McBride v. Houston County Health Care Authority et al

Filing 397

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

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