Ex parte Affinity Hospital, LLC, d/b/a Grandview Medical Center; and Community Health Systems, Inc. PETITION FOR WRIT OF MANDAMUS (In re: Joyce Pates v. Community Health Systems, Inc.; Affinity Hospital, LLC, d/b/a Grandview Medical Center; John Kirchner, M.D.; and Southlake Orthopaedics Sports Medicine and Spine Center, P.C.) (Jefferson Circuit Court: CV-23-900513).

Rel: March 7, 2025

Notice: This opinion is subject to formal revision before publication in the advance sheets of Southern Reporter.
Readers are requested to notify the Reporter of Decisions, Alabama Appellate Courts, 300 Dexter Avenue,
Montgomery, Alabama 36104-3741 ((334) 229-0650), of any typographical or other errors, in order that corrections
may be made before the opinion is printed in Southern Reporter.

SUPREME COURT OF ALABAMA
OCTOBER TERM, 2024-2025

_________________________

SC-2024-0174
__________________________

Ex parte Affinity Hospital, LLC, d/b/a Grandview Medical
Center; and Community Health Systems, Inc.

PETITION FOR WRIT OF MANDAMUS

(In re: Joyce Pates

v.

Community Health Systems, Inc.; Affinity Hospital, LLC, d/b/a
Grandview Medical Center; John Kirchner, M.D.; and Southlake
Orthopaedics Sports Medicine and Spine Center, P.C.)
_________________________

SC-2024-0184
__________________________

Ex parte John Kirchner, M.D., and Southlake Orthopaedics
Sports Medicine and Spine Center, P.C.
SC-2024-0174 and SC-2024-0184

PETITION FOR WRIT OF MANDAMUS

(In re: Joyce Pates

v.

Community Health Systems, Inc.; Affinity Hospital, LLC, d/b/a
Grandview Medical Center; John Kirchner, M.D.; and Southlake
Orthopaedics Sports Medicine and Spine Center, P.C.)

(Jefferson Circuit Court: CV-23-900513)

WISE, Justice.

The petitioners, Affinity Hospital, LLC, d/b/a Grandview Medical

Center ("Grandview"); Community Health Systems, Inc. ("CHSI"); John

Kirchner, M.D.; and Southlake Orthopaedics Sports Medicine and Spine

Center, P.C. ("Southlake"), petition this Court for writs of mandamus

directing the Jefferson Circuit Court to enter an order setting aside its

February 14, 2024, order denying their motions to dismiss the claims of

the plaintiff, Joyce Pates, against them and to enter an order dismissing

Pates's claims against them.

Procedural History

On February 10, 2023, Pates sued CHSI, Grandview, Dr. Kirchner,

and Southlake ("the defendants") in the Jefferson Circuit Court. Pates

asserted medical-malpractice claims against the defendants pursuant to

2
SC-2024-0174 and SC-2024-0184

the Alabama Medical Liability Act ("the AMLA"), § 6-5-480 et seq. and §

6-5-540 et seq., Ala. Code 1975.

The complaint alleged that, on or about July 31, 2020, Pates injured

her right ankle; that, on August 10, 2020, she went to her primary doctor

and an X-ray showed a distal fibula fracture; and that Pates's primary

doctor referred her to Southlake for further evaluation. Pates further

alleged that, on August 10, 2020, she saw Dr. Kirchner, a physician at

Southlake's medical facility; that Dr. Kirchner advised her that she

needed surgery on her right ankle; that Dr. Kirchner performed the

surgery on August 20, 2020, at Grandview Medical Center; that, during

the surgery, Dr. Kirchner inserted plates and screws to fix the fracture;

that Pates remained in the hospital overnight; and that Pates was

released from Grandview Medical Center on August 21, 2020, "after not

exhibiting any medical distress." Pates went on to allege that she had at

least six visits with Dr. Kirchner for postoperative care beginning on

August 31, 2020; that she advised Dr. Kirchner that she had discomfort

in her right leg; that X-rays were taken at Southlake's medical facility;

and that "she was given oral medications and topical ointments to

alleviate her discomfort through at least November 11, 2020."

3
SC-2024-0174 and SC-2024-0184

Pates alleged that she did not receive any relief from the

medications; that, on November 9, 2020, she went to the emergency room

at UAB Hospital-Highlands in Birmingham due to "excruciating pain she

was feeling in her right leg"; that medical personnel saw drainage from

the wound that showed signs of infection; that the hardware was removed

from her right ankle in a subsequent procedure performed on November

22, 2020; that she was prescribed additional oral medications after that

procedure, "[b]ut the initial wound had not healed and [Pates] noticed

more wounds on other parts of her right leg"; that, on January 29, 2021,

Pates went back to the emergency room at UAB Hospital-Highlands; and

that, after seeing the new wound on Pates's right thigh, Pates was

transferred "to the main UAB Hospital for surgical evaluation." Pates

alleged that she underwent surgical procedures to debride her right

ankle on February 2, 2021, February 3, 2021, and February 5, 2021.

Pates further alleged:

"On or about February 11, 2021, [Pates] had her right leg
amputated at the waist due to the advancing infection in her
leg. She avers that she was told that amputation may be the
only way to save her life. Prior to this date, she had no
knowledge that the surgery on her ankle had caused this
much damage."

4
SC-2024-0174 and SC-2024-0184

She further alleged that she had two additional medical procedures after

the amputation and that the wound around the amputation was

ultimately closed on February 19, 2022.

In her complaint, Pates asserted a negligence claim against Dr.

Kirchner in which she alleged:

"31. On or about August 20, 2020, the Defendant Kirchner
performed a surgical procedure on [Pates] where he inserted
medical plates and screws in her right leg.

"32. That on at least six different occasions after the date of
the surgical procedure, [Pates] complained of post-surgical
discomfort in her right leg.

"33. It was later determined that the medical appliances that
were placed in [Pates's] leg by the Defendant Kirchner were
covered in infection.

