dr. Adler's testimony is "Q. C o u l d you state with a reasonable degree of medical certainty that Lennon's condition today w o u l d be any d i f f e r e n t i f Dr. Mussell and Dr. J o h n s t o n had spoJien and the diagnosis was made earlier? "A. W e l l , I t h i n k h e w o u l d h a v e b e e n t r e a t e d m o n t h s e a r l i e r a n d he w o u l d b e b e t t e r , b u t I d o n ' t t h i n k he w o u l d be n o r m a l . I think I said that earlier. "Q. Do y o u a g r e e t h a t t h a t o p i n i o n , t h a t he w o u l d b e b e t t e r w i t h an e a r l i e r d i a g n o s i s , k n o w i n g t h a t i t ' s a l r e a d y y o u r o p i n i o n t h a t he w o u l d h a v e a l r e a d y had p e r m a n e n t n e u r o l o g i c a l i n j u r i e s b y t h a t t i m e , do you 58 as 1071143 agree that this opinion that y o n have about a d d i t i o n a l n e u r o l o g i c a l - - permanent n e u r o l o g i c a l i n j u r y o c c u r r i n g a f t e r D r . M u s s e l l became i n v o l v e d requires you t o speculate? "A. I d o n ' t t h i n k i t ' s s p e c u l a t i o n t o s a y t h a t w h e n you have an ongoing p r o c e s s t h a t produces i n j u r y t o the b r a i n o r leads t o i n j u r y t o t h e b r a i n and as i t c o n t i n u e s t h a t t h e i n j u r y -- o r t h e e f f e c t s o f t h a t i n j u r y w o r s e n s . B u t I'm n o t a b l e t o t e l l y o u how much w o r s e i t w o u l d b e , j u s t t h a t he w o u l d be better. "Q. I s t h a t j u s t b a s e d o n some g e n e r a l c o n c e p t o f the sooner you t r e a t a c o n d i t i o n , t h e b e t t e r t h e outcome, g e n e r a l l y ? "A. I mean, medicine. that' s a general and accepted rule i n "Q. A n d d o y o u a p p l y t h a t t o L e n n o n ' s c o n d i t i o n i n supporting your opinion t h a t i f Lennon had been d i a g n o s e d i n S e p t e m b e r o r O c t o b e r he w o u l d be b e t t e r t h a n he i s today? "A. Y e s . I m e a n , I t h i n k i t ' s a c u m u l a t i v e i n j u r y . I t h i n k t h e B-12 d e f i c i e n c y b e g i n s , t h e n e u r o l o g i c a l d i s a b i l i t y begins, the neurological i n j u r y reaches the point o f no r e t u r n , so t o speak, and i t continues t o increase u n t i l treatment i s i n i t i a t e d . "Q, Y o u c a n ' t s a y i n a n y w a y how L e n n o n w o u l d b e d i f f e r e n t t o d a y i f he h a d b e e n d i a g n o s e d i n t h e m i d d l e o f September o r e a r l y October, can you? "A, I w o u l d s a y h e w o u l d b e b e t t e r , I don't have an o p i n i o n , "Q. Y o u j u s t s a y h e w o u l d b e b e t t e r , q u a n t i f y t h a t i n a n y way, c o r r e c t ? 59 but after that but you can't 1071143 Moreover, Dr. A d l e r ' s form the b a s i s Ill. The It basis testimony, of Dr. Shore's Inapplicability w o u l d be of speculative or not, d i d not testimony. of Rule 2 8 , A l a . R. App. e r r o r t o a f f i r m t h e summary j u d g m e n t on t h e Rule 28, Ala. R. App. (requiring b r i e f must contentions cases, relied August 17, 2007] of Rule So. briefs, appellate court other legal P., are the respect of a parts Borden, "A. the [Ms. 1050042, ("The purpose o u t l i n i n g the requirements f o r the time and energy of the the opposing party of the points summary judgment by Rule 28 for failure cite i s no argument p r e s e n t e d i n t h e b r i e f i f any, propositions.'" to "'has been l i m i t e d t o citations to relevant a u t h o r i t y , r e s u l t i n g i n an argument c o n s i s t i n g o f general of t o maJ^e. ") . there few, and to the citations to ( A l a . 2007) i s to conserve a u t h o r i t y as r e q u i r e d there Ex p a r t e , and t o a d v i s e t h o s e c a s e s where and 3d App. he o r s h e i s o b l i g a t e d Affirmance authorities, o n " ) ; see a l s o 2 8, A l a . R. appellate an and t h e r e a s o n s t h e r e f o r , w i t h statutes, record " [ a ] n argument that containing of the a p p e l l a n t / p e t i t i o n e r with issues presented, include P. appellant's the P. undelineated R o b e r t s v . NASCO E q u i p . C o . , Correct." 60 legal 986 So. 1071143 2d 379, ). 28 382-83 This (Ala. Court grounds where cite an 2 0 07) does not citations issues, the b r i e f 986 of So. a 2d The the party's at 383; evaluate the caselaw to brief adequately brief with So. regard 3d at is certainly of the to at Rule does not contain frame the apprise the an argument. , sufficient G r o o v e r s ' argument and merits 3d does i s s u f f i c i e n t to adequately contentions legal So. a party's brief a u t h o r i t y , the Borden, Groovers' Court of the to Borden. a summary j u d g m e n t on although legal sufficient Court affirm (as h e r e ) , abundance of and (quoting to to a l l o w the Groovers' apprise Court position. to The G r o o v e r s c l e a r l y r e l y on t h e w e l l r e c o g n i z e d principle a l s o r e l i e d upon by the J o h n s t o n d e f e n d a n t s , that causation i s an element before us of a medical-malpractice i s whether proof further citation Groovers also causation is medical It to cite The of c a u s a t i o n e x i s t s ; legal legal generally action. of only law, issue therefore, authority is necessary. authority to the established by the effect testimony no The that of a expert. is quite contend that, submitted to clear from s a t i s f y the evidence from the Groovers' element of a medical 61 expert brief that they they have effect that causation, to the 1071143 Dr. Johnston's deterioration of Lennon's condition. to legal authority can rather evaluate simple True, have had to their cite to analyze is satisfied In addition, Johnston of Rule an by defendants support appendix to i s necessary the legal by McAfee but o f my or do further see how any before merits expert not Parker the m e r i t s of their testimony the does trial this of this not preclude i t would think our position: that that order us their negates a defendant damages. P a r k e r were court's from and brought by the considering support the Groovers' position. position r e g a r d i n g the inapplicability I have a t t a c h e d a copy of t o my I t h e f a c t t h a t McAfee and attention 28, I fail c o n t r i b u t e d to the p l a i n t i f f ' s them, e v e n t h o u g h t h e y In the c i t e d McAfee o r P a r k e r , arguments, either doctor's negligence our recognize) the Groovers' responsibility causation (and in" contention. supported failure to "resulted citation further Court negligence dissent. 