It its decision issued on May 17, 2013, the Supreme Court of Alabama (“Alabama Supreme Court”) reinstated a $3.2 million verdict in favor of the medical malpractice plaintiff that the Alabama Supreme Court had earlier vacated in its decision dated January 14, 2011 that held that the medical malpractice defendant, Health Care Authority for Baptist Health, an affiliate of UAB Health System (“the Authority”), was entitled to State immunity under § 14, Ala. Const. 1901.
The Underlying Facts
On September 3, 2005, a 73-year-old woman visited the emergency room of Baptist Medical Center East (“BMCE”), a hospital operated by the Authority, for an evaluation after she had fallen at home. At the time of the visit, she had a number of chronic preexisting medical conditions, including respiratory problems, diabetes, hypertension, chronic pain, gastrointestinal bleed, and stroke-related problems.
The initial examination did not find any injuries from the fall and did not indicate that the woman had an infection. However, after the woman complained that she had a sore throat, a test for streptococcus (“strep”) was ordered. After the woman had been discharged, the step test came back positive for methicillin-resistant staphylococcus aureus (“MRSA”) that was recorded in the electronic medical records but not reported directly to the woman’s treating physician.
On November 3, 2005, the woman returned to BMCE’s emergency room complaining of a cough and moderate to severe respiratory distress. The woman died on November 8, 2005.
On May 25, 2006, a medical malpractice lawsuit was filed on behalf of the woman’s estate naming the Authority and two physicians at BMCE as the medical malpractice defendants. The estate’s expert witnesses testified at trial that BMCE had breached the applicable standard of care by not reporting its finding of MRSA directly to the woman’s attending physician, that the woman died from MRSA-related pneumonia, and that the failure of the BMCE laboratory to report the finding of MRSA to the woman’s doctor caused her death.
The Authority’s expert witnesses testified at trial that MRSA does not cause a sore throat; that, because the woman was not suffering from a throat infection when the streptococcus culture was taken, the standard of care did not require that anyone be notified of the presence of MRSA, which is present in a large part of the population without symptoms or consequences; that notifying the woman’s doctor of the finding of MRSA would not have changed her course of treatment; and, that she died of congestive heart failure unrelated to the MRSA, and not of MRSA-related pneumonia.
The medical malpractice jury sided with the medical malpractice plaintiff and awarded $3.2 million against the Authority and in favor of the plaintiff. The Authority filed a postjudgment motion seeking, in part, a remittitur of the judgment from $3,200,000 to $100,000 based on the statutory cap for damages set forth in § 11-93-2, Ala. Code 1975. On September 29, 2009, the trial court entered an order denying the Authority’s postjudgment motion.
The Authority’s Appeal
The Authority filed an appeal, arguing that it possesses State immunity, also known as sovereign immunity, pursuant to § 14, Ala. Const. 1901, which provides “[t]hat the State of Alabama shall never be made a defendant in any court of law or equity.” Also, the Authority argued that the trial court erred by not remitting the $3,200,000 damages award to $100,000, pursuant to § 11-93-2.
The Alabama Supreme Court’s (Second) Decision
The Alabama Supreme Court noted that the Authority is a public corporation that is an entity separate from the State and from the persons and entities who participated in its creation. The Alabama Supreme Court stated, “Although the powers to arrange for the provision of health-care services to the indigent and to promote public health are legitimate ends of government, they certainly are not functions unique to government. Thus, the power granted authorities under the HCA Act in this regard, and in particular by the Board to the Authority, is not of the same character, for example, as the power granted an entity that is charged with a strictly governmental function … Clearly, the nature of the authority to operate a public hospital is not such as to dictate an affirmative answer to the question whether the entity who holds that authority is entitled to immunity … we must conclude that a health-care authority organized and operating under the HCA Act is not an “‘immediate and strictly governmental agenc[y] of the State'” … The Authority does not serve as “an arm of the State.” Instead, it is a “franchisee licensed for some beneficial purpose” … namely to participate with other health-care providers in this State, both public and private, in rendering health-care services to citizens of this State. The Authority therefore is not entitled to State immunity under § 14 of the Alabama Constitution.”
Damages Cap (§ 11-93-2)
With regard to the damages cap, the Alabama Supreme Court held, “we can and must conclude in the present case that the Authority “do[es] not enjoy the unique status of counties or cities; and, therefore, no such status … supports the constitutionality of the [§ 11-93-2] cap on any … judgment against [the Authority].” That is, to the extent § 22-21-318(a)(2) [§ 22-21-318(a)(2) of the HCA Act provides that health-care authorities shall be amenable to suit in both tort and contract actions] may be construed as an attempt to extend the partial immunity for counties and municipalities recognized in § 11-93-2 to an entity that is neither of those, that attempt is unconstitutional.”
You can read the entire decision of the Alabama Supreme Court as well as the concurring and dissenting opinions in this case by clicking here.
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