"34. At all material times, Defendant [Kirchner] owed a non-
delegable duty to [Pates] to exercise reasonable care and
ensure that the medical hardware used in her surgery was
safe for insertion.

"35. Additionally, … Defendant [Kirchner] had a duty to
properly inspect and diagnose [Pates's] injury.

"36. [Pates's] injury was so pronounced that subsequent
medical providers were able to identify the injury and take
steps that saved [Pates's] life.

"37. As a direct and proximate result of one or more of the
foregoing wrongful acts or omissions of the Defendants, Ms.
Pates became further injured and suffered a traumatic
transfemoral amputation of her right leg. Ms. Pates will in
5
SC-2024-0174 and SC-2024-0184

the future suffer great pain, discomfort, and physical
impairment, all of which injuries are permanent, and has
been and will be kept from attending to her ordinary affairs
and duties for the rest of her lifetime."

She also asserted a negligence claim against CHSI and Grandview in

which she alleged:

"39. That during all of the times alleged herein that [Pates]
was receiving medical care and treatment from Defendant
John Kirchner, M.D., [that] Defendant was employed by
Grandview Medical Center, which is a subsidiary of
Community Health Care, Inc.[,] and he was acting within the
scope of that employment.

"40. That Defendant Grandview Medical Center is responsible
for the breach of applicable medical care occasioned by [its]
employee, [Dr. Kirchner], which resulted in a physical injury
to [Pates]."

Pates further asserted a negligence claim against Southlake in which she

asserted:

"42. That during all of the times alleged herein that [Pates]
was receiving medical care and treatment from Defendant
John Kirchner, M.D., [that] Defendant was employed by
Southlake Orthopaedics Sports Medicine and Spine Care,
P.C., and he was acting within the scope of that employment.

"43. That Defendant Southlake Orthopaedics Sports Medicine
and Spine Care, P.C. is responsible for the breach of
applicable medical care occasioned by [its] employee, [Dr.
Kirchner], which resulted in a physical injury to [Pates]."

6
SC-2024-0174 and SC-2024-0184

Dr. Kirchner and Southlake filed a motion to dismiss Pates's claims

against them pursuant to Rule 12(b)(6), Ala. R. Civ. P. In their motion,

Dr. Kirchner and Southlake argued that Pates's claims against them

were barred by the AMLA's two-year statute of limitations set forth in §

6-5-482(a), Ala. Code 1975. Subsequently, Grandview filed a motion to

dismiss or, in the alternative, for a summary judgment, in which it also

asserted that Pates's claims against it were barred and precluded by the

AMLA's two-year statute of limitations set forth in § 6-5-482(a). It also

asserted that Dr. Kirchner was not an employee of Grandview and

attached an affidavit in support of its assertions in that regard. CHSI

filed a motion to dismiss Pates's claims against it for lack of personal

jurisdiction and an affidavit in support thereof. In a footnote, CHSI also

stated:

"Additionally, CHSI raises and asserts that it is alternatively
entitled to dismissal pursuant to Ala. R. Civ. P. 12(b)(6), as a
matter of law. [Pates's] complaint does not aver any fact or
claim upon which relief could even potentially be granted
against CHSI .… Instead, the only averment [that] could
have even possibly been intended to reference CHSI is the
contention that 'Grandview Medical Center … is a subsidiary
of Community Health Care, Inc.' … which obviously avers no
tortious conduct. Moreover, CHSI also adopts and asserts the
defenses and arguments raised by Grandview as establishing
a full and complete defense to any attempt to impose
derivative liability on CHSI."
7
SC-2024-0174 and SC-2024-0184

Pates did not file a response to those motions. On September 25,

2023, the trial court conducted a hearing on the motions. 1 On February

14, 2024, the trial court denied the defendants' motions. In its order

denying the motions, the trial court stated:

"THIS MATTER came before the Court … on the
[defendants'] Motion[s] to Dismiss. Present in Court was …
counsel for the Plaintiff, Joyce Pates; … counsel for [CHSI]
and Grandview …; and … counsel for [Dr. Kirchner and
Southlake]. Evidence was presented and testimony heard ore
tenus.

"The Defendants, [Dr. Kirchner], and Southlake[], and
Grandview …, owned and operated by [CHSI], filed separate
Motions to Dismiss pursuant to Rule 12(b)(6). It is well
established that in considering whether a complaint is
sufficient to withstand a motion to dismiss under Rule
12(b)(6), ' "the appropriate standard of review under Rule
12(b)(6)[, Ala. R. Civ. P.,] is whether, when the allegations of
the complaint are viewed most strongly in the pleader's favor,
it appears that the pleader could prove any set of
circumstances that would entitle [it] to relief." ' Crosslin v.
Healthcare Auth. of Huntsville, 5 So. 3d 1193 (Ala. 2008)
(quoting Nance v. Matthews, 622 So. 2d 297, 299 (Ala. 1993)).
In determining whether this is true, a court considers only
whether the plaintiff may possibly prevail, not whether the
plaintiff will ultimately prevail. Id.

"In the present case, [Pates] has presented evidence that
her injury was caused by the [defendants]. She alleges that
her injury occurred due to negligence by the [the defendants],
who did not object that Ms. Pates was under the care of the

1The parties have not provided this Court with a transcript of that

hearing.
8
SC-2024-0174 and SC-2024-0184

physician, Dr. Kirchner and his medical practice at
Southlake…. Nor was there any objection that the original
procedure was performed at Grandview Medical Center,
owned and operated by [CHSI]. Dismissal by way of … Rule
12(b)(6) ' "is proper only when it appears beyond doubt that
the plaintiff can prove no set of facts in support of the claim
that would entitle the plaintiff to relief." ' Crosslin v.
Healthcare Auth. of Huntsville, 5 So. 3d 1193 (Ala. 2008).

