In the law, both form and substance matter. At the same time, we frequently see judicial opinions making the point that form should not be elevated over substance. Mottern v. Baptist Health System, Inc., 2024 WL 4097539 (Alabama Sept. 6, 2024), supplies a recent example. In Mottern, the Alabama Supreme Court permitted a plaintiff to assert various theories in a wrongful death case. That's all fine and good (we guess). But because all such theories addressed an alleged injury caused by a medical procedure, everyone of them had to satisfy the requirement in the Alabama Medical Liability Act (AMLA) of showing a breach of the medical standard of care.
The Mottern case was brought by the estate of a woman who allegedly died from a blood infection caused by a bacterially contaminated intravenous infusion of total parenteral nutrition (TPN), which is a method of providing nutrition to patients who cannot digest foods. The estate sued the hospital, the manufacturer of the TPN, and three individuals associated with the manufacturer. The case against the manufacturer and individuals was settled. What remained in the amended complaint were claims against the hospital for negligence, wantonness, an action under the Alabama Extended Manufacturer's Liability Doctrine (AEMLD), and breach of implied warranty under the Uniform Commercial Code (UCC).
The issue was whether those claims were subject to the requirement under the AMLA that claims against medical providers alleging medical injury must be supported by "substantial evidence of a breach of the applicable standard of care." The estate wanted to dodge the AMLA standards, at least for the AEMLD and UCC claims, arguing that all that was required under those claims were allegations that the TPN was defective, that the hospital was a seller of the TPN, that the hospital sold the TPN to the decedent, that the TPN caused the death, and that there was no substantial change to the TPN from the time it left the hospital's possession until it reached the decedent.
Mind you, a defendant in this scenario could make a cogent argument that the AMLA should be the exclusive avenue of relief. But the Alabama Supreme Court did not accept that argument. Those other causes of action could go forward. But while plaintiffs might be allowed to pursue claims captioned as such, those claims nevertheless remain governed by the AMLA. Thus, plaintiffs cannot avoid having to establish a breach of the medical standard of care. Any claimant alleging "medical injury" must establish breach of the relevant standard of care, no matter what the claim is called.
In arriving at this conclusion, the Alabama Supreme Court emphasized that the Alabama Legislature enacted the AMLA based on a recognition of an "increasing threat of legal actions for alleged medical injury" that was causing "a crisis threaten[ing] the delivery of medical services to the people of Alabama." The Legislature believed that such threat "contributes to an increase in health care costs and places a heavy burden upon those who can least afford such increases." The Legislature also saw that the proliferation of legal actions resulted in "a limitation on the number of physicians providing specialized health care in this state."
In some quarters, it has become unfashionable to consult legislative history as an aid to statutory interpretation. But no one doubts the primacy of legislative intent. (Good luck fitting those concepts together.). The Mottern court was right to take into account the scope and purpose of the AMLA. The AMLA was not, as the plaintiff contended, merely "procedural" in nature. Because the Mottern case alleged injuries caused by the administration of medical care, the substantive standard of care requirements of the AMLA should and did apply.
This article is presented for informational purposes only and is not intended to constitute legal advice.