62 the Groovers' brief as 1071143 Conclusion For the reasons the majority's s t a t e d above, I r e s p e c t f u l l y d i s s e n t decision to affirm case. Murdock, J . , concurs. 63 summary judgment in from this A P P E N D I X TO C H I E F J U S T I C E COBB'S DISSENT SUPREME COURT OF ALABAMA 1071143 GREG GROOVER, ET AL. APPELLANTS V. WILLIAM H. JOHNSTON, JR., MD, ET AL. APPELLEES APPEAL FROM JEFFERSON CIRCUIT COURT (CV-06-1917) BERT ALLEN ATTORNEY FOR APPELLANTS 112 ACTON AVENUE BIRMINGHAM, ALABAMA 3520 9 (205) 941-0356 elbertsallenQyahoo.com TABLE OF CONTENTS STATEMENT OF JURISDICTION i i TABLE OF AUTHORITIES i i i STATEMENT OF THE CASE 1 STATEMENT OF THE ISSUES 3 STATEMENT OP FACTS 4 STATEMENT OF THE STANDARD OF REVIEW 10 SUMMARY OP THE ARGUMENT 15 ARGUMENT 17 CONCLUSION 31 CERTIFICATE OF SERVICE 33 i STATEMENT OF JURISDICTION T h i s Court has j u r i s d i c t i o n pursuant sought of f o r this t o A l a . Code 1 9 7 5 , § 1 2 - 2 - 7 , exceed the jurisdictional C i v i l Appeals. The damages amount f o r t h e C o u r t See A l a . Code 1 9 7 5 , § 12-3-10 (providing j u r i s d i c t i o n damages s o u g h t appeal f o rc i v i l does n o t exceed ii cases where t h e $50,000). TABLE OF AUTHORITIES Cases Burge v. Parker, 30 510 So. 2ci 538 ( A l a . 1987) Looney v. Davis, 10,11,21;25 Liberty Health Nat'l Servs. 721 S o . 2 d 152 ( A l a . 1998) L i f e Ins. Co. v. University of Alabama Found., P.C., 881 So. 2 d 1013 ( A l a . 2 0 0 3 ) 21 Martin v . Dyas, 11, 14 896 So. 2 d 436 ( A l a . 2004) Moore v . GAB Robins ( A l a . 2002) 20 Corp., North America, Inc., 840 So. 2 d 882 Tell V. Terex 23 962 S o , 2 d 174 ( A l a . 2007) Choice Inc., Builders, Inc, v. Complete Landscape 955 S o . 2 d 437 ( A l a . C i v . A p p . 2006) 21,22 Crowe V. I n t e r s t a t e Safety ( A l a . C i v . A p p . 2002) 10,25 Systems, S t a t u t e s and C o u r t Rules Ala. Code 1 9 7 5 , § 5-5-548 11, 12, 13, 14 Ala. Code 1 9 7 5 , § 12-2-7 i Ala. Code 1 9 7 5 , § 12-3-10 i Rule 56(c)(2), A l a . R. C i v . P. iii Service, Inc. 835 S o . 2 d 255 19,24 R u l e 5 5 ( c ) ( 3 ) , A l a . R. C i v 10,24 R u l e 5 6 { e ) , A l a , R. C i v , P 10, 24 R u l e 5 6 ( f ) , A l a . R. C i v . P 2 , 1 5 , 1 7 , 1 8 , 2 2 , 24 R u l e 7 0 2 , A l a . R. 11, 14 Evid. STATEMENT OF THE CASE Greg Groover and M e l i n d a Groover, as t h e p a r e n t s o f L e n n o n G r o o v e r , J o h n s t o n , J r . , MD, B i r m i n g h a m Inc., i n d i v i d u a l l y and s u e d W i l l i a m H. Pediatric H o l l y M u s s e l l , MD, M u l t i s p e c i a l t y Associates, P e d i a t r i c s , PC, J o y c e l y n A. A t c h i s o n , MD, a n d U n i v e r s i t y o f A l a b a m a Health Services Groover's F o u n d a t i o n , PC ( C . 3 5 - 3 8 ) . a l l e g e d that t h e defendants The committed medical m a l p r a c t i c e i n t h e d i a g n o s i s and t r e a t m e n t o f t h e i r son, Lennon to (C.39). A l l the defendants dismiss; the t r i a l parent's i n d i v i d u a l c l a i m s , b u t d e n i e d them as t o t h e Dr. A t c h i s o n a n d t h e UAHSF f i l e d i n F e b r u a r y 2007 court granted t h e i r summary j u d g m e n t m o t i o n dismissal J o h n s t o n a n d BPA f i l e d 2007 a summary (C.597). Pediatrics i n J u n e 2007 s t i p u l a t e d t o Dr. M u s s e l l Pediatrics's (C.250). The t r i a l summary j u d g m e n t m o t i o n Dr. M u s s e l l a n d M u l t i s p e c i a l t y Groover's motions c o u r t g r a n t e d them as t h e p a r e n t ' s c l a i m s r e p r e s e n t i n g Lennon judgment m o t i o n filed (C.933) . 1 filed (C.886). their The and M u l t i s p e c i a l t y i n S e p t e m b e r 2007 their (C.760). (C.946), Dr. summary j u d g m e n t i n J u l y The Groover's 56 ( f ) , A l a . R. discovery filed C i v . P., (C.942-45). Groover's u n t i l October affidavits a motion pursuant to Rule t o extend the time t o The trial court granted the 1, 2 0 0 7 , t o o f e x p e r t w i t n e s s e s ; and affidavit r e q u i r e d by R u l e 5 6 ( f ) satisfied the t r i a l affidavits o f two (C.949-63). conduct (1) submit (2) t o s u b m i t (C). The the Groover's c o u r t ' s r e q u e s t s and s u b m i t t e d t h e experts, Dr. Shore and Dr. However, t h e t r i a l c o u r t e n t e r e d summary j u d g m e n t f o r D r . J o h n s t o n a n d BPA Groover's appealed t o t h i s court. 2 Adler (C.1040-49), The STATEMENT OF THE ISSUES I. The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment b e f o r e t h e Groover's completed d i s c o v e r y i n compliance with the t r i a l c o u r t ' s scheduling order II. The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment because t h e Groover's p r e s e n t e d s u b s t a n t i a l evidence f o r each r e q u i r e d elements i n t h i s medical malpractice a c t i o n 3 STATEMENT OF THE L e n n o n G r o o v e r was b o r n FACTS O c t o b e r 29, 1999 (C.38). L e n n o n i s i n t h e 1^^ g r a d e a t S h a d e s M o u n t a i n Elementary School Melinda and 7 i n Hoover/ Alabama ( M e l i n d a dep. 16-17). Melinda vegetables testified and f r u i t s vegetarian diet they 30-31), Groover i s a l a c t o - o v o ( M e l i n d a dep. 2 6 ) . ( M e l i n d a dep. 2 7 ) . (Melinda dep. 2 9 ) . c a n h a v e meat o u t s i d e t h e home T h e i r o l d e s t d a u g h t e r who l i v e s Lennon c u r r e n t l y t a k e s Vi-Sol a a t home, ( M e l i n d a dep. in Little ( M e l i n d a dep. 31, a B-12 s u p p l e m e n t , Poly- ( M e l i n d a dep. 3 2 ) . Melinda testified t h a t she t o l d a l l three who t r e a t e d L e n n o n t h a t s h e was a v e g e t a r i a n dep. She She p r e p a r e s f o r h e r two c h i l d r e n who l i v e Rock, A r k a n s a s i s a l s o a v e g e t a r i a n 16). She h a s t h a t Greg, h e r husband and Lennon's f a t h e r , a vegetarian also but a g e s 2 5 , 15, a n d someone who e a t s d a i r y a n d e g g s i n a d d i t i o n b e e n a v e g e t a r i a n f o r 32 y e a r s is dep. 1 6 ) , Greg Groover have t h r e e c h i l d r e n , vegetarian, to {Melinda 36). In fact. Dr. J o h n s t o n doctors (Melinda had been h e r a l l t h r e e c h i l d r e n ' s p e d i a t r i c i a n a n d knew f o r 20 y e a r s t h a t she was a v e g e t a r i a n testified ( M e l i n d a dep. 369-70). 