In Shadrick v. Grana, the Supreme Court of Alabama contributed to a growing body of decisions that interpret state law to limit the admissibility of expert testimony in medical malpractice cases. Many of those laws, including Alabama’s, require a standard-of-care witness to practice in the same field as the allegedly negligent doctor.

The laws are championed by insurance and medical industry lobbyists who have a clear interest in protecting doctors from liability for the negligent conduct. The laws require a judge to ignore an expert’s actual qualifications and impose artificial barriers that make it more difficult for injury victims to find expert witnesses.

Facts of the Case

William Shadrick was treated in an emergency room for chest pain. An ER physician diagnosed a heart attack, then consulted by telephone with a cardiologist and an internist. The internist, Dr. Wilfreda Grana, admitted Shadrick to the hospital.

Dr. Grana thought that Shadrick did not have the kind of heart attack that requires immediate invasive care. However, Dr. Grana allegedly concluded that Shadrick was in cardiogenic shock and needed an emergency heart catheterization, a procedure that Dr. Grana was not qualified to perform.

Dr. Grana telephoned the cardiologist. Dr. Grana claimed he asked the cardiologist to see Shadrick before Dr. Grana went home for the evening.

The cardiologist denied that Dr. Grana told him that he should see Shadrick that evening, that Shadrick was in cardiogenic shock, or that Shadrick needed a heart catheterization. The cardiologist testified that Dr. Grana’s assessment suggested that Shadrick was suffering from pneumonia and sepsis, neither of which required intervention by a cardiologist.

The cardiologist did not see Shadrick that day. When Dr. Grana saw Shadrick the next morning, Shadrick’s condition had worsened. In the early afternoon, Shadrick was transferred to intensive care and the cardiologist was summoned to the hospital. Before the cardiologist arrived, however, Shadrick went into cardiac arrest. The cardiologist eventually performed a heart catheterization but Shadrick suffered brain death before further surgery could be undertaken.

The heart catheterization revealed heart blockages. If the catheterization had been performed earlier, the blockages could have been detected and bypassed, likely saving Shadrick’s life.

Shadrick’s estate sued the cardiologist and Dr. Grana. The cardiologist settled. Dr. Grana moved for summary judgment.

Expert Dispute

Shadrick’s estate relied on the testimony of Dr. James Bower, a board-certified cardiologist, to establish the standard of care that should have been followed by Dr. Grana and by the cardiologist who failed to assess Shadrick. Since the cardiologist settled, Dr. Bower’s testimony was relevant only to Dr. Grana.

Alabama law requires an expert opinion concerning the standard of care a physician should follow to be provided by a “similarly situated” physician. When the defendant physician is a specialist, the expert must be board-certified in the same specialty and must have practiced that specialty within the last year. Dr. Grana was a board-certified internist and therefore met Alabama’s definition of a specialist.

The trial court agreed with Dr. Grana that Dr. Bower was not an internist and therefore was not a “similarly situated” physician. The court therefore struck Dr. Bower’s testimony. In the absence of any other expert standard-of-care testimony, the court granted summary judgment in favor of Dr. Grana. Shadrick’s estate appealed.

Appellate Opinion

As an initial matter, the court considered whether an expert opinion was necessary or whether the breach of the standard of care was too obvious to require expert support. The court noted the absence of any dispute that Dr. Grana gave the cardiologist substantial diagnostic information, including the results of an echocardiogram that suggested Shadrick’s heart was not pumping adequately.

Whether the standard of care also required Dr. Grana to express an opinion that Shadrick was in cardiogenic shock and needed an emergency heart catheterization, or to ask the cardiologist to see Shadrick that day, were not questions a jury could decide without hearing expert testimony. Accordingly, the appellate court asked whether Dr. Bower was qualified to give that testimony.

The appellate court agreed with the trial court that Dr. Bower could not testify about the standard of care that applied to Dr. Grana because Dr. Bower was not a board-certified internist. Whether Dr. Bower was aware of the appropriate standard of care an internist should follow when treating a patient who had a heart attack was not relevant to the court’s cookie-cutter analysis. The actual ability of an expert witness to provide relevant and useful information to an Alabama jury is supplanted by the artificial requirement that the expert must be board-certified in the same specialty.

Given the trend of state legislatures to shield physicians from the consequences of malpractice, it is often necessary for lawyers to hire multiple experts when they bring medical malpractice claims against multiple physicians. Lawyers must do so even if a single expert is perfectly capable of articulating the standard of care that applies to each defendant doctor. That necessity drives up the cost of bringing malpractice lawsuits and discourages lawyers from bringing them, which is exactly the result that lobbyist-friendly state legislatures hoped to achieve by enacting laws that limit expert testimony in malpractice litigation.