"The [defendants] contend that the pleading of [Pates] is
time-barred due to their understanding of the date of the
injury to [Pates]. The time of the injury, in this matter, is in
dispute. [Pates] alleges that she had no knowledge that she
would have her leg amputated until she was told hours prior
to the amputation. It is from there that she states her injury
began, which would start her statute of limitations to file this
Petition. In Mobile Infirmary v. Delchamps, 642 So. 2d 954
(Ala. 1994), the Court reversed a Rule 12(b)(6) Motion to
Dismiss where the Plaintiff disputed the date a cause of action
accrued ('… we cannot say that Delchamps can prove no set of
facts that would entitle her to recover. Whether her claims
are barred … depends on when in fact she first suffered the
alleged legal injury ...'). [Pates] believes that it would be
highly prejudicial to her and a miscarriage of justice to time
bar a woman who lost her leg to negligence of the doctor and
the facilities he used to treat her, when there are facts that
support her claim that would entitle her to relief. Therefore,
the [defendants'] Motions to Dismiss [are] hereby DENIED."

(Capitalization in original.) The defendants subsequently filed petitions

for the writ of mandamus asking this Court to direct the trial court to set

aside its February 14, 2024, order denying their motions to dismiss and

to enter an order granting their motions.

Standard of Review
9
SC-2024-0174 and SC-2024-0184

" 'A writ of mandamus is an extraordinary
remedy available only when the petitioner can
demonstrate: " '(1) a clear legal right to the order
sought; (2) an imperative duty upon the
respondent to perform, accompanied by a refusal
to do so; (3) the lack of another adequate remedy;
and (4) the properly invoked jurisdiction of the
court.' " Ex parte Nall, 879 So. 2d 541, 543 (Ala.
2003) (quoting Ex parte BOC Grp., Inc., 823 So. 2d
1270, 1272 (Ala. 2001)).'

"Ex parte Watters, 212 So. 3d 174, 180 (Ala. 2016).

" 'The general rule is that, subject to certain narrow
exceptions, the denial of a motion to dismiss is not reviewable
by petition for a writ of mandamus.' Ex parte Brown, 331 So.
3d 79, 81 (Ala. 2021). However,

" '[t]his Court has recognized that an appeal
is an inadequate remedy in cases where it has
determined that a defendant should not have been
subjected to the inconvenience of litigation
because it was clear from the face of the complaint
that the defendant was entitled to a dismissal or
to a judgment in its favor.'

"Ex parte Sanderson, 263 So. 3d 681, 687-88 (Ala. 2018)
(citing Ex parte Hodge, 153 So. 3d 734 (Ala. 2014), and Ex
parte U.S. Bank Nat'l Ass'n, 148 So. 3d 1060 (Ala. 2014)). In
particular, in Ex parte Hodge, this Court permitted
mandamus review of a trial court's denial of a motion to
dismiss contending that the plaintiff's malpractice claim was
barred by the four-year statute of repose contained in § 6-5-
482(a), Ala. Code 1975, when the applicability of that statute
was clear from the face of the complaint. Cf. Ex parte
Watters, 212 So. 3d at 182 (denying a mandamus petition
because 'it [was] not abundantly clear from the face of [the
plaintiff's] complaint whether the survival statute dictate[d]
10
SC-2024-0174 and SC-2024-0184

dismissal of the legal-malpractice claim because the issue
whether the claim sound[ed] in tort, in contract, or in both for
that matter, [was] sharply disputed by the parties'). Thus, if
it is clear from the face of Mobile Health's complaint that the
claims against Abbott are barred by the rule of repose or the
applicable statute of limitations, then Abbott is entitled to
mandamus relief.

"With respect to evaluating a trial court's denial of a
Rule 12(b)(6) motion to dismiss,

" '[t]he appropriate standard of review ... is
whether "when the allegations of the complaint
are viewed most strongly in the pleader's favor, it
appears that the pleader could prove any set of
circumstances that would entitle [the pleader] to
relief." Nance v. Matthews, 622 So. 2d 297, 299
(Ala. 1993); Raley v. Citibanc of
Alabama/Andalusia, 474 So. 2d 640, 641 (Ala.
1985). This Court does not consider whether the
plaintiff will ultimately prevail, but only whether
the plaintiff may possibly prevail. Nance, 622 So.
2d at 299. A "dismissal is proper only when it
appears beyond doubt that the plaintiff can prove
no set of facts in support of the claim that would
entitle the plaintiff to relief." Nance, 622 So. 2d at
299; Garrett v. Hadden, 495 So. 2d 616, 617 (Ala.
1986); Hill v. Kraft, Inc., 496 So. 2d 768, 769 (Ala.
1986).'

"Lyons v. River Rd. Constr., Inc., 858 So. 2d 257, 260 (Ala.
2003)."

Ex parte Abbott Lab'ys, 342 So. 3d 186, 193-94 (Ala. 2021).

" ' "[A] Rule 12(b)(6) dismissal is proper only
when it appears beyond doubt that the plaintiff
can prove no set of facts in support of the claim
11
SC-2024-0174 and SC-2024-0184

that would entitle the plaintiff to relief." Nance v.
Matthews, 622 So. 2d 297, 299 (Ala. 1993)
(citations omitted). "Next, the standard for
granting a motion to dismiss based upon the
expiration of the statute of limitations is whether
the existence of the affirmative defense appears
clearly on the face of the pleading." Braggs v. Jim
Skinner Ford, Inc., 396 So. 2d 1055, 1058 (Ala.
1981) (citations omitted).'

"Jones v. Alfa Mut. Ins. Co., 875 So. 2d 1189, 1193 (Ala.
2003)."

Limon v. Sandlin, 200 So. 3d 21, 23-24 (Ala. 2015).

Discussion

The defendants argue that the trial court erroneously denied their

motions to dismiss on the ground that Pates's claims against them were

barred by the AMLA's statute of limitations for medical-malpractice

claims. Section 6-5-482(a) provides:

"All actions against physicians, surgeons, dentists, medical
institutions, or other health care providers for liability, error,
mistake, or failure to cure, whether based on contract or tort,
must be commenced within two years next after the act, or
omission, or failure giving rise to the claim, and not
afterwards; provided, that if the cause of action is not
discovered and could not reasonably have been discovered
within such period, then the action may be commenced within
six months from the date of such discovery or the date of
discovery of facts which would reasonably lead to such
discovery, whichever is earlier; provided further, that in no
event may the action be commenced more than four years
after such act; except, that an error, mistake, act, omission, or
12
SC-2024-0174 and SC-2024-0184

failure to cure giving rise to a claim which occurred before
September 23, 1975, shall not in any event be barred until the
expiration of one year from such date."