4 She t h a t h e r B~12 r a n g e was t e s t e d by her obstetrician, 37). She testified d e f i c i e n c y was t h a t she Howard folic a c i d and Davidson. few born, Melinda first days Groover took (Melinda dep. B-12 feeding vegetarian day took ( M e l i n d a dep, as learned that 54-55). obstetrician, i r o n every I n a d d i t i o n she every Davidson ( M e l i n d a dep. under the care of her took Dr. a risk to breast m o t h e r s f r o m Dr. was i n the low-normal range Once Melinda she Groover as d i r e c t e d by Dr. a Centrum m u l t i v i t a m i n 78-79). After f o l a t e and i n a d d i t i o n t o Centrum s p o r a d i c a l l y iron Lennon was supplement ( M e l i n d a Dep. 81- 82) . The G r o o v e r ' s had health until She he testified w o u l d gag Johnston was no 9 months o l d t h a t he h a d on t h e concerns food about Lennon's ( M e l i n d a dep. trouble eating solid ( M e l i n d a dep. a d v i s e d them t h a t t h e y 196-97). t a b l e food Dr. Johnston, him formula advised her ( M e l i n d a dep, i n addition to breast t o do 202). i f she him She asked could f e e d i n g , and so; t h a t b r e a s t 5 and s h o u l d w a i t t o have Lennon's p e d i a t r i c i a n , not food Dr. L e n n o n ' s t o n g u e c l i p p e d a t 18 m o n t h s t o h e l p manipulate 197). feeding give he provided complete n u t r i t i o n and t o g i v e him f o r m u l a developmentally She t e s t i f i e d i n a p p r o p r i a t e ( M e l i n d a dep. t h a t Dr. J o h n s t o n exclusive breast 201). was feeding u n t i l She f u r t h e r t e s t i f i e d 18 m o n t h s feeding more i n l i n e w i t h Lennon Melinda exclusively (Melinda dep. f e e d Lennon f o r She t e s t i f i e d t h a t Dr. with the e x c l u s i v e breast ( M e l i n d a dep. 2 0 7 ) . older children with t h a t she d i d not ( M e l i n d a dep. 2 0 8 ) , A t c h i s o n was n o t c o n c e r n e d 197-98). comfortable o r i g i n a l l y plan to exclusively breast 18 m o n t h s w o u l d be She h a d b r e a s t f o r 6 months f e d h e r two and t h a t w i t h what s h e o r i g i n a l l y p l a n n e d was t o do ( M e l i n d a dep. 2 0 9 ) . Groover t e s t i f i e d t h a t Lennon's growth and behavior were n o r m a l a f t e r b i r t h Starting a t 9 months, t h e G r o o v e r ' s n o t i c e d development delays ( M e l i n d a dep. 2 1 8 ) . d i d not t u r n over Melinda Dr. J o h n s t o n 12 d e f i c i e n c y , b u t D r . J o h n s t o n Johnston at 381-84). Lennon d i d not c r a w l , ( M e l i n d a dep. 2 1 8 - 2 1 ) , Groover asked o n l y had low i r o n ( M e l i n d a dep. he A t 15 m o n t h s , a b o u t a p o s s i b l e B- s a i d no t h a t L e n n o n ( M e l i n d a dep, 225, 2 7 8 ) . Dr, t o l d t h e m i t was n o r m a l f o r L e n n o n n o t t o w a l k 15 months ( M e l i n d a dep. 2 5 5 ) . 6 Melinda Groover testified t h a t she q u e s t i o n e d Dr. J o h n s t o n 3 times a b o u t a B-12 d e f i c i e n c y as a p r o b l e m ; a t t h e 12, 15, and 21 month c h e c k - u p s e a c h t i m e possibility (Melinda dep. 3 1 9 ) . Lennon d i d not walk u n t i l he was 2 ^ w i t h a Hand I n Hand g a v e t h e G r o o v e r ' s potty t r a i n e d at 4 ^ (Melinda 346). cannot t a l k w e l l , school Dr, education, dep. 3 5 5 ) . Bowles e v a l u a t e d cannot w r i t e dep. 3 4 7 ) . well, classes testified that ( M e l i n d a dep. 355-56). Lennon t o Dr. M u s s e l l dep. 2 3 2 ) . concerned with Muscular diseases, (Melinda (Melinda L e n n o n ' s IQ a n d i t i s 60, b e l o w The G r o o v e r ' s t o o k (Melinda He He h a s a issues Melinda walker dep. 3 4 6 ) . and has o c c u p a t i o n a l t h e r a p y (Melinda normal range 2001 sensory He h a s s e l e c t i v e m u t i s m Lennon i s i n s p e c i a l at (Melinda dep. 3 4 6 ) , l i m i t e d d i e t due t o c o n t i n u e d dep. he r e j e c t e d t h a t a s a D r . M u s s e l l was Dystrophy, i n August first and o t h e r muscle and r e f e r r e d Lennon t o E a r l y I n t e r v e n t i o n (Melinda dep. 2 7 1 ) . L e n n o n was weak a n d n o t t a l k i n g (Melinda D r . M u s s e l l was c o n v i n c e d dep, 2 7 2 ) . muscopolysaccharide (Melinda diseases dep. 3 0 1 ) , 7 and d i d a s k i n he h a d a biopsy The Groover's next r e f e r r a l was t o Dr, A t c h i s o n (Melinda dep. 3 0 2 ) . medical records (Melinda M e l i n d a Groover o b t a i n e d Lennon's from Dr, J o h n s t o n i n November 2001 dep, 321-22). A f t e r she r e a d t h e r e c o r d s she n o t i c e d he had n o t had normal b l o o d work a f t e r 12 months and she asked Dr. M u s s e l l (Melinda dep. 3 3 2 ) . t o t e s t f o r B-12 Dr. J o h n s t o n p e r f o r m e d t h e b l o o d t e s t and i n f o r m e d them i n December 2001 t h a t Lennon d i d have a B~12 d e f i c i e n c y (Melinda dep. 333-36). M u s s e l l t o l d t h e Groover's she has had o t h e r Dr. patients l i k e Lennon and d i d not t e s t t h e s e c h i l d r e n e i t h e r f o r B-12 d e f i c i e n c y , as she b e l i e v e d t h e y had an u n i d e n t i f i e d syndrome (Melinda dep. 343-44). The G r o o v e r ' s f i r s t a t t o r n e y ' s Dr. Shore i n A t l a n t a . r e f e r r e d them t o Dr. Shore s t a t e d t h a t Lennon's b r a i n damage i s caused by a B-12 d e f i c i e n c y t h a t Dr. J o h n s t o n , Dr. M u s s e l l , and Dr. A t c h i s o n diagnosis and t r e a t (Melinda failed to dep. 353-356). Dr. M u s s e l l t e s t i f i e d t h a t t h e MRI were caused by a B~12 d e f i c i e n c y abnormalities ( M u s s e l l dep. 3 3 ) . Dr. M u s s e l l a l s o a d m i t t e d t o n o t r e c o r d i n g conversations she had w i t h t h e G r o o v e r ' s 8 ( M u s s e l l dep. 69-71), Dr. Mussell were r e f e r r e d t o Dr, ( M u s s e l l dep. 65). t e s t i f i e d that n u t r i t i o n recognized J o h n s t o n as Dr. Mussell the p o t e n t i a l the Dr. Mussell pediatrician; Dr. Mussell was while 205). r e f e r r a l l e t t e r t o Dr. Her she M e l i n d a G r o o v e r as a was treating vegetarian. 