In Hrynkiw v. Trammell, [Ms. 1101099, May 11, 2012] __ So. 3d __(Ala. 2012), the Supreme Court affirmed a $2.15 million dollar judgment for the plaintiffs in a medical malpractice case. The case involved a fusion surgery to repair a herniated disk in Mr. Trammell's back. Plaintiff alleged the surgery was not performed properly, and as a result, caused him to develop cauda equina syndrome. Within hours of his surgery, the plaintiff began exhibiting classic symptoms of cauda equina syndrome. However, his doctor waited 10 days to perform a second surgery. As a result, the plaintiff alleged he was left with very limited mobility, severe weakness in his hips and legs, impotence and suffering from urinary and fetal incontinence. The plaintiffs filed suit against Dr. Hrynkiw alleging that the doctor breached the standard of care in performing the initial fusion surgery and also in his dilatory diagnosis and treatment of the plaintiff's cauda equina syndrome. The case was tried to a jury in Jefferson County, Alabama, which returned a verdict in favor of the plaintiffs for $2.15 million compensatory damages. The defendant doctor appealed, arguing that 1) the trial court should have granted his motion for judgment as a matter of law relating to plaintiffs' claims concerning the post-fusion surgery because Mr. Trammell had not presented substantial evidence that his injuries were caused by the negligent delay in performing the post-fusion surgery; and 2) the trial court erred by allowing the plaintiff's expert to reference medical treatises during his direct examination which he did not rely upon as a basis for his opinions. The Supreme Court rejected the doctor's claim that there was not substantial evidence that his delay in performing post-fusion surgery treatment caused the plaintiff's injuries. In a detailed discussion, the Court explained that while Alabama does not recognize a cause of action for the loss of chance to achieve a better medical outcome, statistical evidence of success and survival rates may still play a role in proving that a medical negligence victim's condition was probably adversely affected by the deviation from the standard of care. Thus, the Court found substantial evidence of causation from the delayed treatment. The plaintiff's expert testified that while he could not guarantee that the plaintiff would have recovered fully had he received timely post-fusion surgery treatment, 80% of patients like plaintiff make a complete or delayed partial recovery. Based on this and other evidence, the plaintiff's expert testified that "[t]here is no doubt in my mind the delay had a detrimental outcome on [the plaintiff's] long-term neurologic status. Based on the statistical evidence and expert testimony, the Supreme Court concluded that the plaintiff had offered substantial evidence that his injuries were caused by the defendant doctor's dilatory treatment. As a result, the Court affirmed the denial of the doctor's motion for judgment as a matter of law. The Supreme Court also rejected the doctor's claim that the trial court erred by allowing the plaintiff's expert to discuss medical treatises during his direct examination that he had not relied on in forming his opinions. Plaintiff argued that Al. R Evid. 803(18) (addressing hearsay exceptions for learned treatises) does not require that an expert rely on a medical treatise in forming his or her opinions. Instead, Rule 803(18) permits medical treatises to be used to bolster, corroborate, or better explain an expert's opinions. The Court agreed with the plaintiff, noting that for many years Alabama courts have permitted parties to use learned treatises to support an expert's opinions. As a result, the Court found no error in the trial court's decision to allow the plaintiff to discuss the medical treatises during the direct examination of his expert.
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