Ex Parte Cranman
792 So. 2d 392, 2000 WL 1728367 (2000)
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Rule of Law:
State-agent immunity does not extend to the exercise of medical judgment by state-employed physicians in the course of treating a patient, as such conduct is not a discretionary governmental function related to policy-making or administration that the immunity doctrine is designed to protect.
Facts:
- Matthew Cranman was a student at the University of Alabama in 1994.
- On September 12, 1994, Cranman visited the university's student health center with swelling in his left testicle, where Dr. David Maxwell diagnosed him with epididymitis.
- Over the following 14 months, Cranman made multiple return visits to the health center for persistent testicular discomfort, low-back pain, flank pain, and other symptoms.
- During these visits, he was treated by Drs. Maxwell, John Galaznik, Joe Bethany, and Patricia Hubbs, who diagnosed him with conditions such as muscle pain, recurrent epididymitis, and back strain.
- In December 1995, Cranman was diagnosed with testicular cancer, which had metastasized to his lungs and behind his kidneys.
- Following the diagnosis, Cranman's left testicle was surgically removed, and he underwent chemotherapy and radiation treatments.
Procedural Posture:
- In September 1996, Matthew Cranman filed a medical-malpractice action in an Alabama trial court against Drs. Maxwell, Hubbs, and Galaznik, and the student health center.
- The defendant physicians asserted the defense of discretionary-function immunity.
- Cranman amended his complaint to add Dr. Bethany as a defendant.
- Following Matthew Cranman's death, his father, Paul J. Cranman, was substituted as the plaintiff.
- The trial court entered summary judgment in favor of all four defendant physicians, concluding they were protected by discretionary-function immunity.
- Paul Cranman, as appellant, appealed the summary judgments.
- The case was transferred to the Alabama Court of Civil Appeals, which affirmed the trial court's judgment in favor of the physicians (appellees).
- Paul Cranman petitioned the Supreme Court of Alabama for a writ of certiorari, which was granted.
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Issue:
Does discretionary-function immunity protect state-employed physicians from civil liability for alleged medical malpractice committed in the course of treating a patient?
Opinions:
Majority - Justice Lyons
No. Discretionary-function immunity does not shield state-employed physicians from liability for medical malpractice. The court re-examined the doctrine of State-agent immunity, balancing the constitutional right to a remedy (§ 13) against State immunity (§ 14) and the separation of powers doctrine (§ 43). It concluded that immunity is intended to protect governmental acts involving policy-making, planning, and administration, not every act that involves professional judgment. The court restated the rule for State-agent immunity, creating a new framework that enumerates specific categories of protected discretionary conduct. Because the professional treatment of a patient by a physician does not fall within any of these protected categories, the defendant physicians are not entitled to immunity.
Concurring - Justice Johnstone
Concurs with the outcome but asserts that the basis for State-agent immunity is the common law and public policy embodied in the Restatement (Second) of Torts § 895D, rather than derived directly from Alabama Constitution §§ 14 or 43. He agrees that the majority's restatement of the rule provides needed clarity in distinguishing immune from non-immune conduct.
Concurring - Justice Cook
Concurs in the judgment but raises two concerns. First, the majority's broad restatement of the entire immunity rule constitutes dicta, as the case could be decided solely on the issue of medical discretion. Second, he argues that discretionary-function immunity for state agents is a common law doctrine derived from the Restatement, not from § 14 of the Alabama Constitution, which provides absolute immunity for the State itself. He agrees with drawing a distinction between unprotected 'medical discretion' and protected 'governmental discretion'.
Dissenting - Justice Maddox
Maintains that the sovereign immunity provided by § 14 of the Alabama Constitution creates a nearly 'invincible' wall. He argues that this constitutional immunity extends to the state-employed physicians in this case and that any change to this long-standing doctrine must come from a constitutional amendment, not a judicial decision.
Dissenting - Justice See
Argues that the defendant physicians were exercising a discretionary function and that existing precedent correctly extended immunity to state-employed health-care providers. He criticizes the majority's new rule as circular for simply omitting physicians from the list of protected actors. He asserts that denying immunity will improperly burden the state by increasing the costs of providing public services like higher education and student health care.
Analysis:
This landmark decision significantly narrows the scope of State-agent immunity in Alabama by drawing a sharp distinction between governmental discretion and professional medical discretion. It effectively carves out an exception for medical malpractice, holding that the public policy of protecting government decision-making does not extend to a physician's duty of care to a patient. This ruling aligns Alabama with a growing number of jurisdictions and overrules prior caselaw that had more broadly shielded state-employed healthcare professionals, thereby exposing them to the same liability as their private-sector counterparts.
