Ex parte Coosa Valley Medical Center PETITION FOR WRIT OF MANDAMUS (In re: Rhiannon Carroll, as the natural parent and next of kin of her minor child, J.C. v. Marble City Family Care and Obstetrics, P.C.; Coosa Valley Medical Center; and Clifton Garris, M.D.) (Talladega Circuit Court: CV-22-900226).

Rel: December 12, 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, 2025-2026

_________________________

SC-2024-0767
_________________________

Ex parte Coosa Valley Medical Center

PETITION FOR WRIT OF MANDAMUS

(In re: Rhiannon Carroll, as the natural parent and next of kin
of her minor child, J.C.

v.

Marble City Family Care and Obstetrics, P.C.; Coosa Valley
Medical Center; and Clifton Garris, M.D.)

(Talladega Circuit Court: CV-22-900226)
SC-2024-0767 and SC-2024-0770

_________________________

SC-2024-0770
_________________________

Ex parte Marble City Family Care and Obstetrics, P.C., and
Clifton Garris, M.D.

PETITION FOR WRIT OF MANDAMUS

(In re: Rhiannon Carroll, as the natural parent and next of kin
of her minor child, J.C.

v.

Marble City Family Care and Obstetrics, P.C.; Coosa Valley
Medical Center; and Clifton Garris, M.D.)

(Talladega Circuit Court: CV-22-900226)

COOK, Justice. 1

In July 2022, Rhiannon Carroll sued Coosa Valley Medical Center

("Coosa Valley"), Marble City Family Care and Obstetrics, P.C. ("Marble

City"), and Clifton Garris, M.D. (collectively referred to as "the

defendants"), on behalf of her minor child, J.C. She filed one complaint

against Coosa Valley and a separate complaint against Marble City and

1This case was originally assigned to another Justice on this Court.

It was reassigned to Justice Cook on August 22, 2025.
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Dr. Garris, both in the Talladega Circuit Court. In those complaints, she

alleged claims under the Alabama Medical Liability Act of 1987, § 6-5-

541 et seq., Ala. Code 1975 ("the AMLA"), for injuries suffered by J.C.

during his birth on October 19, 2020.

On July 25, 2022, Carroll filed identical first amended complaints

against the defendants in which she sought both compensatory and

punitive damages for injuries sustained by both her and J.C. during

childbirth. In her amended complaints, Carroll alleged that there were

multiple breaches of the applicable standard of care before, during, and

after J.C.'s birth, including a failure to discuss all options for delivery

with her; the crudeness of the delivery, which, she alleged, resulted in an

injury to J.C.'s shoulder; and the failure to perform both an after-birth

ultrasound and a fetal-growth examination.

After Carroll amended her complaints, the defendants spent the

next two years conducting and responding to written discovery,

preparing witnesses, participating in depositions, retaining experts, and

constructing their defense strategies for this litigation with the

understanding that the allegations in Carroll's amended complaints

described "each act and omission" upon which her claims were based.

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After the close of fact discovery, Carroll served her expert

disclosures on the defendants. Those disclosures indicated that Carroll's

experts -- three doctors and one nurse -- would be offering opinions also

addressing acts or omissions that were not previously alleged in Carroll's

original or first amended complaints. However, Carroll had not amended

her complaints to add allegations concerning those new acts or omissions.

As a result, the defendants moved to strike portions of the expert

disclosures so as to prevent Carroll's experts from testifying about acts

or omissions that were not alleged in her original or first amended

complaints. It was only after those motions were filed that Carroll finally

amended her complaints to add additional allegations about the new acts

or omissions identified by her experts.

The defendants thereafter moved to dismiss the new allegations in

Carroll's second amended complaints on the basis that they were not

timely asserted. The trial court denied the defendants' motions.

The defendants have now petitioned this Court for writs of

mandamus directing the trial court to vacate its orders denying their

motions to dismiss the new allegations in Carroll's second amended

complaints and to enter orders granting the defendants motions to

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dismiss. For the reasons explained below, we grant both petitions

Facts and Procedural History

I. Carroll's Prenatal Care

On March 9, 2020, Carroll initiated prenatal maternity care at

Marble City's clinic and had her first obstetrician appointment with Dr.

Garris. Carroll continued to visit Dr. Garris during her pregnancy, and,

at her appointment on July 14, 2020, Dr. Garris diagnosed Carroll with

gestational diabetes mellitus and ordered a consultation with a

maternal-fetal-medicine specialist. At the time, Carroll was at 23 weeks'

gestation.

