Ex parte David Murl Spalding, M.D.; Vanessa Kay Hill, CRNP; and University of Alabama Health Services Foundation, P.C. PETITION FOR WRIT OF MANDAMUS (In re: Arlene Morgan and Daniel Morgan v. Maynor & Mitchell Eye Center, P.C.; Jennifer B. Martin, O.D.; University of Alabama Health Services Foundation, P.C. ; David Murl Spalding, M.D.; and Vanessa Kay Hill, CRNP) (Madison Circuit Court: CV-24-901651).

Rel: August 29, 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
SPECIAL TERM, 2025

_________________________

SC-2025-0275
_________________________

Ex parte David Murl Spalding, M.D.; Vanessa Kay Hill, CRNP;
and University of Alabama Health Services Foundation, P.C.

PETITION FOR WRIT OF MANDAMUS

(In re: Arlene Morgan and Daniel Morgan

v.

Maynor & Mitchell Eye Center, P.C.; Jennifer B. Martin, O.D.;
University of Alabama Health Services Foundation, P.C.; David
Murl Spalding, M.D.; and Vanessa Kay Hill, CRNP)

(Madison Circuit Court: CV-24-901651)
SC-2025-0275 and SC-2025-0283

_________________________

SC-2025-0283
_________________________

Ex parte Maynor & Mitchell Eye Center, P.C., and Jennifer B.
Martin, O.D.

PETITION FOR WRIT OF MANDAMUS

(In re: Arlene Morgan and Daniel Morgan

v.

Maynor & Mitchell Eye Center, P.C.; Jennifer B. Martin, O.D.;
University of Alabama Health Services Foundation, P.C.; David
Murl Spalding, M.D.; and Vanessa Kay Hill, CRNP)

(Madison Circuit Court: CV-24-901651)

SELLERS, Justice.

These consolidated petitions for the writ of mandamus involve an

action commenced by Arlene Morgan and her husband Daniel Morgan,

alleging medical malpractice against various health-care providers. In

case no. SC-2025-0275, University of Alabama Health Services

Foundation, P.C. ("the Foundation"), David Murl Spalding, M.D., and

Vanessa Kay Hill, CRNP (collectively referred to as "the Foundation

defendants"), petition this Court for a writ of mandamus directing the

2
SC-2025-0275 and SC-2025-0283

Madison Circuit Court to dismiss the claims asserted against them by

the Morgans, based on the application of the limitations period or the

period of repose set forth in § 6-5-482(a), Ala. Code 1975. In case no. SC-

2025-0283, Maynor & Mitchell Eye Center, P.C. ("the Eye Center"), and

Jennifer B. Martin, O.D. (collectively referred to as "the Eye Center

defendants"), petition this Court for a writ of mandamus seeking the

same relief as the Foundation defendants.1 For the reasons explained

below, we grant the petitions and issue the writs.

I. Facts

On October 22, 2024, the Morgans commenced the underlying

action against the defendants. In that action, Arlene asserted medical-

malpractice claims against the defendants pursuant to the Alabama

Medical Liability Act ("the AMLA"), § 6-5-480 et seq. and § 6-5-540 et

seq., Ala. Code 1975, and Daniel asserted a claim of loss of consortium.

The gravamen of the complaint is (1) that Arlene was prescribed

1According to the complaint, the Foundation employs Dr. Spalding

and Hill and is, therefore, allegedly vicariously liable for the acts and/or
omissions of those health-care providers. And, the Eye Center is Dr.
Martin's practice group and is, therefore, allegedly vicariously liable for
her acts or omissions.

3
SC-2025-0275 and SC-2025-0283

Plaquenil, a drug that poses a risk of retinopathy or damage to the retina,

which can lead to severe and permanent vision loss if timely cessation of

use of the drug does not occur, and (2) that the defendants were negligent

and wanton by failing to properly screen her for retinopathy while

prescribing Plaquenil, by ignoring her medical history and symptoms,

and by permitting her to remain on the drug, thus causing her to suffer

permanent vision loss. The Foundation defendants and the Eye Center

defendants filed separate motions to dismiss, arguing that the Morgans'