9 the 69- board c e r t i f i e d well- ( M u s s e l l dep. aware t h a t M e l i n d a G r o o v e r was vegetarian in ( M u s s e l l dep. J o h n s t o n s h o u l d be versed i n c h i l d n u t r i t i o n issues Dr. she for medical malpractice t e s t i f i e d t h a t any s u c h as pediatrician t e s t i f i e d that t r e a t m e n t o f L e n n o n i n A u g u s t 2002 70). issues Lennon Atchison 194). a (Mussell relates dep, STATEMENT OF THE STANDARD OF REVIEW I. Summary Judgment A summary j u d g m e n t i s p r o p e r o n l y fact exists asserted. i f no i s s u e o f on e a c h o f t h e e l e m e n t s o f t h e c l a i m s R u l e 5 6 ( c ) ( 3 ) , A l a . R. C i v . P. A summary j u d g m e n t i s p r o p e r o n l y w h e r e t h e nonmovant f a i l s t o present s u b s t a n t i a l evidence f o r each element o f each claim asserted. reviews Rule 56(e); A l a . R. C i v . P. T h i s a summary j u d g m e n t de novo, of correctness attaches Court a n d no p r e s u m p t i o n t o thet r i a l Systems, court's decision. Crowe V. I n t e r s t a t e Safety Inc. 835 So. 2 d 255 (Ala. C i v . App. 2002). Whether t o a f f i r m or reverse a summary j u d g m e n t i s an i s s u e o f l a w . Id. II. M e d i c a l M a l p r a c t i c e Elements The medical w e l l - e s t a b l i s h e d standard malpractice o f review f o r cases i s : To p r o v e l i a b i l i t y i n a m e d i c a l m a l p r a c t i c e c a s e , t h e 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 s t a n d a r d o f c a r e , (2) t h e d o c t o r ' s d e v i a t i o n f r o m t h a t s t a n d a r d , a n d (3) a p r o x i m a t e c a u s a l c o n n e c t i o n between t h e doctor's a c t o r omission c o n s t i t u t i n g the 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 . Complete Family Care v. Sprinkle, 638 S o . 2 d 774 { A l a . 1 9 9 4 ) / Bradford v. McGee, 534 S o . 2 d 1 0 7 6 ( A l a . 1 9 8 8 ) ; § 6-5-484, A l a . C o d e 1975. The p l a i n t i f f i n a m e d i c a l m a l p r a c t i c e a c t i o n g e n e r a l l y must e s t a b l i s h t h e p r i m a 10 f a c i e elements by i n t r o d u c i n g e x p e r t t e s t i m o n y . Bradford, supra. Looney v. Davis, 721 S o . 2 d 152, 158 ( A l a . 1998) . I I I . M e d i c a l M a l p r a c t i c e E x p e r t Witness Ala. Evid., Code 1 9 7 5 , § 6-5-548, a n d R u l e govern the requirements a medical malpractice action. So. 2d 436 ( A l a . 2 0 0 4 ) . 702, A l a . R. f o r an e x p e r t w i t n e s s i n See Martin S e c t i o n 6-5-548 v. Dyas, states: (a) I n a n y a c t i o n f o r i n j u r y o r damages o r wrongful death, whether i n c o n t r a c t or i n t o r t , against a h e a l t h care p r o v i d e r f o r breach of the standard of care, the p l a i n t i f f s h a l l have t h e burden o f p r o v i n g by s u b s t a n t i a l evidence that the h e a l t h care p r o v i d e r f a i l e d t o e x e r c i s e such reasonable c a r e , s k i l l , a n d d i l i g e n c e as o t h e r s i m i l a r l y s i t u a t e d h e a l t h c a r e p r o v i d e r s i n t h e same g e n e r a l l i n e o f 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. (b) N o t w i t h s t a n d i n g a n y p r o v i s i o n o f t h e Alabama Rules of Evidence t o t h e c o n t r a r y , i f t h e h e a l t h c a r e p r o v i d e r whose b r e a c h o f t h e s t a n d a r d o f care i s c l a i m e d t o have c r e a t e d t h e c a u s e o f a c t i o n i s n o t c e r t i f i e d by an a p p r o p r i a t e A m e r i c a n b o a r d as b e i n g a s p e c i a l i s t , i s not t r a i n e d and e x p e r i e n c e d i n a m e d i c a l s p e c i a l t y , o r does n o t h o l d h i m s e l f o r h e r s e l f o u t as a s p e c i a l i s t , a " s i m i l a r l y s i t u a t e d h e a l t h c a r e p r o v i d e r " i s one who meets a l l o f t h e f o l l o w i n g q u a l i f i c a t i o n s : (1) I s l i c e n s e d by t h e a p p r o p r i a t e r e g u l a t o r y b o a r d o r a g e n c y o f t h i s o r some other state. 11 896 (2) I s t r a i n e d a n d e x p e r i e n c e d i n t h e same d i s c i p l i n e o r s c h o o l o f p r a c t i c e . (3) Has p r a c t i c e d i n t h e same d i s c i p l i n e or s c h o o l of p r a c t i c e d u r i n g t h e year p r e c e d i n g t h e date t h a t t h e a l l e g e d breach o f the standard of care occurred. (c) N o t w i t h s t a n d i n g a n y p r o v i s i o n o f t h e Alabama Rules of Evidence t o t h e c o n t r a r y , i f t h e h e a l t h c a r e p r o v i d e r whose 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 i s c l a i m e d t o have c r e a t e d t h e c a u s e o f a c t i o n i s c e r t i f i e d b y an a p p r o p r i a t e A m e r i c a n b o a r d as a s p e c i a l i s t , i s t r a i n e d and e x p e r i e n c e d i n a m e d i c a l s p e c i a l t y , a n d h o l d s h i m s e l f o r h e r s e l f o u t as a specialist, a "similarly situated health c a r e p r o v i d e r " i s one who m e e t s a l l o f t h e following requirements: (1) I s l i c e n s e d b y t h e a p p r o p r i a t e r e g u l a t o r y b o a r d o r a g e n c y o f t h i s o r some other state. (2) I s t r a i n e d a n d e x p e r i e n c e d same s p e c i a l t y . i nthe (3) I s c e r t i f i e d b y an a p p r o p r i a t e A m e r i c a n b o a r d i n t h e same s p e c i a l t y . (4) Has p r a c t i c e d i n t h i s s p e c i a l t y d u r i n g t h e year preceding t h e date t h a t t h e a l l e g e d breach of the standard of care occurred. (d) N o t w i t h s t a n d i n g a n y p r o v i s i o n o f t h e A l a b a m a R u l e s o f E v i d e n c e t o t h e c o n t r a r y , no e v i d e n c e s h a l l be a d m i t t e d o r r e c e i v e d , whether of a s u b s t a n t i v e nature or f o r impeachment p u r p o s e s , c o n c e r n i n g t h e m e d i c a l l i a b i l i t y insurance, or medical insurance c a r r i e r , o r a n y i n t e r e s t i n an i n s u r e r t h a t insures medical or other p r o f e s s i o n a l l i a b i l i t y , o f any w i t n e s s p r e s e n t i n g t e s t i m o n y 12 as a " s i m i l a r l y s i t u a t e d h e a l t h c a r e p r o v i d e r " under t h e p r o v i s i o n s o f t h i s s e c t i o n o r o f any d e f e n d a n t . The l i m i t s o f l i a b i l i t y insurance coverage a v a i l a b l e t o a h e a l t h care p r o v i d e r s h a l l n o t be d i s c o v e r a b l e i n a n y a c t i o n f o r i n j u r y o r damages o r w r o n g f u l d e a t h , w h e t h e r i n c o n t r a c t or t o r t , against a h e a l t h care p r o v i d e r f o r an a l l e g e d b r e a c h o f t h e s t a n d a r d of care. (e) The p u r p o s e o f t h i s s e c t i o n i s t o e s t a b l i s h a r e l a t i v e standard of care f o r h e a l t h care p r o v i d e r s . A h e a l t h care p r o v i d e r may t e s t i f y a s a n e x p e r t w i t n e s s i n any a c t i o n f o r i n j u r y o r damages a g a i n s t a n o t h e r h e a l t h c a r e p r o v i d e r b a s e d on a 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 o n l y i f he o r s h e i s a " s i m i l a r l y s i t u a t e d h e a l t h c a r e p r o v i d e r " as d e f i n e d