McBride v. Houston County Health Care Authority et al

Filing 397

OPINION. Signed by Honorable Judge Myron H. Thompson on 7/22/15. (djy, )

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IN THE DISTRICT COURT OF THE UNITED STATES FOR THE MIDDLE DISTRICT OF ALABAMA, SOUTHERN DIVISION COURTNEY McBRIDE, ) ) ) ) ) ) ) ) ) Plaintiff, v. DINESH KARUMANCHI, Defendant. CIVIL ACTION NO. 1:12cv1047-MHT (WO) OPINION The court recently concluded the trial of defendant Dinesh Karumanchi, the psychiatrist against whom plaintiff Courtney medical-malpractice claim. to instruct the jury McBride brought a One threshold issue was how regarding McBride’s burden in medical-malpractice cases. The court gave the following instruction, to which all parties agreed, as to the burden: “To recover damages on this claim McBride must prove to your reasonable satisfaction by substantial evidence all of the following elements .... [The court then listed the elements] “Reasonable satisfaction means that, in light of all the evidence, what McBride claims is more likely true than not. So, if you could put the evidence favoring McBride and the evidence favoring Karumanchi on opposite sides of balancing scales, McBride needs to make the scales tip to her side. If McBride fails to meet this burden, you must find in favor of Karumanchi. “Substantial evidence is that character of evidence that would convince an unprejudiced thinking mind of the truth of the fact to which the evidence is directed.” See Court’s Instructions to the Jury (doc. no. 390) at 6-7. In light of the confusion over this standard in previous cases, this opinion explains why the court adopted this language. I. As standard explained of at proof length currently in other opinions, applicable in the Alabama medical-malpractice cases arose out of a “tort reform” 2 push by the Alabama Legislature in 1987. Edgeworth v. Family Chiropractic & Health Center, P.C., 940 So. 2d 1011 (Ala. 2006) (detailing history behind medical-malpractice burden of proof); Hayes v. Lucky, 33 F. Supp. 2d 987 (M.D. Ala. 1997) (Smith, J.) (same). This push included two efforts: a general bill applicable to all civil tort actions and a separate medical-malpractice bill. 990-91. not Hayes, 33 F. Supp. 2d at While it appears that the legislature would have passed one medical-malpractice bill bill without “traveled the a other, course the quite distinct from the remainder of the tort reform package. ... Those who drafted the Medical Liability Act had little input from those who drafted the remainder of the package, and vice versa.” Id. (emphasis omitted). The differing language of the bills reveals these distinct courses. changed the Before 1987, Among other things, the general bill summary-judgment a plaintiff requirement needed 3 to in present Alabama. only a “scintilla of evidence” to reach the jury in the face of a motion for summary judgment; however, in 1987 the Alabama Legislature abolished this scintilla rule and replaced it with the “substantial evidence” requirement, stating, “In all civil actions brought in any court of the State of Alabama, proof by substantial evidence shall be required to submit an issue of fact to the trier of the facts. Proof by substantial evidence shall be required for purposes of testing the sufficiency of the evidence to support an issue of fact in rulings by the court .... A scintilla of evidence is insufficient to permit submission of an issue of fact to the trier of facts.” 1975 Ala. Code § 12-21-12 (emphasis added). Like the more general act, the medical-malpractice act included a “substantial evidence” requirement, but the requirement appeared to go beyond the limited scope of rulings by the court on sufficiency of the evidence. It states: 4 “In any action for injury or damages or wrongful death, whether in contract or in tort, against a health care provider for breach of the standard of care, the plaintiff shall have the burden of proving by substantial evidence that the health care provider failed to exercise such reasonable care, skill, and diligence as other similarly situated health care providers in the same general line of practice ordinarily have and exercise in a like case .... ” 1975 Ala. Code § 6-5-548 (emphasis added). The differing use of “substantial evidence” between the general bill and the medical-malpractice bill spawned confusion about whether “substantial evidence” was confined to a question for the judge on a motion testing the sufficiency of the evidence, such as a motion for summary judgment or judgment as a matter of law, or