Carroll attended a prenatal appointment at the University of

Alabama-Birmingham Obstetrics Special Care Clinic on July 27, 2020,

during which it was recommended that Carroll start taking metformin

orally if she did not meet her prenatal-treatment goals. It was also

recommended that an ultrasound be conducted at 36-37 weeks' gestation

to record an estimated fetal weight.

Following that appointment, Dr. Garris started Carroll on

metformin on August 18, 2020. Dr. Garris also ordered a nonstress test,

a biophysical-profile ultrasound, and a fetal-growth ultrasound on

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September 29, 2020. However, according to Carroll, the fetal-growth

ultrasound was never conducted, and "[n]o fetal weight determination or

fetal growth parameters were performed or reported."

On October 13, 2020, when Carroll was at 36 weeks' gestation, Dr.

Garris diagnosed Carroll with preeclampsia and ordered at-home blood-

pressure monitoring. He also gave Carroll Celestone in anticipation of

inducing labor at 37 weeks' gestation.

II. Carroll's Induction

On October 19, 2020, Carroll was admitted to Coosa Valley for her

planned induction of labor. At that time, Dr. Garris performed "an

artificial rupture of membranes and began Pitocin intravenous infusion

to stimulate uterine contraction and labor."

Carroll alleges that her medical records indicate that she pushed

for approximately two hours and that "Dr. Garris then applied a Kiwi

Vacuum device to pull the baby out." J.C.'s right shoulder initially could

not be extracted, and, even after Carroll was placed in "the McRoberts'

position," the shoulder still could not be extracted. Dr. Garris then

"reached in and grabbed the posterior shoulder (left shoulder) and

delivered the shoulder with a pop which was felt." The right shoulder

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was then delivered while Carroll was in the McRoberts' position. Mild hip

dystocia was noted after J.C. was delivered.

Carroll also alleged that her "perineum was noted to have a 4th

degree midline tear through the posterior vaginal wall into the rectal

mucosa and right labial tear." According to Carroll, "[t]his required

multiple sutures to repair."

J.C. was born at 5:02 p.m. on October 19, 2020, and weighed 9

pounds and 13 ounces. J.C. had a left midshaft humerus fracture and a

right brachial plexus injury. He was transferred to the neonatal-

intensive-care unit on October 21, 2020.

III. Carroll's Underlying Lawsuit Against the Defendants

On July 1, 2022, Carroll filed a complaint against Coosa Valley and

a complaint against Marble City and Dr. Garris. Later that month,

Carroll filed identical first amended complaints against the defendants

in which she sought both compensatory and punitive damages for injuries

sustained by both her and J.C. during childbirth. She alleged four counts

against the defendants.

In Count One, Carroll alleged that Dr. Garris failed to meet the

"national standard of care" in 25 different ways. For instance, Carroll

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alleged that, before delivery, Dr. Garris failed to determine J.C.'s fetal

weight, which would have required him to consider performing a primary

cesarean section and to offer that as an option to Carroll before her

induction. Carroll also alleged that, during delivery, Dr. Garris

negligently applied the Kiwi vacuum device and failed to perform a

cesarean section after Carroll pushed for more than two hours.

In Count Two, Carroll alleged that Dr. Garris failed to meet the

applicable standard of care because he did not inform Carroll about all

the material risks, benefits, and alternatives to vaginal delivery. More

specifically, Carroll alleged that Dr. Garris knew, or should have known,

the increased risk of injury to J.C. with vaginal delivery because of

Carroll's gestational diabetes, larger than expected fundal height, and

short maternal stature and the lack of an estimated fetal weight. Carroll

alleged that had Dr. Garris disclosed the material risks of vaginal

delivery, both Carroll and a reasonable person in Carroll's position would

not have consented to vaginal delivery and would have instead chosen a

cesarean section, which, she asserted, likely would have prevented all of

J.C.'s injuries.

In Count Three, Carroll alleged that Marble City, from which she

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received prenatal care, did not obtain informed consent and breached the

applicable standard of care by failing to follow its own established policies

and procedures. Specifically, Carroll alleged that the national standard

of care requires Marble City to have policies in place to follow up on

important tests ordered but not performed by its physicians. Carroll

further alleged that Marble City negligently trained and supervised its

physicians, nurses, and office personnel on the policies and procedures

that were in place regarding patient testing. Carroll also alleged that

Marble City breached the applicable standard of care by not conducting

the fetal-growth ultrasound and by scheduling Carroll for vaginal

delivery without her informed consent before obtaining an estimated

fetal weight.