In this case, it is undisputed that Dr. Kirchner performed the

surgery during which he inserted the plates and screws to stabilize

Pates's fracture on August 20, 2020. It is also undisputed that, starting

on August 31, 2020, Pates had at least six postoperative visits with Dr.

Kirchner and that she complained of discomfort in her right leg during

those visits. She further asserted that "she was given oral medication …

and topical ointments to alleviate her discomfort through at least

November 11, 2020." Pates alleged that, "[a]fter not receiving any relief

from the medications, and not satisfied with the diagnosis from Dr.

Kirchner and Southlake, [she] sought additional medical help"; that, on

November 9, 2020, she went to the emergency room at UAB Hospital-

Highlands; that medical personnel saw drainage from the wound that

showed signs of infection; that, on November 22, 2020, she underwent a

subsequent surgical procedure to remove the hardware that had been

placed by Dr. Kirchner; that she received additional medications after

the surgery to remove the hardware, "[b]ut the initial wound had not

healed and [Pates] noticed more wounds on other parts of her right leg";

13
SC-2024-0174 and SC-2024-0184

that she went back to the UAB Hospital-Highlands emergency room on

January 29, 2021; that she underwent surgical procedures to debride her

ankle on February 2, 2021, February 3, 2021, and February 5, 2021; and

that her right leg was ultimately amputated on February 11, 2021.

Pates did not allege that she received any medical treatment from

Dr. Kirchner after November 2020. Additionally, based on the facts

before this Court, it is undisputed that, in November 2020, there were

signs of infection at the surgical site of Pates's August 2020 surgery; that,

in November 2020, Pates had the hardware from that surgery removed;

and that, even after receiving additional medications, "the initial wound

had not healed" and Pates developed "more wounds on other parts of her

right leg." (Emphasis added.) Rather than alleging that she did not

suffer any injury until the amputation of her leg on February 11, 2021,

Pates alleged that, before the amputation, "she had no knowledge that

the surgery on her ankle had caused this much damage."

This Court addressed a similar situation in Ex parte Mobile

Infirmary Ass'n, 349 So. 3d 842 (Ala. 2021). In that case, the plaintiff,

John R. McBride, filed a complaint in which he listed the defendants as

" 'J.L. Bedsole/Rotary Rehabilitation Hospital,' " " 'Mobile Infirmary

14
SC-2024-0174 and SC-2024-0184

Association,' " and fictitiously named defendants. Id. at 843. In his

complaint, McBride alleged that he had been admitted to the J.L.

Bedsole/Rotary Rehabilitation Hospital ("Rotary Rehab") on June 2018

and "that, while he was a patient at Rotary Rehab, he 'suffered a

decubitus pressure ulcer to his left and right heels, causing severe pain

and suffering, infection, hospital treatment, financial loss, emotional

distress, and eventually amputation below his left knee.' " Id. McBride

asserted claims of negligence and wantonness. Subsequently, Mobile

Infirmary Association ("MIA"), doing business as Rotary Rehab and

Mobile Infirmary Medical Center ("Mobile Infirmary"), filed a motion to

dismiss McBride's complaint on the ground that his claims were barred

by the limitations period set forth in § 6-8-482(a). Specifically, MIA

asserted that McBride had been discharged from Mobile Infirmary on

June 2, 2018; that he had been discharged from Rotary Rehab on June

20, 2018; that the last day any claim could have accrued against Mobile

Infirmary was June 2, 2018; that the last day any claim could have

accrued against Rotary Rehab was June 20, 2018; and that McBride did

not file his complaint until July 22, 2020, more than two years after any

claims against either Mobile Infirmary or Rotary Rehab would have

15
SC-2024-0174 and SC-2024-0184

accrued. McBride filed a response and a supplemental response to the

motion to dismiss, in which he

"argued that the legal injury forming the basis of his claims
was the below-the-knee amputation of his left leg, which he
contends occurred on July 23, 2018. Because he commenced
this action within two years of the occurrence of that injury,
McBride argued, his claims are not barred by § 6-5-482(a)."

Id. at 844. In its reply to McBride's response, MIA argued that the

pressure ulcers referenced in the complaint were McBride's actual legal

injuries; that those pressure ulcers were present before July 22, 2018;

and that McBride's claims accrued more than two years before he

commenced his action. After conducting a hearing, the trial court denied

MIA's motion to dismiss, and MIA filed a petition for a writ of mandamus

in this Court.

In this Court, MIA argued that it was clear from the face of the

complaint that McBride's claims accrued more than two years before he

filed the complaint and, therefore, were barred by the two-year statute of

limitations set forth in § 6-5-428(a). In addressing this issue, this Court

stated:

"MIA cites, among other cases, this Court's decision in Mobile
Infirmary v. Delchamps, 642 So. 2d 954 (Ala. 1994). In
Delchamps, the Court stated the following general

16
SC-2024-0174 and SC-2024-0184

propositions concerning the operation of the limitations
period set out in § 6-5-482:

" 'The limitations period of § 6-5-482
commences with the accrual of a cause of action.
Street v. City of Anniston, 381 So. 2d 26 (Ala.
1980); Bowlin Horn v. Citizens Hosp., 425 So. 2d
1065 (Ala. 1983); Ramey v. Guyton, 394 So. 2d 2
(Ala. 1981). A cause of action "accrues" under § 6-
5-482 when the act complained of results in legal
injury to the plaintiff. Grabert v. Lightfoot, 571
So. 2d 293, 294 (Ala. 1990); Colburn v. Wilson, 570
So. 2d 652, 654 (Ala. 1990). The statutory
limitations period begins to run whether or not the
full amount of damages is apparent at the time of
the first legal injury. Garrett v. Raytheon Co., 368
So. 2d 516, 518 (Ala. 1979). When the wrongful act
or omission and the resulting legal injury do not
occur simultaneously, the cause of action accrues
and the limitations period of § 6-5-482 commences
when the legal injury occurs. Moon v. Harco
Drugs, Inc., 435 So. 2d 218, 219 (Ala. 1983); Ramey
v. Guyton, 394 So. 2d 2, 4-5 (Ala. 1981).'