should be part of an instruction that should be read to the jury. There was also confusion over the definition of substantial evidence. The general reform bill defines substantial evidence as “evidence of such quality and 5 weight that reasonable and fair-minded persons in the exercise of impartial judgment might reach different conclusions as to the existence of the fact sought to be proven.” using the evidence 1975 Ala. Code § 12-21-12. general for bill’s the definition of medical-malpractice Rather than substantial bill, the legislature instead chose to look to the Supreme Court of Washington, which defines substantial evidence as “that character of admissible evidence which would convince an unprejudiced thinking mind of the truth of the fact to which the evidence is directed.” 1975 Ala. Code § 6-5-542(5); see also Edgeworth, 940 So. 2d at 1014. In Clements v. Dr. John Alvan Stewart, P.C., 595 So. 2d 858, 861 (Ala. 1992), the Alabama Supreme Court clarified that evidence” in the two the definitions general of bill “substantial and the medical-malpractice bill are a “distinction without a difference” and that a court may use either definition 6 when instructing a jury. That ruling continues to be good law. Nevertheless, in the context of the general bill, substantial evidence clearly points to a question of law for the judge to decide in determining whether a case should reach a jury. As discussed above, the legislature replaced the scintilla standard for summary judgment in all substantial-evidence tort cases standard, with requiring the “real, material, not seeming or imaginary” evidence for a case to get to the jury. See Ex Parte Gradford, 699 So. 2d 149, 151-152 (Ala. 1997); see also id. (finding, in a general tort case, that the trial court committed reversible error by instructing the jury that it must be “reasonably satisfied by substantial evidence” to find for the plaintiff because “the substantial evidence rule has no place in the jury’s deliberations and because the charge has a tendency to mislead and confuse the jury”). But, 7 in the original medical-malpractice bill, it was unclear whether the legislature was simply repeating from the general bill the increased standard judges must apply at summary judgment or was going further and making substantial evidence part of the instruction that should go to the jury. See Gallups v. Crook, 792 F. Supp. 1231, 1233 (N.D. Ala. 1992) (Acker, J.) test in substantial-evidence (finding Alabama that the medical malpractice law went to a legal, procedural standard and therefore applying federal law in its place under diversity principles). Perhaps in reaction to this confusion, the Alabama Legislature in 1996 clarified what instruction should go to the jury in medical-malpractice cases. F. Supp. 2d at 993. Hayes, 33 That clarification states, “In the case of a jury trial, the jury shall be instructed that in order to return a verdict against a health care provider, the jury shall be substantial evidence that reasonably satisfied by the 8 health care provider failed to comply with the standard of care and that such failure probably caused the injury or death in question.” 1975 Ala. Code § 6-5-549 (emphasis added). Even though the Alabama Legislature made clear in this revision what instruction a judge should give in a medical-malpractice requirement--that satisfaction puzzling. it case, the by the jury find substantial meaning to its of this “reasonable evidence”--remains Indeed, the Alabama Supreme Court has found inaccurate to characterize this standard as a “burden of proof ... up a little from” the “reasonable satisfaction by the evidence” standard in a typical tort case but has refused to address the difference between “reasonable satisfaction by the evidence” and “reasonable satisfaction by substantial evidence.” Edgeworth, routinely 940 So. define 2d at 1020-21. reasonable Although satisfaction See courts and substantial evidence separately, the question remains 9 how to make sense of an instruction to the jury that combines these two standards. Given this background, this court next turns to how it makes sense substantial of the evidence” “reasonable standard and satisfaction why it gave by the instruction it did to the jury. II. To decipher the meaning of “reasonable satisfaction by substantial evidence,” it is useful to separate the two parts of this standard--“reasonable satisfaction” and “by substantial evidence.” Reasonable satisfaction is the normal standard in Alabama tort cases. This standard addresses the burden of persuasion and