In Count Four, Carroll alleged a medical-negligence claim against

Coosa Valley. Carroll alleged that Coosa Valley was required to have

policies and procedures in place to prevent avoidable harm and that

Coosa Valley's failure to perform the fetal-growth ultrasound ordered by

Dr. Garris, and its potential failure to inform Dr. Garris, his staff, or

Carroll that the test had not been performed, were breaches of the

applicable standard of care. Carroll also alleged that Coosa Valley's

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nurses breached the applicable standard of care, and that Coosa Valley

was liable under the doctrine of respondeat superior, because the nurses

failed to properly assess the position of the presenting cephalic part

during delivery and because they did not attempt to stop Dr. Garris from

applying a vacuum device to assist with the delivery.

The defendants filed their answers in August 2022 and raised

various affirmative defenses, including the defenses provided in the

AMLA.

The parties then conducted discovery over the next two years.

Pursuant to the trial court's scheduling order entered on January 12,

2024, fact discovery was scheduled to close on May 28, 2024, which was

extended once by mutual agreement to June 11, 2024.

IV. Carroll's Rule 26, Ala. R. Civ. P, Expert Disclosures

On June 11, 2024, Carroll served her Rule 26 expert disclosures,

which identified four expert witnesses: Dr. Brian Woodruff, Dr. Brock

McMillen, Dr. Michelle Alba, and Nurse Julie Miller-Morin.

According to those expert disclosures, Dr. Woodruff intended to

testify about the extent of J.C.'s injuries, that J.C. may not fully recover

through physical or occupational therapy, and that J.C. likely would not

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have suffered his injuries had a cesarean section been performed.

Next, the expert disclosures revealed, Dr. McMillen and Dr. Alba

intended to testify about various topics related to Dr. Garris's alleged

breach of the applicable standard of care, including Dr. Garris's efforts to

obtain an estimated fetal weight, his application of a vacuum to assist

with delivery, his failure to offer Carroll a primary cesarean section, and

his failure to explain the risks and benefits of a primary cesarean section

to Carroll.

In addition, the expert disclosures indicated that they intended to

testify about acts and omissions not previously set out in Carroll's first

amended complaints, including Dr. Garris's allegedly improper

administration of Pitocin and his repair of Carroll's perineal tear.

Finally, the expert disclosures revealed that Nurse Miller-Morin

intended to testify that Coosa Valley's nurses breached the applicable

standard of care for a variety of reasons, including by failing to properly

assess the position of the presenting cephalic part during delivery and by

failing to attempt to stop Dr. Garris from applying the vacuum during

delivery.

In addition, the expert disclosures revealed that she intended to

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testify about acts and omissions not previously set out in Carroll's first

amended complaints, including the nurses' alleged failure to properly

recognize and report risk factors associated with shoulder dystocia, to

correctly manage and respond to changes in fetal status, to follow

physician orders, and to manage the administration of Pitocin.

V. The Defendants' Motions to Strike and Carroll's Subsequent
Second Amended Complaints

More than two weeks later, on June 28, 2024, the defendants filed

motions to strike portions of Carroll's expert disclosures, arguing that

some of the expert opinions addressed acts or omissions that were not

contained in Carroll's first amended complaints, in violation of the

discovery privileges provided in § 6-5-551 of the AMLA.

On July 29, 2024, approximately seven weeks after the close of fact

discovery and after Carroll had disclosed her experts, Carroll responded

by filing second amended complaints. She also filed a response to the

defendants' motions to strike.

Carroll's second amended complaints added new claims related to

the new acts and omissions alleged in Carroll's Rule 26 expert

disclosures, specifically, claims pertaining to (1) the administration of

Pitocin, (2) the repair of Carroll's perineal tear, and (3) the additional
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ways Coosa Valley's nurses allegedly breached the applicable standard of

care.

In her response to the defendants' motions to strike, Carroll argued

that the defendants' motions were now "moot" because Carroll had now

amended her complaints "in a timely manner following the completion of

fact discovery" and more than 90 days before trial.

The defendants then filed motions to dismiss the new allegations in

Carroll's second amended complaints on August 12, 2024, arguing that

those new allegations against the defendants violated the "timely

amendment" requirement in § 6-5-551 of the AMLA.

VI. The Trial Court's Orders on the Defendants' Motions to Strike
and Motions to Dismiss

The trial court then held a hearing on the defendants' motions to

strike portions of Carroll's expert disclosures and motions to dismiss the

new allegations in Carroll's second amended complaints.