above. I t i s t h e i n t e n t o f t h e L e g i s l a t u r e t h a t i n t h e event t h e defendant h e a l t h c a r e p r o v i d e r i s c e r t i f i e d b y an appropriate American board or i n a p a r t i c u l a r s p e c i a l t y and i s p r a c t i c i n g t h a t s p e c i a l t y a t the time o f the a l l e g e d breach o f the standard o f c a r e , a h e a l t h c a r e p r o v i d e r may t e s t i f y a s an e x p e r t w i t n e s s w i t h r e s p e c t t o an a l l e g e d 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 i n any a c t i o n f o r i n j u r y , damages, o r w r o n g f u l d e a t h a g a i n s t a n o t h e r h e a l t h c a r e p r o v i d e r o n l y i f he o r s h e i s c e r t i f i e d b y t h e same A m e r i c a n b o a r d i n t h e same s p e c i a l t y . R u l e 7 0 2 , A l a . R. E v i d . , states: If s c i e n t i f i c , t e c h n i c a l , or other s p e c i a l i z e d knowledge w i l l a s s i s t t h e t r i e r o f fact t o understand the evidence or t o determine a f a c t i n issue, a witness q u a l i f i e d as a n e x p e r t b y k n o w l e d g e , s k i l l , experience, t r a i n i n g , o r e d u c a t i o n , may t e s t i f y t h e r e t o i n t h e f o r m o f an o p i n i o n o r o t h e r w i s e . 13 The d e c i s i o n t o admit e x p e r t testimony the d i s c r e t i o n trial that court satisfies was Martin, court; s h o u l d admit m e d i c a l t e s t i m o n y was and of the t r i a l § 6-5-548 i f t h e w i t h i n the scope of clearly relevant 896 2d a t So. however, expert 14 the testimony "proposed [the] to the issue 441. i s within in expertise dispute. S U M R OF THE ARGUMENT "MAY I, The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment b e f o r e t h e Groover's completed d i s c o v e r y i n compliance w i t h t h e t r i a l c o u r t ' s scheduling order The trial court e r r e d by e n t e r i n g before t h e Groover's with the t r i a l the Groover's yet, for completed court's order. court h a s t i l y I t i sundisputed their that e x p e r t Dr. Shore. Dr. Shore's o f Rule 56(f); completed a The G r o o v e r ' s evidence i s c r u c i a l t o case; i t e s t a b l i s h e s t h e Dr. Johnston's the standard o f care and that t h e breach Lennon's i n j u r i e s . that e n t e r e d summary j u d g m e n t Dr. Johnston b e f o r e t h e Groover's deposition of their judgment d i s c o v e r y i n compliance s a t i s f i e d t h e requirements thet r i a l demonstrated summary breach of caused The i s s u e o f c a u s a t i o n i s n o t p r o p e r l y on a p p e a l because Dr. J o h n s t o n u n t i m e l y that issue i n a supplemental b r i e f with the t r i a l II. t h a t d i d n o t comply court's scheduling order. The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment because t h e Groover's 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 f o r each r e q u i r e d elements i n t h i s medical malpractice action The each raised Groover's element submitted substantial evidence f o r of themedical malpractice claim. 15 The Groover's presented the standard care, The qualified of care, testimony f a c t that Melinda as t o the breach of the standard and t h a t t h e breach caused i n j u r i e s support a conclusion that contributory of t o Lennon. Groover i s a vegetarian caused Lennon's i n j u r y ; that expert does n o t negligence Dr. J o h n s t o n has n o t r a i s e d i s s u e i n h i s summary j u d g m e n t m o t i o n a n d a n y e v i d e n c e r e l a t e d t o h e r d i e t as a cause o f Lennon's injuries i s conflicting. e r r e d by e n t e r i n g summary Therefore, judgment. 16 the t r i a l court TEGUMENT I. The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment b e f o r e the Groover's completed d i s c o v e r y i n compliance w i t h the t r i a l c o u r t ' s scheduling order The (C.35). Groover's f i l e d Their o r i g i n a l c a s e i n J u n e 2007 this July 26, (C.942). (C.928-30). The i n March attorneys withdrew Gathings e n t e r e d appearance Groover's lawsuit In J u l y 2006 from the 2007, Jonathan as c o u n s e l f o r t h e trial c o u r t e n t e r e d an o r d e r on 2007, t h a t s t a t e d t h a t G a t h i n g s f i l e d 5 6 { f ) , A l a . R. C i v . P., motion, requesting a Rule additional t i m e t o p e r f o r m d i s c o v e r y t o r e s p o n d t o Dr, Johnston's summary j u d g m e n t m o t i o n shortly filed a f t e r the Groover's o r i g i n a l in July 2007, attorneys withdrew (C.933- 41) . The trial court's July 26, t h a t t h e G r o o v e r ' s have u n t i l identify 1, 2007, t o of expert witnesses to r e s p o n s e t o Dr. J o h n s t o n ' s judgment m o t i o n . summary I f the Groover's d i d not s a t i s f y requirements of the J u l y trial October and s u b m i t a f f i d a v i t s support t h e i r 2007, o r d e r p r o v i d e d 2 6, 2 00 7, o r d e r , t h e n the the c o u r t w o u l d t a k e D r . J o h n s t o n ' s J u l y 2007 summary judgment m o t i o n under submission. 17 On September 28, 2007, t h e G r o o v e r ' s f i l e d summary j u d g m e n t m o t i o n a r e s p o n s e t o Dr. J o h n s t o n ' s (C.949-63). That i n c l u d e d t h e a f f i d a v i t o f Dr. Shore of motion and t h e d e p o s i t i o n Dr. Adler.. On O c t o b e r 3, 2007, t h e t r i a l order that stated that the Groover's requirements of the July The trial court court i s s u e d an s a t i s f i e d the 26, 2007, o r d e r {C.965-66). c o u r t t h e n e n t e r e d a new s c h e d u l e . The trial s e t a h e a r i n g on t h e summary j u d g m e n t m o t i o n J a n u a r y 10, 2 0 0 8 . Dr. J o h n s t o n ' s d e a d l i n e t o f i l e h i s m o t i o n was December 3 1 , 2007 hearing). on (10 d a y s b e f o r e t h e The G r o o v e r ' s d e a d l i n e t o f i l e a response was J a n u a r y 8, 2 0 0 8 , t w o d a y s b e f o r e t h e h e a r i n g . On J a n u a r y 10, 2008, t h e d a y o f t h e summary judgment h e a r i n g . brief Dr. J o h n s t o n f i l e d a supplemental i n s u p p o r t o f h i s m o t i o n f o r summary (C.967), d e s p i t e t h e f a c t that the t r i a l judgment c o u r t had g i v e n D r . J o h n s t o n a December 3 1 , 2007, d e a d l i n e t o file h i s summary j u d g m e n t m o t i o n The Groover's supplemental b r i e f Groover's argued filed (C.965). a motion t o s t r i k e the on J a n u a r y 22, 2008 (C.997). i n the motion t o s t r i k e IS that the The supplemental b r i e f was filed late hearing, rather