"Delchamps, 642 So. 2d at 958 (emphasis added).

"McBride's complaint lists the following injuries he
allegedly suffered '[a]s a direct and proximate result of [the
defendants'] negligent [and wanton] acts and omissions':

" 'a. A pressure ulcer to his left heel,

" 'b. Severe pain and suffering,

" 'c. Infection,

" 'd. Wound deterioration,

17
SC-2024-0174 and SC-2024-0184

" 'e. Loss of dignity, and

" 'f. Amputation of his left leg below the knee.'

"According to McBride's complaint, he was discharged
from Rotary Rehab '[o]n June 20, 2018, ... with pressure ulcers
present on both his left and right heels. [McBride]'s left heel
pressure ulcer was recorded as unstageable with dark gray
eschar and erythema and edema surrounding the wound.' His
allegation is that, but for the negligent and wanton failure by
the defendants to provide him with adequate care while he
was a patient, he would not have suffered the injuries
referenced in his complaint.

"Thus, based on the allegations set out in McBride's July
22, 2020, complaint, it is clear that he commenced this action
more than two years after the alleged negligence and
wantonness that caused the 'pressure ulcers ... on both his left
and right heels' and 'the dark gray eschar and erythema and
edema surrounding the' left-heel pressure ulcer. See
Delchamps, 642 So. 2d at 958. Notwithstanding the inclusion
of those injuries in his complaint, McBride does not appear to
dispute in his answer to MIA's mandamus petition that any
claims predicated on those injuries are barred by the
limitations period set out in § 6-5-482(a).

"However, McBride argues that his cause of action did
not actually accrue until his lower left leg was amputated.
Specifically, he states:

" 'McBride's injury developed on July 23, 2018,
with his lower leg amputation .... The Complaint
accurately identifies McBride's amputation as his
injury, but describes the other factors of his
medical condition in pleading the matter with
specificity, as required by the Alabama Medical
Malpractice Act. ... To affix McBride's statute of
limitations to a medical condition that preceded
18
SC-2024-0174 and SC-2024-0184

his actual injury would be considered unfair to any
plaintiff.'

"McBride's answer at 8-9 (emphasis added).

"Thus, McBride appears to argue that the Court should
view the amputation of his lower left leg as a separate or
different injury from the 'pressure ulcers ... on both his left
and right heels' and 'the dark gray eschar and erythema and
edema surrounding the' left-heel pressure ulcer that were
present when he was discharged from Rotary Rehab on June
20, 2018. In other words, it appears that McBride believes
that the amputation of his lower left leg constituted a
separate and new cause of action altogether. Put yet another
way, McBride suggests that this case is like McWilliams v.
Union Pacific Resources Co., 569 So. 2d 702, 704 (Ala. 1990),
'wherein the damage complained of occurred at a date later
than the actions of the defendants.' See also Ramey v.
Guyton, 394 So. 2d 2 (Ala. 1980)(holding that a plaintiff's
cause of action did not accrue for the purposes of the two-year
limitations period in § 6-5-482(a) until she suffered a stroke
possibly caused by certain medication, notwithstanding the
fact that the stroke occurred almost one year after the
defendant had written the plaintiff's last prescription for the
medication). He also appears to suggest that the actual cause
of his need for the lower-left-leg amputation is currently
unknown but can be determined after discovery. McBride's
answer at 7.

"We emphasize that, at this stage of the proceedings, the
applicable standard of review required the circuit court and
requires this Court to view McBride's allegations most
strongly in his favor and to consider only whether he might
possibly prevail if he can prove his allegations. See Ex parte
Abbott Lab'ys, 342 So. 3d [186,] 194 [(Ala. 2021)]. The issue
before us is not one of proof; rather, the issue is whether the
action can be maintained if McBride's allegations are true.
See id.
19
SC-2024-0174 and SC-2024-0184

"However, our obligation to assume the truth of
McBride's allegations likewise compels us to confront the
reality that McBride's argument essentially amounts to an
invitation for pure speculation by this Court. Specifically, to
surmise, as McBride appears to suggest in his answer, that
the eventual need for the amputation of McBride's lower left
leg could have been an altogether new injury, totally
unrelated to the injuries already present on June 20, 2018,
would be a supposition that is not only absent from, but
directly contrary to, McBride's actual allegations. Moreover,
such speculation would fail to provide an explanation of any
causal relationship between the defendants' alleged
negligence and wantonness and the amputation.

"We note that McBride's complaint has not alleged that
any negligent or wanton acts or omissions by the defendants
occurred after he was discharged from Rotary Rehab on June
20, 2018. Therefore, to connect the alleged negligence and
wantonness of the defendants in failing to properly treat
McBride's pressure ulcers and related conditions to his lower-
left-leg amputation, his complaint necessarily alleges that a
causal chain exists between those conditions and the
amputation. Specifically, as McBride describes it in his
complaint, his allegation is that, after his discharge from
Rotary Rehab, '[h]is left heel pressure ulcer continued to
worsen and develop infections.' (Emphasis added.) If the
need for the amputation was not a consequence of
deteriorating circumstances brought on by the conditions
present at the time of his discharge from Rotary Rehab, and
therefore the defendants' alleged negligence and wantonness,
the complaint is devoid of any allegation that the defendants'
alleged negligence and wantonness caused the amputation.

