Did Dr. who ordered methotrexane doom viable fetus?

CASE ON POINT: Lawson v. Moore, 2008-AL-0102.002 (12/31/2008) So.2d--AL

CASE FACTS: On December 27, 2003, Cherrie Lawson went to the emergency room of Baptist Medical Center South in Montgomery, Alabama, with complaints of pain in her abdomen and pelvic area. Henry Kurusz, an emergency room physician, examined Lawson and ordered that she undergo several tests, including a pregnancy test and an ultrasound. The pregnancy test was positive, and the ultrasound revealed the existence of a cyst on Lawson's left ovary. The ultrasound did not, however, definitely show the existence of an intrauterine pregnancy. The hospital records from Lawson's visit indicated that Lawson informed Dr. Kurusz that she had previously experienced an ectopic pregnancy. Dr. Moore instructed Lawson that an ectopic pregnancy is a serious, life-threatening condition and that she would be monitored closely pending a follow-up laboratory analysis. He discussed giving her the drug methotrexate to terminate her pregnancy. He also told her that she might need surgical intervention. On the morning of January 2, 2004, Dr. Moore again evaluated Lawson. She continued to be in excruciating pain. Dr. Moore discussed her treatment options again. He provided her with medical literature discussing methotrexate and its benefits and the risks of treatment with the drug. That afternoon, Lawson informed Dr. Moore that she had decided to undergo the methotrexate treatment. Lawson received an injection of Methotrexate later that evening. Lawson remained in the hospital under Dr. Moore's care until January 4, 2004. After her discharge from the hospital, Lawson continued to receive treatment from Dr. Moore at his office, including follow-up ultrasounds. Ultimately, the methotrexate injection terminated the pregnancy. On January 30, 2004, Dr. Moore performed a dilation-and-curettage procedure to remove the remains of the terminated pregnancy. On December 23, 2005, Lawson sued Dr. Moore and his practice group, alleging that at the time she received the methotrexate injection, she, in fact, had a viable intrauterine pregnancy, and that Dr. Moore acted negligently: (1) in failing to discover the alleged intrauterine pregnancy; and (2) in recommending and administering the methotrexate injection. The defendants answered the complaint denying the allegations. After the parties completed discovery, the case was tried before a jury. The trial court denied the defendants' motion for judgment as a matter of law (JML) made at the close of all of the case. The jury was unable to reach a verdict. The defendants moved for a mistrial and for JML. The trial court granted the defendants' motion for JML. Lawson appealed.

COURT'S OPINION: The Supreme Court of Alabama reversed the order of the trial court, which granted the defendants' motion for JML. The court held, inter alia, that JML is proper only where there is a "complete absence of proof on a material issue or where there are no controverted questions of fact on which reasonable people could differ and the moving party is entitled to a judgment as a matter of law." Consequently, the court concluded that the trial court erred in granting the defendants' motion for JML. The court remanded the case back to the trial court for a new trial for the plaintiff.

LEGAL COMMENTARY: The court perceived the sole issue on appeal to be whether the plaintiff offered substantial evidence indicating that, when the methotrexate was administered, there was a viable intrauterine pregnancy. The defendants contended: "Based on the nature of Ms. Lawson's allegations, she could recover damages against [Dr. Moore] if, and only if, her intrauterine pregnancy was viable, i.e., if the pregnancy probably would have survived to term without Dr. Moore administering Methotrexate. If Ms. Lawson's intrauterine pregnancy was probably nonviable--and probably would not have survived to term regardless of Dr. Moore's treatment--then there would be no basis for attributing Ms. Lawson's alleged damages to Dr. Moore. Simply stated, if the intrauterine pregnancy probably would have failed regardless of Dr. Moore's treatment, he cannot be found to have caused Ms. Lawson's injury." The court noted that the defendants cited the testimony of their expert medical witness, Dr. Richard Blackwell, who testified that, taking into account the information Dr. Moore had at the time, Dr. Moore acted appropriately in administering the methotrexate on January 2, 2004. Dr. Blackwell asserted, Lawson's pregnancy would have failed regardless of the administration of the methotrexate. Additionally, the defendants contended that the ultrasounds conducted on Lawson on January I and January 3, 2004, demonstrated that no viable intrauterine pregnancy was present. In support of that assertion, the defendants cited Dr. Moore's testimony at trial. Lawson, however, contended that Dr. Lopez's testimony at trial provided substantial evidence indicating that a viable intrauterine pregnancy existed and that, based on the information available to him on January 2, 2004, Dr. Moore acted negligently, and the viable pregnancy was doomed as a direct and proximate cause of the administration of methotrexate administered by Dr. Moore. Accordingly, the court determined that this was not a case to be decided on a JML motion, and ordered it remanded for a jury trial!

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years. he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's Who in America mid Who's Who in the World.