and t h a t i t r a i s e d the issue of causation f o r the time. t h a n t h e December (the day o f t h e The t r i a l court denied the motion a l l o w the Groover's but e v e n t u a l l y 31, 2007, deadline), first to strike, did to reply t o the supplemental brief, e n t e r e d summary j u d g m e n t f o r D r . Johnston. The G r o o v e r ' s court Rule reassert on a p p e a l t h a t t h e e r r e d by a c c e p t i n g t h e l a t e supplemental 5 6 ( c ) ( 2 ) r e q u i r e s t h a t a movant days b e f o r e t h e h e a r i n g , which file i n this 56(c)(2) a n d i t s own o r d e r b y a l l o w i n g t h e The t r i a l "Movant shall submissions, The t r i a l h i s motion, brief, 31, 2007," The t r i a l e r r e d by a l l o w i n g t h e s u p p l e m e n t a l in Johnston's motion J u l y 2007, argued substantial stated and Rule that evidentiary by court f o r summary j u d g m e n t no clearly filed d i d not present Dr. J o h n s t o n b r e a c h e d s t a n d a r d o f c a r e because t h e y had not p r e s e n t e d 19 court brief. that the Groover's evidence that 10 supplemental o r any s u p p l e m e n t a t i o n s t h e r e t o , l a t e r t h a n December Dr. h i s motion court violated court's order c l e a r l y file brief. i s what t h e t r i a l required brief. case. trial the that e v i d e n c e f r o m an e x p e r t . The t r i a l court July 21, 2007, o r d e r a l l o w e d t h e G r o o v e r ' s e x t r a t i m e t o p r e s e n t expert a f f i d a v i t s , affidavit which they d i d . Both Dr. Shore's and Dr. A d l e r ' s d e p o s i t i o n (Dr. A d l e r had b e e n r e t a i n e d f o r some t i m e b e f o r e t h i s was r e t a i n e d a f t e r t h e J u l y 27, 2007, The and Dr. Shore order). Groover's response addressed the standard of care i s s u e i n response t o Dr. Johnston's original summary j u d g m e n t m o t i o n . original Dr. Johnston's summary j u d g m e n t m o t i o n d i d n o t a d d r e s s t h e i s s u e o f causation. allowing As s t a t e d above, the t r i a l Dr. J o h n s t o n t o r a i s e t h i s d a t e o f t h e summary j u d g m e n t In So. Moore 2d 882 court v. GAB Robins ( A l a . 2002), committed reversible non-movant p l a i n t i f f new i s s u e on t h e hearing. North this America, showing Inc., 840 Court held that the t r i a l e r r o r by not a l l o w i n g t h e an o p p o r t u n i t y t o r e s p o n d t o t h e d e f e d a n t ' s m o t i o n f o r summary j u d g m e n t . stated that court e r r e d by This Court " t o c u t o f f M o o r e ' s o p p o r t u n i t y t o make a of disputed facts to the t r i a l court i s to p r e v e n t h i m f r o m h a v i n g h i s d a y i n c o u r t . " Id. a t 884.' 20 similarly, in this case, a l l o w i n g the supplemental motion prevented the Groover's from t h e i r "day in court." The trial c o u r t s h o u l d have d i s a l l o w e d supplemental motion because i t raised the a new issue had not been r a i s e d i n t h e o r i g i n a l m o t i o n - t h e of c a u s a t i o n . The o r i g i n a l motion argued that j u d g m e n t s h o u l d be e n t e r e d b e c a u s e had expert that Dr. J o h n s t o n b r e a c h e d t h e s t a n d a r d o f c a r e . The o r i g i n a l m o t i o n d i d n o t a r g u e t h a t t h e summary was issue summary the Groover's not p r o v i d e d testimony through a q u a l i f i e d that judgment s u p p o r t e d by a l a c k of c a u s a t i o n e v i d e n c e , a n o t h e r element Davis, of a medical malpractice action. 721 So. 2 d 152, 158 e v i d e n c e o f an i s s u e o f f a c t nonmovant has substantial as t o e a c h l e g a l issue L o g i c a l l y then, the t o produce substantial to issues not r a i s e d by t h e movant. Life Co. Ins. Found., Choice B.C., Builders, v. 881 University See of Alabama So. 2 d 1013, Inc. v. t o produce R u l e 56. no b u r d e n Looney {Ala. 1998). A nonmovant has t h e b u r d e n a r g u e d by t h e movant. See 1020 v. Complete 21 Liberty Health evidence Nat'l Servs. { A l a . 2 0 0 3 ) ; and Landscape Service, Inc., the 955 So. 2 d 437 ( A l a . C i v . App. 2 0 0 6 ) . Because s u p p l e m e n t a l m o t i o n was n o t p r o p e r l y b e f o r e t h e trial court and t h e r e f o r e , t h e i s s u e o f c a u s a t i o n had not been p r o p e r l y r a i s e d , burden trial t h e n t h e G r o o v e r ' s h a d no t o respond t o the issue of causation and t h e c o u r t e r r e d b y e n t e r i n g summary j u d g m e n t on this issue. Even i f t h e i s s u e o f c a u s a t i o n before the t r i a l entering court, the t r i a l summary j u d g m e n t b e c a u s e been g i v e n the opportunity issue of causation. were court properly a l s o e r r e d by t h e Groover's had not t o complete d i s c o v e r y on t h e Rule 56(f) s t a t e s : Should i t appear from t h e a f f i d a v i t s o f a p a r t y opposing the motion that the p a r t y cannot, f o r reasons s t a t e d , p r e s e n t by a f f i d a v i t facts essential to j u s t i f y the p a r t y ' s o p p o s i t i o n , t h e c o u r t may d e n y t h e m o t i o n f o r summary j u d g m e n t o r may o r d e r a c o n t i n u a n c e t o p e r m i t a f f i d a v i t s t o be o b t a i n e d o r d e p o s i t i o n s t o be t a k e n o r d i s c o v e r y t o be h a d o r may make s u c h o t h e r o r d e r as i s j u s t . As s t a t e d above, the Groover's s a t i s f i e d the r e q u i r e m e n t s o f R u l e 5 6 ( f ) as s t a t e d i n t h e t r i a l court's October 3, 2007, o r d e r (C.965). s u b m i t t e d t h e a f f i d a v i t o f Dr. Shore, pediatrician (C.952-54). The G r o o v e r ' s a board certified The G r o o v e r ' s h a d a l r e a d y 22 c o m p l e t e d t h e d e p o s i t i o n o f Dr. A d l e r , a board c e r t i f i e d p e d i a t r i c s , p e d i a t r i c neurology, and e l e c t r o d i a g n o s t i c medicine depositions entered ( A d l e r dep. 2 6 ) . Before o f D r . S h o r e h a d b e e n made, t h e t r i a l summary j u d g m e n t . The t r i a l court until before t a k i n g t h e summary j u d g m e n t f o r d e c i s i o n . the trial 56(f) D r , S h o r e ' s d e p o s i t i o n was court was s a t i s f i e d the trial the enter If Rule 3 months l a t e r d i d d e p o s i t i o n o f Dr, Shore? This court have completed with the Groover's s h o w i n g i n O c t o b e r , why o n l y court should waited any summary j u d g m e n t w i t h o u t C o u r t has h e l d t h a t court t o enter files