"As MIA notes,

" ' " '[this Court has] held that the statute
begins to run whether or not the full amount of
damages is apparent at the time of the first legal
20
SC-2024-0174 and SC-2024-0184

injury. In Kelly v. Shropshire, 199 Ala. 602, [604-
05,] 75 So. 291, 292 (1917), the rule was stated as
follows:

" ' " ' "If the act of which the injury
is the natural sequence is of itself a
legal injury to plaintiff, a completed
wrong, the cause of action accrues and
the statute begins to run from the time
the act is committed, be the actual
damage (then apparent) however
slight, and the statute will operate to
bar a recovery not only for the present
damages but for damages developing
subsequently and not actionable at the
time of the wrong done; for in such a
case the subsequent increase in the
damages resulting gives no new cause
of action...." ' " '

"Moon v. Harco Drugs, Inc., 435 So. 2d 218, 220 (Ala. 1983)
(quoting Garrett v. Raytheon Co., 368 So. 2d 516, 519 (Ala.
1979), overruled on other grounds, Griffin v. Unocal Corp.,
990 So. 2d 291 (Ala. 2008)) (emphasis added). See also Ex
parte Abbott Lab'ys, 342 So. 3d at 194 (' "The statute of
limitations begins to run when the cause of action accrues,
which this Court has held is the date the first legal injury
occurs." Ex parte Integra LifeSciences Corp., 271 So. 3d 814,
818 (Ala. 2018). "A cause of action accrues as soon as the
claimant is entitled to maintain an action, regardless of
whether the full amount of the damage is apparent at the time
of the first legal injury." Chandiwala v. Pate Constr. Co., 889
So. 2d 540, 543 (Ala. 2004).' (Emphasis added.)).

"It is clear from the face of McBride's complaint that his
claims depend upon the notion that the amputation of his
lower left leg was a 'natural sequence' of the alleged
negligence and wantonness of the defendants while McBride
21
SC-2024-0174 and SC-2024-0184

was a patient at Rotary Rehab. Moon, 435 So. 2d at 220. As
McBride phrased it in response to MIA's motion to dismiss,
his allegation is that the defendants' 'neglect placed [him] on
a path toward his injury of surgical amputation.'

"Because McBride's injuries, 'however slight,' ultimately
'resulting' in the need for the amputation were already
present when he was discharged from Rotary Rehab on June
20, 2018, it is likewise clear that 'the cause of action accrue[d]
and the statute beg[an] to run' no later than June 20, 2018.
Id. The eventual need for an amputation, or the 'subsequent
increase' in McBride's injuries, 'gives no new cause of action.'
Id.; see also Grabert v. Lightfoot, 571 So. 2d 293, 294 (Ala.
1990)('Certainly, Grabert was entitled to maintain an action
against Dr. Lightfoot immediately after the May 1, 1987,
operation, despite the fact that the extent of Grabert's injuries
allegedly caused by Dr. Lightfoot's failure to find or to remedy
the hernia may not have been fully known then.'), and Street
v. City of Anniston, 381 So. 2d 26, 31 (Ala. 1980)(noting this
Court's precedent holding that, when a legally cognizable
injury occurs immediately upon the defendant's negligence,
even though 'the actual injury initially incurred was so slight
that it [i]s not discovered until years later, the cause of action
accrue[s], nevertheless, at the time of the act or omission
complained of').5 Therefore, the two-year limitations period
for McBride to commence his action imposed by § 6-5-482(a)
expired on June 20, 2020. Because McBride did not file his
complaint until July 22, 2020, this action was commenced
outside the limitations period and is, therefore, barred.

"____________________________

"5In his answer to MIA's mandamus petition, McBride
argues that his cause of action did not accrue until the
amputation of his lower left leg on July 23, 2018, because, he
says, that was the first time he could have recognized that his
injuries were proximately caused by the defendants.
McBride's answer at 10. It appears that McBride is arguing
22
SC-2024-0174 and SC-2024-0184

that his cause of action did not accrue until he discovered the
alleged negligence or wantonness of the defendants.
However, this Court has previously explained that it will not
apply a 'discovery rule' to a statute of limitations unless one
is specifically prescribed by the legislature. See Coilplus-
Alabama, Inc. v. Vann, 53 So. 3d 898, 908 (Ala. 2010)(quoting
the appendix to Griffin v. Unocal Corp., 990 So. 2d 291, 311
(Ala. 2008)). Section 6-5-482(a) actually represents an
instance in which the legislature has provided for such a rule,
but the rule applies only in specified circumstances. See
Vann, 53 So. 3d at 908. In particular, § 6-5-482(a) provides,
in pertinent part:

" '[I]f the cause of action is not discovered and could
not reasonably have been discovered within [the
two-year limitations] period, then the action may
be commenced within six months from the date of
such discovery or the date of discovery of facts
which would reasonably lead to such discovery,
whichever is earlier ....'

"(Emphasis added.) As MIA points out on page 12 of its reply
brief, the foregoing portion of § 6-5-482(a) has no application
in this case because McBride discovered the defendants'
alleged negligence and wantonness within the two-year
limitations period set out in § 6-5-482(a). See Smith v. Bay
Minette Infirmary, 485 So. 2d 716, 717 (Ala. 1986) ('It is only
when the cause of action is not discovered in time to bring it
within two years of the act or omission that the statute allows
six months after discovery as an additional period in which
the action may be commenced.')."

Ex parte Mobile Infirmary, 349 So. 3d at 845-49 (footnote 4 omitted).

In its order denying the motions to dismiss, the trial court stated:

"[Pates] alleges that she had no knowledge that she would
have her leg amputated until she was told hours prior to the
23
SC-2024-0174 and SC-2024-0184

amputation. It is from there that she states her injury began,
which would start her statute of limitations to file this
Petition."

However, Pates's argument is similar to McBride's argument in Ex parte

Mobile Infirmary that the amputation of his left leg was the legal injury

that formed the basis of his claims, which was rejected by this Court. As

was the case in Ex parte Mobile Infirmary, it is clear that Pates's "claims

depend upon the notion that the amputation of [her] … leg was a 'natural

sequence' of the alleged negligence" of Dr. Kirchner during the August

2020 surgery and his subsequent postoperative care of Pates. 349 So. 3d

at 848 (quoting Moon v. Harco Drugs, Inc., 435 So. 2d 218, 220 (Ala.