is interchangeable with preponderance of the evidence. See, e.g., Court’s Instructions to the Jury, Progressive Specialty Ins. Co. v. Snipe, No. 00-1678 (doc. no. 116) (Thompson, J.) (tacitly equating reasonable satisfaction with 10 preponderance by instructing jury to apply preponderance standard while sitting in diversity on Alabama tort case); Court’s Instructions to the Jury at 4, Nisbet v. George, No. 05-570 (doc. no. 92) (Watkins, J.) (same); Court’s Instructions to the Jury at 3, Free v. Baker, No. 09-26 (doc. no. 134) (Watkins, J.) (same). It simply asks the jury whether the plaintiff’s case is more likely than not true. The question, then, is what is the purpose of the additional “substantial evidence” language in the jury instruction discussed of a above, medical-malpractice the Alabama addressed this issue. 1020-21. issue Supreme case? Court has As not See Edgeworth, 940 So. 2d at The one federal court that has addressed the found “substantial that the evidence” Alabama to Legislature replace intended “reasonable satisfaction” as the burden of persuasion and that this burden is actually lower than reasonable satisfaction. Hayes, 33 F. Supp. 2d at 994-95. 11 However, first, this interpretation ignores, the impermissibly use of the overlooks, and, “reasonable thus, satisfaction” standard in the statute, 1975 Ala. Code § 6-5-549 (“the jury shall be reasonably satisfied evidence...) (emphasis added). by substantial See Custer v. Homeside Lending, Inc., 858 So. 2d 233, 245 (Ala. 2003) (“A statute must be considered as a whole and every word in it made effective if possible.”); Bd. of Trustees of Leland Stanford Junior Univ. v. Roche Molecular Sys., Inc., 131 S. Ct. 2188, 2196 (2011) (noting the United States Supreme statutory marks Court’s terms omitted)). as “general surplusage” Second, it reluctance to (internal quotation undermines the treat clear purpose of the legislature for juries to put additional scrutiny on medical-malpractice claims. See Hayes, 33 F. Supp. 2d at 993-94 (noting the irony that, under its reasoning, it “would be easier for a recover damages for medical malpractice”). 12 plaintiff to Instead, the phrase “by substantial evidence” appears to present a threshold question to the jury of whether the quality § 6-5-542(5), of or the “character,” evidence is 1975 good Ala. Code enough to “convince an unprejudiced thinking mind of the truth of the fact to which the evidence is directed.” Id. This distinction is likely why the Alabama Supreme Court stated it was error for the burden of persuasion in medical-malpractice standard to be characterized as requiring more than the typical tort case--that is, the substantial evidence requirement does not change the weighing of the satisfaction evidence standard but under rather the goes reasonable to the additional, or threshold, question of the “character” of the evidence. To be sure, there is an open question of how this distinction resonates with juries. character interrelated of evidence with The question of the required weighing 13 that is evidence, inherently especially when a jury, unlike a judge at summary judgment, does not have a thumb on the scale in favor of one party in making inferences from the evidence. is certainly prerogative within to the require Alabama a jury elements are interrelated. Nevertheless, it Legislature’s instruction whose Edgeworth, 940 So. 2d at 1021. As Chief Justice Roberts has explained, “In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined--‘to say what the law is.’ Marbury v. Madison, 1 Cranch 137, 177, 2 L.Ed. 60 (1803). cases than in others. But That is easier in some in every case we must respect the role of the Legislature, and take care not to undo what it has done.” King v. Burwell, 135 S. Ct. 2480, 2496 (2015). Here, in its directive that a plaintiff must prove her case to the jury’s “reasonable satisfaction by substantial evidence,” the Alabama Legislature has been 14 clear that the jury must be instructed on two points. Therefore, first, this court used the “reasonable satisfaction” standard, although, consistent with other courts in this district, it defined that standard to be the same as preponderance of the evidence; and, second, the court used the definition of “substantial evidence” required by the medical-malpractice bill, which focuses the jury on the character of the evidence. Cf. 1 Ala. Pattern Jury Instr. Civ. 25.05 (3d ed.). DONE, this the 22nd day of July, 2015. _ /s/ Myron H. Thompson UNITED STATES DISTRICT JUDGE

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