action was barred by the limitations period and/or the period of repose

set forth in § 6-5-482(a), which is part of the AMLA. 2 The trial court

2The Morgans filed a first amended complaint that included as
exhibits medical literature regarding Plaquenil, as well a discussion of
that literature in the complaint; the trial court did not exclude those
exhibits. Because the medical literature is central to the Morgans'
complaint and is referred to in the complaint, the motions to dismiss in
this case are not treated as motions for a summary judgment, pursuant
to Rule 56(c), Ala. R. Civ. P. See Donoghue v. American Nat'l Ins. Co.,
838 So. 2d 1032 (Ala. 2002) (noting that, if an exhibit is central to and
referred to in the complaint, its consideration does not convert a motion
to dismiss into a motion for a summary judgment). The Morgans also filed
a second amended complaint to substitute the Foundation for a
previously named defendant, UAB Medicine Enterprise, which had been
dismissed as an improper defendant. Because neither the first amended
complaint nor the second amended complaint altered the material facts
and allegations of the original complaint, the motions to dismiss were not
moot. See Meadows v. Shaver, 327 So. 3d 213, 222 (Ala. 2020) (holding
that an amendment of a pleading moots an opponent's pending motion
4
SC-2025-0275 and SC-2025-0283

entered separate orders denying the motions to dismiss. These

mandamus petitions followed, and this Court consolidated the petitions.

II. Standard of Review

"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 Alabama Dep't of Corr., 252 So. 3d 635, 636 (Ala. 2017).

The Foundation defendants and the Eye Center defendants seek

mandamus review of the orders denying of their motions to dismiss,

which were filed pursuant to Rule 12(b)(6), Ala. R. Civ. P. " 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, this Court has permitted

mandamus review of a trial court's order denying a motion to dismiss

when it was clear from the face of a complaint that the claims asserted

therein were barred by the limitations period or the period of repose set

only to the extent that the substance of the amendment moots the
substance of the motion).
5
SC-2025-0275 and SC-2025-0283

forth in § 6-5-482(a). See Ex parte Hodge, 153 So. 3d 734 (Ala. 2014)

(permitting mandamus review of a trial court's order denying a motion to

dismiss when it was clear from the face the complaint that the plaintiff’s

medical-malpractice claim was barred by the four-year period of repose

set forth in § 6-5-482(a)).

Regarding Rule 12(b)(6) dismissals, this Court has stated:

"On appeal, a dismissal is not entitled to a presumption
of correctness. The appropriate standard of review under Rule
12(b)(6) 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 her to relief. In making this determination, this Court
does not consider whether the plaintiff will ultimately prevail,
but only whether she may possibly prevail. We note that 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 that would entitle the plaintiff to relief."

Nance v. Matthews, 622 So. 2d 297, 299 (Ala. 1993) (internal citations

omitted).

III. Discussion

The defendants argue that it is clear from the face of the complaint

that the causes of action in this case accrued on October 24, 2019, when

Arlene first discovered through testing that she had "definitive signs of

retinol toxicity." Thus, they say, the Morgans' action, which was
6
SC-2025-0275 and SC-2025-0283

commenced on October 22, 2024, is barred by § 6-5-482(a). We agree.

Section 6-5-482(a) provides, in relevant part, that claims brought

pursuant to the AMLA must be brought "within two years next after the

act, or omission, or failure giving rise to the claim ...; provided further,

that in no event may the action be commenced more than four years after

such act." In Mobile Infirmary v. Delchamps, 642 So. 2d 954 (Ala. 1994),

this Court stated the following general propositions concerning the

limitations period set forth in § 6-5-482(a):

"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)."

642 So. 2d at 958 (emphasis added).

7
SC-2025-0275 and SC-2025-0283

The key fact in this case is the time at which Arlene first suffered a

legal injury caused by the defendants' alleged failure to discontinue her

use of Plaquenil. The following factual allegations concerning the alleged

malpractice are taken from the second amended ("the operative

complaint"):

"27. On or about July 10, 2013, [Arlene] presented to
the Kirklin Clinic of UAB Hospital … with complaints of joint
pain and was seen by Dr. Spalding, a Rheumatologist, who
diagnosed [Arlene] with erosive inflammatory osteoarthritis.

"28. Dr. Spalding chose to prescribe a medication called
Hydroxychloroquine, also known by its brand name of
Plaquenil, in order to treat [Arlene's] diagnosed erosive
inflammatory osteoarthritis.

"29. Plaquenil poses a known risk of retinopathy, or
damage to the retina, which can lead to severe and permanent
vision loss if timely cessation of the drug does not occur. …

"….

"31. Annual screening is required in order to properly
screen a patient for Plaquenil retinopathy and must begin no
later than five (5) years after a patient has started taking
Plaquenil, as long as the patient is receiving a proper dose
and does not have any major risk factors for Plaquenil
retinopathy. … The goal of screening is to recognize definitive
signs of toxicity at an early enough stage to prevent a serious
loss of visual acuity.

"….

8
SC-2025-0275 and SC-2025-0283

"46. The risk of harm associated with Plaquenil use
increases exponentially with the duration of Plaquenil use. …
The risk of harm is low at the beginning of a patient's use of
Plaquenil, but that risk increases more severely with each
passing year as the patient continues to take Plaquenil.