2021)). In this case, Pates did not allege that she received any treatment

from Dr. Kirchner after November 2020. Additionally, the undisputed

facts before this Court indicate that, in November 2020, there were signs

of infection at the surgical site of the August 2020 surgery; that, in

November 2020, Pates had the hardware from that surgery removed; and

that, after that subsequent procedure, "the initial wound had not healed

and [Pates] noticed more wounds on other parts of her right leg." In her

complaint, Pates did not allege that she had not suffered any injury

24
SC-2024-0174 and SC-2024-0184

before the amputation of her leg on February 11, 2021. In the factual

allegations of her complaint, Pates alleged:

"As a direct and proximate result of one or more of the
foregoing wrongful acts or omissions of the Defendants, Ms.
Pates became further injured and suffered a traumatic
transfemoral amputation of her right leg."

(Emphasis added.) She further alleged that her right leg was amputated

"due to the advancing infection in her leg." Additionally, in her

negligence claim against Dr. Kirchner, Pates alleged that, before the

amputation, "she had no knowledge that the surgery on her ankle had

caused this much damage." Based on these facts, it is clear that Pates's

injuries, " 'however slight,' " were present in November 2020; "that 'the

cause of action accrue[d] and the statute beg[an] to run' " no later than

November 2020; and that "[t]he eventual need for an amputation, or the

'subsequent increase' in [Pates's] injuries, 'gives no new cause of action.' "

349 So. 3d at 848 (citations omitted). However, Pates did not file her

complaint until February 10, 2023, more than two years after any claim

against the defendants would have accrued. Accordingly, her claims

were barred by the two-year limitations period set forth in § 6-5-482(a).

Therefore, the defendants are entitled to the dismissal of Pates's claims

against them.
25
SC-2024-0174 and SC-2024-0184

Conclusion

For the above-stated reasons, we grant the mandamus petitions

and issue writs directing the trial court to set aside its February 14, 2024,

order denying the motions to dismiss and to enter an order dismissing

Pates's claims against the defendants.

SC-2024-0174 -- PETITION GRANTED; WRIT ISSUED.

SC-2024-0184 -- PETITION GRANTED; WRIT ISSUED.

Shaw, Bryan, Mitchell, Cook, and McCool, JJ., concur.

Stewart, C.J., and Sellers, J., concur in the result.

Mendheim, J., concurs in the result, with opinion.

26
SC-2024-0174 and SC-2024-0184

MENDHEIM, Justice (concurring in the result).

I agree with the main opinion that Joyce Pates's claims against

Affinity Hospital, LLC, d/b/a Grandview Medical Center; Community

Health Systems, Inc; Dr. John Kirchner; and Southlake Orthopaedics

Sports Medicine and Spine Center, P.C. ("the defendants"), are barred by

the two-year statute of limitations in § 6-5-482(a), Ala. Code 1975, and

that, therefore, the defendants are entitled to writs of mandamus.

However, I disagree with the main opinion's reliance upon Ex parte

Mobile Infirmary Ass'n, 349 So. 3d 842 (Ala. 2021), to support that

conclusion because I do not believe the cases are analogous.

As the main opinion details, in Ex parte Mobile Infirmary Ass'n, the

plaintiff, John R. McBride, asserted medical-malpractice claims against

Mobile Infirmary Association, doing business as Mobile Infirmary

Medical Center ("Mobile Infirmary") and J.L. Bedsole/Rotary

Rehabilitation Hospital ("Rotary Rehab"), because of injuries he allegedly

suffered while receiving care at Mobile Infirmary and Rotary Rehab.

Among the injuries McBride alleged that he suffered as a result of

negligent and/or wanton care from Mobile Infirmary and Rotary Rehab

were pressure ulcers in his left and right heels, infection, and amputation

27
SC-2024-0174 and SC-2024-0184

of his left leg below the knee. See Ex parte Mobile Infirmary Ass'n, 349

So. 3d at 846. McBride was released from Mobile Infirmary on June 2,

2018, and he was released from Rotary Rehab on June 20, 2018.

According to his complaint, at the time of his discharge from Rotary

Rehab, the pressure ulcers were present in both of his heels. The

amputation of McBride's lower left leg occurred on July 23, 2018.

McBride alleged that "but for the negligent and wanton failure by the

defendants to provide him with adequate care while he was a patient, he

would not have suffered the injuries referenced in his complaint." Id. at

846. McBride filed his complaint on July 22, 2020.

McBride conceded that the applicable statute of limitations barred

claims based on his pressure ulcers. See id. However, he contended that

the amputation of his lower left leg was a distinct injury and that his

complaint was timely filed with respect to that injury. The majority in Ex

parte Mobile Infirmary Ass'n disagreed, concluding that it was forced

"to confront the reality that McBride's argument essentially
amounts to an invitation for pure speculation by this Court.
Specifically, to surmise, as McBride appears to suggest in his
answer, that the eventual need for the amputation of
McBride's lower left leg could have been an altogether new
injury, totally unrelated to the injuries already present on
June 20, 2018, would be a supposition that is not only absent
from, but directly contrary to, McBride's actual allegations.
28
SC-2024-0174 and SC-2024-0184

Moreover, such speculation would fail to provide an
explanation of any causal relationship between the
defendants' alleged negligence and wantonness and the
amputation."

Id. at 847. In essence, the majority reasoned that McBride's allegations

required a finding that the pressure ulcer in his left heel caused the

amputation of his lower left leg and that, because the pressure ulcer was

present when McBride was discharged from Rotary Rehab, McBride had

filed his complaint after the expiration of the applicable limitations

period.