Following that hearing, on October 2, 2024, the trial court entered

a single order denying Coosa Valley's motion to strike some of the expert

opinions and motion to dismiss the new allegations in Carroll's second

amended complaint. In support of its decision, the trial court reasoned

that Carroll had "filed her Second Amended Complaint within 40 days of
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the last discovery deposition and close of fact discovery, prior to expert

depositions, and nearly a year prior to trial" and that, therefore, the

"additional allegations against [Coosa Valley] … were timely under Ala.

Code § 6-5-551 and are due to be granted." The trial court further

reasoned that Coosa Valley's motion to strike portions of Carroll's expert

disclosures should be denied "because this Court finds the additional

allegations against [Coosa Valley] in Plaintiffs' Second Amended

Complaint timely."

That same day, the trial court also entered an order denying Marble

City and Dr. Garris's motion to strike portions of Carroll's expert

disclosures and their motion to dismiss the new allegations in Carroll's

second amended complaint. The trial court entered an amended order the

following day. In support of its decision, the trial court reasoned, among

other things, that Carroll had "filed her Second Amended Complaint

within 40 days of the last discovery deposition and close of fact discovery,

prior to expert depositions, and nearly a year prior to trial" and that,

therefore, the "additional allegations against Defendant Clifton Garris in

Plaintiffs' Second Amended Complaint were timely under Ala. Code § 6-

5-551 and are due to be granted."

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The trial court also concluded that Marble City and Dr. Garris's

motion to strike portions of Carroll's expert disclosures should be denied

because Carroll had properly amended her complaint to include her new

allegations. More specifically, the trial court reasoned that the motion

should be denied "because this Court finds the additional allegations

against Clifton Garris in Plaintiffs' Second Amended Complaint timely,

and that the additional allegations relate back to the original allegations

in the complaint," and because § 6-5-551 of the AMLA "provides plaintiffs

the right to amend their complaints to reflect newly discovered breaches

of the standard of care and to amend their complaint to reflect the course

of discovery."

Thereafter, the defendants filed motions to reconsider those orders.

After the trial court denied those motions, the defendants filed the

present petitions for the writ of mandamus. Our Court ordered answers

and briefs.

Standard of Review

Our Court has previously explained that a

"'writ of mandamus is an extraordinary remedy, and it will be
"issued only when there is: 1) a clear legal right in the
petitioner to the order sought; 2) an imperative duty upon the
respondent to perform, accompanied by a refusal to do so; 3)
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the lack of another adequate remedy; and 4) properly invoked
jurisdiction of the court."'"

Ex parte Alfa Mut. Ins. Co., 212 So. 3d 915, 918 (Ala. 2016) (quoting Ex

parte Yarbrough, 788 So. 2d 128, 132 (Ala. 2000)) (other citation omitted).

Furthermore, if the "'remedy by way of appeal is adequate, as is usually

the case with rulings allowing or disallowing amendments, we will

decline to grant the writ; in those cases in which an appeal does not

provide an adequate remedy, we will issue the writ.'" Id. (quoting Ex

parte Yarbrough, 788 So. 2d at 132). However, a "'writ of mandamus …

will issue to correct a trial court's ruling regarding the amendment of

pleadings … when it is shown that the trial court has exceeded its

discretion.'" Id. (quoting Ex parte Liberty Nat'l Life Ins. Co., 858 So. 2d

950, 952 (Ala. 2003)).

Discussion

The defendants argue, among other things, that the new allegations

in Carroll's second amended complaints violate the AMLA's "timely

amendment" requirement in § 6-5-551. In response, Carroll argues that

the new allegations in her second amended complaints were timely under

§ 6-5-551, relate back to the date the case was originally filed, under Rule

15(c), Ala. R. Civ. P., and therefore do not implicate the discovery
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privileges provided in § 6-5-551 of the AMLA. For the reasons explained

below, we agree with the defendants.

I. A Plaintiff's Right to Amend a Complaint under Rule 15(a), Ala.
R. Civ. P., and § 6-5-551 of the AMLA

Ordinarily, Rule 15(a) governs whether an amendment to a

pleading is allowed. That rule provides, in relevant part, that

"a party may amend a pleading without leave of court, but
subject to disallowance on the court's own motion or a motion
to strike of an adverse party, at any time more than forty-two
(42) days before the first setting of the case for trial, and such
amendment shall be freely allowed when justice so requires."

Rule 15(a) (emphasis added).