a R u l e 56 ( f ) a f f i d a v i t "crucial Corp., this i t i s error for a and t h e e v i d e n c e sought i s and d e f e n s e s . " 962 So. 2 d 174, 183 (Ala. 2007). t o the Groover's malpractice s t a t e d i n Dr. S h o r e ' s a f f i d a v i t , care Tell v. Terex Clearly i n case, Dr. Shore's d e p o s i t i o n t e s t i m o n y testify trial summary j u d g m e n t when t h e nonmovant t o [the] claims "crucial" allowing is claim. As he i s p r e p a r e d t o t h a t D r . J o h n s t o n d i d n o t meet t h e s t a n d a r d f o r p e d i a t r i c s (C.953). Johnston's delay of He a l s o s t a t e d t h a t D r . i n t r e a t i n g L e n n o n ' s B-12 d e f i c i e n c y 23 c o n t r i b u t e d t o Lennon's i n j u r i e s S h o r e ' s t e s t i m o n y was and t h e t r i a l "crucial" court committed (C.953). Clearly, to the Groover's reversible error Dr. case, by entering summary j u d g m e n t f o r D r . J o h n s t o n b e f o r e allowing Dr. S h o r e ' s d e p o s i t i o n t o be II. completed. The t r i a l c o u r t e r r e d by e n t e r i n g summary judgment because the Groover's p r e s e n t e d s u b s t a n t i a l evidence f o r each r e q u i r e d element in t h i s medical malpractice a c t i o n W i t h o u t w a i v i n g t h e above argument t h a t t h e c o u r t ' s summary j udgment v i o l a t e d 56(c)(2) and R u l e 5 6 ( f ) , medical malpractice order. Rule the Groover's a l s o argue they presented s u b s t a n t i a l the i t s own exists asserted. R u l e 5 6 ( c ) ( 3 ) , A l a . R. of the C i v . P. issue A summary e v i d e n c e f o r each element R u l e 5 6 ( e ) , A l a . R. r e v i e w s a summary j u d g m e n t de of novo, correctness attaches to the t r i a l 24 of claims judgment i s p r o p e r o n l y where t h e nonmovant f a i l s claim asserted. of claims. on e a c h o f t h e e l e m e n t s present substantial that e v i d e n c e on e a c h e l e m e n t A summary j u d g m e n t i s p r o p e r o n l y i f no fact trial of to each C i v . P. This Court a n d no presumption court's decision. Crowe V. Interstate (Ala. C i v . App. Safety Systems, Inc. 835 2002). Whether t o a f f i r m summary j u d g m e n t i s an i s s u e of law. So. 2d 255 or r e v e r s e a Id. To p r o v e l i a b i l i t y i n a m e d i c a l m a l p r a c t i c e c a s e , t h e p l a i n t i f f m u s t p r o v e (1) t h e a p p r o p r i a t e s t a n d a r d o f c a r e , (2) t h e d o c t o r ' s d e v i a t i o n f r o m t h a t s t a n d a r d , and (3) a p r o x i m a t e c a u s a l c o n n e c t i o n between the d o c t o r ' s act or omission c o n s t i t u t i n g the 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 . Complete Family Care v. Sprinkle, 638 S o . 2 d 774 ( A l a . 1 9 9 4 ) ; Bradford v. McGee, 534 S o , 2 d 1076 ( A l a . 1 9 8 8 ) ; § 6-5-484, A l a . C o d e 1 9 7 5 . The p l a i n t i f f i n a m e d i c a l m a l p r a c t i c e a c t i o n g e n e r a l l y must e s t a b l i s h t h e p r i m a f a c i e e l e m e n t s by i n t r o d u c i n g e x p e r t t e s t i m o n y . Bradford, supra. Looney v. Dr. are Davis, 721 2d 152, 158 J o h n s t o n c o n c e d e s t h a t Dr. qualified experts; experts qualified standard of care, causation his So. ( A l a . 1998) . Adler therefore, their to give testimony status regarding Dr. The i s not entering A. substantial as the and the trial summary j u d g m e n t f o r Dr. Standard of Care 25 Adler evidence Groover's argue t h a t the s u b s t a n t i a l evidence, Shore and J o h n s t o n does a s s e r t i n m o t i o n f o r summary j u d g m e n t t h a t Dr. elements. Dr. the breach of t h a t standard, i s undisputed. Shore'3 evidence and and of these testimony court erred Johnston. Dr. is by The Groover's presented s u b s t a n t i a l evidence, through expert standard t e s t i m o n y t h a t Dr. J o h n s t o n b r e a c h e d o f c a r e of a p e d i a t r i c i a n . board c e r t i f i e d p e d i a t r i c i a n . J o h n s t o n d i d not He Shore i s a stated that comply w i t h the s t a n d a r d h i s t r e a t m e n t o f Lennon. Dr. of c a r e d e l a y t o r e f e r Lennon t o a p p r o p r i a t e in Dr. of c a r e by h i s Lennon's d e v e l o p m e n t a l d e l a y s Shore f u r t h e r s t a t e d t h a t Dr. Dr. Shore s t a t e d t h a t J o h n s t o n ' s b r e a c h e d the s t a n d a r d to recognize Dr. the delay and his specialists. Johnston's Dr. actions ( f a i l u r e t o d i a g n o s e f o r 6 months) caused Lennon's health to deteriorate further B. (C.952-53). D e v i a t i o n from Standard o f Dr. A d l e r , who improperly entered was Care deposed, b e f o r e the t r i a l summary judgment, t e s t i f i e d t h a t M u s s e l l breached the a p p l i c a b l e standard f a i l i n g t o d i a g n o s e Lennon's B~12 s e v e r a l months ( A d l e r dep. 43). t e s t i f i e d t h a t Dr. M u s s e l l and communicate r e g a r d i n g of care ( A d l e r dep. Dr. A d l e r by Dr. also Johnston f a i l e d Lennon's c o n d i t i o n and 43). to their standard Dr. M u s s e l l a d m i t t e d t h a t 26 Dr. deficiency for r e s p e c t i v e t r e a t m e n t , which a l s o b r e a c h e d t h e of c a r e court she d i d not read referred pointed Lennon's m e d i c a l Lennon t o h e r records ( M u s s e l l dep. 1 4 7 ) . o u t t h a t Dr. M u s s e l l admitted t h a t s h e b e l i e v e d L e n n o n ' s MRI r e l a t e d t o B-12 when D r , Johnston Dr. A d l e r i n her d e p o s i t i o n abnormalities were d e f i c i e n c y ( M u s s e l l d e p , 33, A d l e r dep, 45) . C. Dr. Causation Adler t e s t i f i e d most l i k e l y dep. 6 4 ) . t h a t L e n n o n ' s B-12 d e v e l o p e d a r o u n d 12 m o n t h s Dr. A d l e r p o i n t e d o f age ( A d l e r dep. 6 4 ) . timeline Dr. A d l e r f o r L e n n o n ' s B-12 (Adler out t h a t Lennon c o u l d s i t up a t 9 m o n t h s , b u t c o u l d n o t w a l k u n t i l months deficiency after 19 explained h i s d e f i c i e n c y as f o l l o w s : I t h i n k t h a t t h i s b a b y was b o r n w i t h a d e q u a t e s t o r e s o f B-12. He was n o r m a l a t b i r t h . A l l n o t e s a b o u t h i m e a r l y i n l i f e w e r e t h a t he was t h r i v i n g and d o i n g w e l l . I t h i n k t h a t h i s n u t r i t i o n a l d e f i c i e n c i e s -- a n d , a g a i n , s p e a k i n g a s a p e d i a t r i c n e u r o l o g i s t -- w e r e s u c h t h a t f r o m t h e f a c t t h a t he w a s n ' t e a t i n g a n y