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Suing State and Local Government

Brief - Are state university health service physicians immune from medical malpractice suits? Ex parte Cranman, 1999 WL 1065051 (Ala. Nov 24, 1999), withdrawn and superseded by Ex parte Cranman, 792 So.2d 392 (Ala. 2000)

This is a very important case on the extent that physicians employed by the state have governmental immunity from medical malpractice litigation. Plaintiff was a student at the University of Alabama.  He is represented here by his father, who plead a 14 month pattern of misdiagnosis of testicular cancer by student health service physicians, ending with plaintiff's death.  The trial court, affirmed by the court of appeals, dismissed plaintiff's case, finding that the physician was a state official exercising discretionary authority and was thus immune from suit because of sovereign immunity.  The Alabama Supreme Court first ruled on this case in November 1999, finding that defendant physicians were immune.  After motions for reconsideration, the court withdrew that opinion in June 2000 and substituted this opinion, reversing its previous holdings and finding the personal medical services are not covered by state immunity.

The court began its analysis with a detailed review of the history of governmental immunity in Alabama, reaching back to the first statute abrogating immunity in 1819.  The central issue of this is analysis is that Alabama has a constitutional sovereign immunity, while that of the U.S. and many other states derives from the common law.  Thus, unlike U.S., immunity law, the courts and legislatures are constrained in their creation of exceptions to immunity.  Despite this differing heritage, Alabama uses the same ministerial/discretionary distinction as other states and the federal government do is determining whether individual acts should be subject to immunity.  In a previous case, the court found that a day care worker at the University of Alabama was only exercising ministerial authority and thus was liable to suit.  Expanding that decision, the court proposed a new system of classifying discretionary actions (paragraph numbers from the opinion):

[58]     We therefore restate the rule governing State-agent immunity:

[59]     A State agent shall be immune from civil liability in his or her personal capacity when the conduct made the basis of the claim against the agent is based upon the agent's

[60]     (1) formulating plans, policies, or designs; or

[61]     (2) exercising his or her judgment in the administration of a department or agency of government, including, but not limited to, examples such as:

[62]     (a) making administrative adjudications;

[63]     (b) allocating resources;

[64]     (c) negotiating contracts;

[65]     (d) hiring, firing, transferring, assigning, or supervising personnel; or

[66]     (3) discharging duties imposed on a department or agency by statute, rule, or regulation, insofar as the statute, rule, or regulation prescribes the manner for performing the duties and the State agent performs the duties in that manner; or

[67]     (4) exercising judgment in the enforcement of the criminal laws of the State, including, but not limited to, law-enforcement officers' arresting or attempting to arrest persons; or

[68]     (5) exercising judgment in the discharge of duties imposed by statute, rule, or regulation in releasing prisoners, counseling or releasing persons of unsound mind, or educating students.

[69]     Notwithstanding anything to the contrary in the foregoing statement of the rule, a State agent shall not be immune from civil liability in his or her personal capacity

[70]     (1) when the Constitution or laws of the United States, or the Constitution of this State, or laws, rules, or regulations of this State enacted or promulgated for the purpose of regulating the activities of a governmental agency require otherwise; or

[71]     (2) when the State agent acts willfully, maliciously, fraudulently, in bad faith, beyond his or her authority, or under a mistaken interpretation of the law.

Applying these to the instant case, the court ruled that physicians providing personal medical services are not immunity to liability, although such suits will be governed by the Tort Claims Act which provides for personally immunity unless abrogated by other laws.  The opinion contains a detailed analysis of the precedent in Alabama and other jurisdictions. Everyone concerned about state actor immunity for medical care decisions should read this case.

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