"….

"51. On or about October 24, 2019, Dr. Martin saw
[Arlene] at the Maynor & Mitchell Eye Center. At this visit,
Dr. Martin knew, or should have known, that [Arlene] had
been taking Plaquenil for over five (5) years and was required
to receive, at minimum, both an automated visual field test
and an SD OCT [Spectral Domain Optical Coherence
Tomography] test every year. Dr. Martin chose not to provide
[Arlene] with an automated visual field test, but did perform
an SD OCT on [Arlene]. The SD OCT revealed localized
thinning of the photoreceptor layers in the parafoveal region
of [Arlene's] eyes. Dr. Martin knew, or should have known,
that this thinning was a strong indicator of toxicity. Dr.
Martin chose to permit [Arlene] to continue taking Plaquenil
despite the results of the SD OCT which revealed definitive
signs of toxicity. …

"52. On or about November 19, 2019, Dr. Spalding saw
[Arlene] at the Kirklin Clinic of UAB Hospital. … Dr.
Spalding chose not to discontinue prescribing Plaquenil to
[Arlene] despite [the October 24, 2019, SD OCT] ….

"….

"54. On or about October 29, 2020, Dr. Martin saw
[Arlene] at the Maynor & Mitchell Eye Center. [Arlene]
complained of seeing a glare with headlights and indicated
that she no longer drove at night anymore due to her visual
acuity. At this visit, Dr. Martin knew, or should have known,
that [Arlene] had been taking Plaquenil for over five (5) years,
that loss of night vision is associated with Plaquenil
9
SC-2025-0275 and SC-2025-0283

retinopathy, and that [Arlene] … was required to receive, at a
minimum, both an automated visual field test and an SD OCT
test every year. Dr. Martin chose not to provide [Arlene] with
either of the two required minimum tests to screen for
Plaquenil retinopathy. Dr. Martin chose to permit [Arlene] to
continue taking Plaquenil despite the loss of night vision and
despite the absence of the required minimum Plaquenil
retinopathy screening tests within the past year. …

"….

"59. On or about May 24, 2022, [Arlene] presented to
the Kirklin Clinic of UAB Hospital and was seen by Ms. Hill,
a Certified Registered Nurse Practitioner ('CRNP'). As a
CRNP prescribing Plaquenil … Ms. Hill chose not to
discontinue prescribing Plaquenil to [Arlene] despite the
absence of the required minimum Plaquenil retinopathy
screening tests within the past year. …

"60. On or about November 3, 2022, Dr. Martin saw
[Arlene] at the Maynor & Mitchell Eye Center. [Arlene]
complained of seeing afternoon glares, seeing blocks of light
and dark when reading, having difficulty seeing the TV, and
being unable to drive at night. Dr. Martin chose, for the first
time, to perform an automated visual field test. Dr. Martin
also chose to perform an SD OCT on [Arlene], the first SD
OCT since 2019. The automated visual field test revealed
visual field defects consistent with Plaquenil retinopathy.
The SD OCT revealed significant thinning of the
photoreceptor layers in [Arlene's] eyes. Dr. Martin chose to
refer [Arlene] to Ophthalmologist [Dr. Alexander Talalight] …
for possible Plaquenil toxicity and instructed [Arlene] to stop
taking Plaquenil.

"61. On or about December 15, 2022, Dr. Talalight saw
[Arlene] at the Retina Centers of Alabama … where she
diagnosed [Arlene] has having toxic maculopathy of both eyes
due to Plaquenil."
10
SC-2025-0275 and SC-2025-0283

(Emphasis added.)

According to the allegations of the operative complaint, Arlene's use

of Plaquenil, which began in July 2013, did not immediately cause a

medically identifiable legal injury. Rather, the operative complaint

specifically alleges that the "risk of harm associated with Plaquenil use

increases exponentially with the duration of Plaquenil use" and that, on

October 24, 2019, a Spectral Domain Optical Coherence Tomography test

revealed "definitive signs of [retinal] toxicity." In the Morgans' own

words, that is the date when Arlene first alleged that she had a medically

identifiable legal injury.3 As indicated, the operative complaint alleges

(1) that Arlene was prescribed Plaquenil at some point in July 2013; (2)

that there was a known risk that Plaquenil could cause retinopathy or

damage to the retina; (3) that annual screening is required to properly

3Despite the Morgans' allegations that testing showed "definitive

signs" of retinal toxicity, they now argue that they could not have
reasonably discovered their causes of action within the two-year
limitations period set forth in § 6-5-482(a), which provides, in relevant
part, 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 …."
Thus, the argument they now make on appeal, being contrary to the
allegations of the operative complaint, is without merit.
11
SC-2025-0275 and SC-2025-0283