I dissented in Ex parte Mobile Infirmary Ass'n on the ground that,

on the face of McBride's complaint, he had "commenced his action within

two years of his leg-amputation injury." Id. at 851 (Mendheim, J.,

dissenting). I believed that the majority was reaching "a medical

conclusion at the motion-to-dismiss stage of the litigation" by finding that

the left-heel pressure ulcer was "the first onset of injury that eventually

led to the leg amputation." Id. at 852, 851. I noted that McBride's

complaint could be read as alleging that "the left-heel pressure ulcer was

one medical condition McBride had, just as he had a right-heel pressure

ulcer, but that the left-leg amputation was his actual injury." Id. at 851.

"[I]t [was] at least possible that the left-[heel] pressure ulcer was not the
29
SC-2024-0174 and SC-2024-0184

cause of the left-leg amputation" because McBride had a pressure ulcer

in his right heel at the time of his release from Rotary Rehab, yet that

had not led to the amputation of his right leg. Id. at 852. Moreover,

McBride also had alleged other medical conditions at the time of his

release from Rotary Rehab, such an infection. I therefore concluded that

McBride's complaint could not be dismissed on a motion to dismiss based

on a statute-of-limitations defense.

The factual allegations in this case present a different picture than

in Ex parte Mobile Infirmary Ass'n. The relevant allegations in Pates's

complaint are as follows:

"14. On or about August 20, 2020, Dr. Kirchner
performed the surgery on Pates's ankle fracture at Grandview
Medical Center. The procedure was an outpatient procedure,
and plates and screws were used to fix the fracture. Dr.
Kirchner was the sole physician performing the surgery and
he was the individual responsible for inserting and fixating
the medical hardware inside of Ms. Pates.

"….

"16. [Pates] made at least six visits to see Dr. Kirchner
at Southlake for post-operative care, beginning on August 31,
2020. During her appointments, she notified Dr. Kirchner
that she was feeling discomfort in her right leg, which was the
leg [on which] Dr. Kirchner performed the procedure.

"….

30
SC-2024-0174 and SC-2024-0184

"19. On or about November 9, 2020, [Pates] presented
herself to the emergency room at UAB Highlands in
Birmingham, Alabama to seek relief for the excruciating pain
she was feeling in her right leg. Upon an initial evaluation,
medical personnel saw drainage from the wound that showed
signs of an infection. The hardware that had been placed in
her ankle at the time of the surgery was removed in an
additional procedure on or about November 22, 2020.

"20. [Pates] received prescriptions for more oral
medications after the medical procedure on November 22,
2020. But the initial wound had not healed and [Pates]
noticed more wounds on other parts of her right leg.

"….

"23. On our about February 11, 2021, [Pates] had her
right leg amputated at the waist due to the advancing
infection in her leg. She avers that she was told that
amputation may be the only way to save her life. Prior to this
date, she had no knowledge that the surgery on her ankle had
caused this much damage.

"….

"25. That the standard of medical care applicable to the
Defendant Dr. Kirchner prior to placing foreign bodies inside
of a patient is to ensure that those bodies are free from
infection or other harmful influences prior to usage. In this
case, Dr. Kirchner, nor his proxy, did not properly inspect or
evaluate the hardware that was placed inside of [Pates] or
otherwise ensure that her injuries, as described after the
procedure, were not a direct result of the insertion of the
medical hardware that was used. As a direct and proximate
result of these failures, [Pates] suffered a physical injury to
her body. All of these failures amounted to a breach of the
applicable standard of medical care.

31
SC-2024-0174 and SC-2024-0184

"….

"31. On or about August 20, 2020, the Defendant
Kirchner performed a surgical procedure on [Pates] where he
inserted medical plates and screws in her right leg.

"32. That on at least six different occasions after the
date of the surgical procedure, [Pates] complained of post-
surgical discomfort in her right leg.

"33. It was later determined that the medical appliances
that were placed in [Pates's] leg by the Defendant Kirchner
were covered in infection.

"….

"37. As a direct and proximate result of one or more of
the foregoing wrongful acts or omissions of the Defendants,
Ms. Pates became further injured and suffered a traumatic
transfemoral amputation of her right leg. …"

(Emphasis added.)

The foregoing allegations clearly declare that the true injury in this

case was an infection in Pates's right leg. The complaint plainly states

that Pates "had her right leg amputated at the waist due to the advancing

infection in her leg." In other words, the leg infection was Pates's first

legal injury, while the leg amputation was a consequence of that injury.

In fact, one could even say that the leg amputation was a treatment for

Pates's leg infection because, as Pates asserts, "she was told that

amputation may be the only way to save her life." Pates even describes
32
SC-2024-0174 and SC-2024-0184

the leg amputation as a "further injur[y]" and as an illustration of how

"much damage" had been caused by "the surgery on her ankle." Thus,

unlike McBride in Ex parte Mobile Infirmary Ass'n, who never stated

that the pressure ulcer in his left heel led to the amputation of his left

leg, Pates directly and clearly states on the face of her complaint that the

leg infection she had contracted led to the amputation of her right leg.

Moreover, also unlike McBride in Ex parte Mobile Infirmary Ass'n, who

"appear[ed] to suggest that the actual cause of his need for a lower-left-

leg amputation [was] currently unknown but [could] be determined after

discovery," 349 So. 3d at 846-47, Pates openly alleges that the cause of

the infection was "that the medical appliances that were placed in

[Pates's] leg by the Defendant Kirchner were covered in infection."

Consequently, in this case, the Court does not engage in speculation

about the cause of Pates's injury in concluding that the amputation of her

right leg was not her first legal injury and, therefore, that the date of the

amputation was not the date from which her cause of action accrued.

Pates's complaint states that the infection manifested on November 9,

2020; that was the date when the act complained of -- Dr. Kirchner's

insertion of allegedly unsterile medical hardware into Pates's right ankle

33
SC-2024-0174 and SC-2024-0184

-- resulted in a legal injury. See Mobile Infirmary v. Delchamps, 642 So.

2d 954, 958 (Ala. 1994). However, Pates did not file her complaint until

February 10, 2023, which is clearly outside the applicable two-year

limitations period. For this reason, the main opinion correctly concludes

that the defendants are entitled to their requested relief of the dismissal

of the claims asserted against them.

34