t h i n g a n d he was o n l y b e i n g b r e a s t - f e d w e r e n o t o n l y v i t a m i n B-12 d e f i c i e n c y , w h i c h , o f c o u r s e , we l e a r n e d l a t e r , b u t much e a r l i e r we seemed t o h a v e i r o n d e f i c i e n c y t h a t ' s described i n the records. Iron supplementation i s commenced. T h a t ' s a t about a year o f age. So my f e e l i n g i s t h a t t h e r e was more l i k e l y t h a n n o t a c o m b i n a t i o n , and t h a t t h e p r o b l e m s w i t h B-12 t h a t u l t i m a t e l y p r o d u c e d more, y o u know, s i g n i f i c a n t p r o b l e m s began r e a l l y a f t e r a few 27 more months o f c o n t i n u e d deficiency. vitamin B-12 ( A d l e r dep. 65-56) . Dr. A d l e r e x p l a i n e d t h e p r o g r e s s i o n o f Lennon's i n j u r i e s from t h e B-12 d e f i c i e n c y as f o l l o w s : I t h i n k he had a degree o f w h i t e m a t t e r i n j u r y based on t h e imaging a b n o r m a l i t i e s . That must have been a t l e a s t f o u r t o s i x weeks o l d , because he's t a l k i n g about a d i m i n u t i o n i n t h e volume o f t h e w h i t e m a t t e r . So s i n c e B-12 i s i n v o l v e d i n m y e l i n p r o d u c t i o n , i t s absence leads to i n j u r y i n myelin producing c e l l s . So f i r s t you get i n j u r y . You would see i t on s p e c i f i c a b n o r m a l i t i e s . And t h e n whatever t h o s e c e l l s a r e , s i n c e t h e y c a n ' t s u r v i v e m e t a b o l i c a l l y -- s i n c e t h e y have a m e t a b o l i c i n j u r y , they c a n ' t s u r v i v e . Then t h e y s h r i n k a f t e r a w h i l e . And t h a t t a k e s time t o develop. There was a l r e a d y a l o s s o f volume i n t h e b r a i n t h a t was caused by c h r o n i c v i t a m i n B-12 d e f i c i e n c y , so t h a t t h e i m a g i n g i n August [2001] was abnormal. And I t h i n k even B-12 a d m i n i s t r a t i o n a t t h a t p o i n t would have s t i l l -- would not have p e r m i t t e d t h i s boy t o be normal. Q. He had permanent b r a i n i n j u r i e s by t h a t p o i n t i n t i m e t h a t were g o i n g t o cause him t o have d e v e l o p m e n t a l d e l a y s and o t h e r i s s u e s t h a t o c c u r from b r a i n i n j u r y , c o r r e c t ? A. True. 28 Q. And t h a t c o n d i t i o n had e x i s t e d , i n y o u r o p i n i o n , a t l e a s t f o u r t o s i x weeks b y t h e t i m e t h a t MRI was p e r f o r m e d , c o r r e c t ? A. Correct. Q. Which would p o i n t t h e i n j u r i e s t o t h e s e permanent i n j u r i e s t o Lennon o c c u r r i n g by m i d - J u l y t o e a r l y A u g u s t , c o r r e c t ? A. True. ( A d l e r d e p . 70-71) . When a s k e d i f any o t h e r problems contributed testified, that "there's records Again, no o t h e r Adler or Dr, Adler i n the records deficiency." states that (Adler Lennon's causes f o r h i s i n j u r i e s deficiency dismissed diagnosis t h a n B-12 Dr. A d l e r show no o t h e r t h a n t h e B~12 defects t o Lennon's i n j u r i e s , I can see, other dep. 8 0 ) . birth ( A d l e r d e p . 82-83) . Dr. J o h n s t o n ' s e a r l i e r iron deficiency or iron other Dr. r e l i a n c e on an anemia b e c a u s e t h e l o w would not cause the white b r a i n m a t t e r decrease the B-12 D. d e f i c i e n c y caused i n Lennon Evidence The q u e s t i o n s Groover during J o h n s t o n may of Contributory iron that ( A d l e r dep. 8 3 ) . Negligence Dr. J o h n s t o n p o s e d t o M e l i n d a her deposit ion i n d i c a t e that Dr. argue t h a t Melinda Groover's d e c i s i o n t o be a v e g e t a r i a n caused Lennon's i n j u r y . 29 This argument cannot s u p p o r t t h e suiumary j u d g m e n t b e c a u s e the causal r e l a t i o n s h i p between M e l i n d a Groover's v e g e t a r i a n and Lennon's i n j u r i e s the i s disputed. As s t a t e d Groover's presented evidence that known o f M e l i n d a G r o o v e r ' s v e g e t a r i a n vegetarian diet. a l s o knew o f M e l i n d a above, Dr, Johnston had d i e t f o r t h e 25 y e a r s he t r e a t e d h e r 3 c h i l d r e n , a n d t h a t and Dr. A t c h i s o n diet Dr. M u s s e l l Groover's F u r t h e r m o r e , Dr. J o h n s t o n has n o t a r g u e d i n h i s summary j u d g m e n t m o t i o n t h a t M e l i n d a Groover's vegetarian therefore, diet i s contributory he c a n n o t a r g u e that t o s u p p o r t t h e summary j u d g m e n t . 510 So. 2 d 538 negligence ( A l a . 1987) negligence; on a p p e a l as a g r o u n d See Burge (holding that v. Parker, contributory m u s t be r a i s e d as a d e f e n s e i n t h e t r i a l court). 30 CONCLUSION The trial judgment. c o u r t e r r e d by e n t e r i n g The t r i a l own s c h e d u l i n g before court v i o l a t e d their allowing o r d e r b y e n t e r i n g summary claim. Also, the t r i a l Dr. J o h n s t o n to file after the deadline the t r i a l Johnston. The t r i a l Johnston first time court and i t s judgment court a supplemental e r r e d by brief c o u r t s e t f o r Dr. f u r t h e r e r r e d by a l l o w i n g supplemental the procedural brief. e r r o r s made b y t h e t r i a l the Groover's presented t h a t Dr. Johnston, s u b s t a n t i a l evidence Dr. M u s s e l l , and Dr. A t c h i s o n committed m a l p r a c t i c e . The G r o o v e r ' s evidence from q u a l i f i e d medical standard of care, and 55(f) t o r a i s e the issue of causation f o rthe i n the untimely Despite court, Rule t h e Groover's had completed c r u c i a l d i s c o v e r y t o support Dr. summary the breach damages t o L e n n o n . experts submitted as t o t h e of the standard Therefore, the t r i a l of care, court e r r e d b y e n t e r i n g summary j u d g m e n t f o r t h e G r o o v e r ' s and this the t r i a l c o u r t ' s j u d g m e n t s h o u l d be r e v e r s e d f o r case t o proceed t o a j u r y 31 trial. Respectfully /s/ Elbert S. submitted, Allen CERTIFICATE OF SERVICE I h e r e b y c e r t i f y t h a t a copy o f t h e above b r i e f o f a p p e l l a n t h a s b e e n s e r v e d on c o u n s e l o f r e c o r d , b y p l a c i n g same i n t h e U n i t e d S t a t e s m a i l , f i r s t - c l a s s p o s t a g e p r e p a i d , and a d d r e s s e d t o : Michael Florie Starnes and A t c h i s o n P.O. B o x 598512 B i r m i n g h a m , A l a b a m a 35259-8512 / 5 / E l b e r t S. A l l e n OF COUNSEL 33

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