monitor a patient for retinal toxicity and the screening must begin no

later than five years after a patient has started taking Plaquenil; (4) that

the goal of screening is to recognize definitive signs of toxicity at an early

enough stage to prevent a loss of visual acuity; (5) that, on October 24,

2019 (six years after beginning to take Plaquenil), testing "revealed

localized thinning of the photoreceptor layers in the parafoveal region" of

Arlene's eyes, which is a strong indicator of retinal toxicity; and (6) that

Arlene was permitted to continue taking Plaquenil despite the results of

that testing. Thus, accepting as true the facts as alleged by the Morgans

in their operative complaint, their causes of action accrued on October

24, 2019. Despite the allegations of their operative complaint, the

Morgans argue that medical negligence in cases involving Plaquenil

toxicity occurs "when a patient is not timely taken off of Plaquenil," that

the legal injury occurs when a patient "suffers severe vision loss that

would have otherwise been prevented had the patient been timely taken

off" the drug, and that the "threshold of 'severe vision loss' is ingrained

within the medical literature." Answer at 23. Although it is clear from

the allegations of the operative complaint that Arlene's symptoms

continued to progress or worsen, it is well established that the two-year

12
SC-2025-0275 and SC-2025-0283

limitations period and the four-year period of repose set forth in § 6-5-

482(a) begin to run when the cause of action accrues, which is the date

the first legal injury occurs. See Ex parte Affinity Hosp., LLC, [Ms. SC-

2024-0174, Mar. 7, 2025] ___ So. 3d ___ (Ala. 2025) (holding that a

patient's cause of action manifested when the first signs of infection

arising out of a surgical procedure appeared, not when the infection

worsened to the point when amputation of the leg was required);

Delchamps, 642 So. 2d at 958 (noting that "[w]hether [Delchamps's]

claims are barred by § 6-5-482 depends on when in fact she first suffered

the alleged legal injury, i.e., the bone degeneration in her jaw"); Cutler v.

University of Alabama Health Servs. Found., P.C., 215 So. 3d 1065, 1073

(Ala. 2016) (plurality opinion) ("[I]t is clear from the allegations of his

complaint that Cutler suffered a legal injury 'within the [four] years

following [the] June 28, 2005,' MRI, because it is within that time that

Cutler alleges the tumor/lesion began its growth process and/or became

malignant. Thus, Cutler's argument that his 'legal injury' could not have

manifested itself until he actually suffered harm is unavailing."); and

Garrett v. Raytheon Co., 368 So. 2d 516, 520 (Ala. 1979) (noting that the

limitations period in a medical-malpractice action begins to run

13
SC-2025-0275 and SC-2025-0283

regardless of whether the full amount of the damage is apparent at the

time of the first legal injury).

It is well settled that a plaintiff is the master of his or her complaint

and that, in considering a motion to dismiss under Rule 12(b)(6), courts

are required to accept the allegations of the complaint as factually true.

Those facts are then measured and assessed against the legal

requirements to maintain a cause of action. In cases such as this, in

which there has been no discovery, the dates and times alleged in the

complaint are critical to evaluating whether the applicable statute of

limitations bars the cause of action. Because, in this case, the Morgans

allege that the first sign of a legal injury manifested on October 24, 2019,

their medical-malpractice action, which was commenced almost five

years later on October 22, 2024, was commenced well beyond the four-

year period of repose set forth in § 6-5-482(a); thus, their action is barred.

See Ex parte Hodge, 153 So. 2d at 742 (reiterating that the four-year

period of repose set forth in § 6-5-482(a) is an absolute bar to all medical-

malpractice claims bought more than four years after the cause of action

accrues).

IV. Conclusion

14
SC-2025-0275 and SC-2025-0283

The Morgans have alleged on the face of their operative complaint

specific facts demonstrating that their causes of action accrued on

October 24, 2019, yet they did not file their original complaint until well

beyond the four-year period of repose set forth in § 6-5-482(a); thus, the

defendants have demonstrated a clear legal right to orders dismissing

the claims against them. Therefore, we grant the petitions for the writ of

mandamus filed by the defendants, and we direct the trial court to vacate

its orders denying their motions to dismiss and to enter orders dismissing

the claims against them.

SC-2025-0275 -- PETITION GRANTED; WRIT ISSUED.

SC-2025-0283 -- PETITION GRANTED; WRIT ISSUED.

Stewart, C.J., and Shaw, Wise, Bryan, Mendheim, Cook, McCool,

and Lewis, JJ., concur.

15