The right to amend provided in Rule 15(a) is not unlimited. At any

time not more than 42 days before the first setting of the case for trial, "a

party may amend a pleading only by leave of court, and leave shall be

given only upon a showing of good cause." Id. In addition, our Court has

previously recognized that other reasons, such as undue delay in

requesting an amendment, can support the denial of an amended

pleading before the case is set for trial. See, e.g., Puckett, Taul &

Underwood, Inc. v. Schrieber Corp., 551 So. 2d 979, 984 (Ala. 1989) ("We

have frequently recognized that undue delay in filing an amendment,

when it could have been filed earlier based on the information available
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or discoverable, is in itself ground for denying an amendment." (citing

Stallings v. Angelica Uniform Co., 388 So. 2d 942, 947 (Ala. 1980))); see

also Ex parte Liberty Nat'l Life Ins. Co., 858 So. 2d at 953 (noting that

"actual prejudice or undue delay" are valid grounds to deny an

amendment before the first setting of the case for trial).

However, the present case involves claims that were brought under

the AMLA. The AMLA includes pleading requirements for certain actions

against a health-care provider for breaching the applicable standard of

care. See § 6-5-551 (providing that "the [AMLA] shall govern the

parameters of discovery and all aspects of the action" (emphasis added)).

Unlike with other actions, the AMLA requires the plaintiff to include in

the complaint "a detailed specification and factual description of each act

and omission alleged by [the] plaintiff to render the health care provider

liable to [the] plaintiff and shall include when feasible and ascertainable

the date, time, and place of the act or acts." § 6-5-551 (emphasis added).

Section 6-5-551 also governs amendments to complaints alleging

claims under the AMLA. That statute provides, in relevant part: "The

plaintiff shall amend his complaint timely upon ascertainment of new or

different acts or omissions upon which his claim is based; provided,

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however, that any such amendment must be made at least 90 days before

trial." (Emphasis added.)

The AMLA's more specific amendment requirements in § 6-5-551

supplement Rule 15(a)'s more general provisions. See § 6-5-552, Ala.

Code 1975 ("[The AMLA] applies to all actions against health care

providers based on acts or omissions accruing after June 11, 1987, and as

to such causes of action, shall supersede any inconsistent provision of

law." (emphasis added)). To conclude otherwise would make the text of

§ 6-5-551 a nullity. See, e.g., Rule 1(a), Ala. R. Civ. P. ("These rules govern

procedure in the circuit courts and in courts of full, like jurisdiction …

except as otherwise provided by statute …." (emphasis added)); Ala.

Const. 2022, Art. VI, § 150 (providing that the Supreme Court has the

power to "make and promulgate rules" but that those "rules may be

changed by a general act of statewide application"); Ex parte Kennedy,

656 So. 2d 365, 267-68 (Ala. 1995) (concluding that the AMLA's venue

provisions govern instead of the venue provisions in the Alabama Rules

of Civil Procedure).

The defendants argue that Carroll's new allegations in her second

amended complaints were untimely. More specifically, the defendants

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argue that Carroll had knowledge of the acts and omissions upon which

her new allegations are based at the time the case was originally filed,

or, according to Carroll's own statements during discovery, at least more

than a year before she filed her second amended complaints. Carroll’s

delay in amending her complaints, the defendants argue, violates § 6-5-

551's requirement that the plaintiff "timely" amend her complaint "upon

ascertainment of new or different acts or omissions upon which [her]

claim is based." (Emphasis added.) We will address each of the new

allegations in Carroll's second amended complaints in turn.

II. Carroll's New Allegations in her Second Amended Complaints

A. Carroll's New Allegations Concerning the Administration
of Pitocin Were Untimely with Respect to Marble City and Dr.
Garris.

Although the first amended complaint contained an itemized list of

25 alleged breaches of the applicable standard of care by Dr. Garris, it

did not include an allegation that the administration of Pitocin

constituted a breach of the standard of care. The materials before us

indicate that Carroll had a copy of her medical records and possessed the

information required to assert a claim concerning the administration of

Pitocin when she first filed this lawsuit on July 1, 2022. However, she

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did not amend her complaint to assert such a claim until July 29, 2024,

more than two years after the suit was initiated.

It is further evident from the materials before us that, at the very

latest, Carroll knew of the facts that formed the basis of her Pitocin claim

on March 9, 2023, when her attorney deposed Dr. Garris, or on June 20,

2023, when her attorney deposed Nurse Skinner. Carroll herself states

in her answer that Nurse Skinner's deposition revealed "key

communications between the care team -- particularly between Nurse

Skinner and Dr. Garris -- regarding fetal response to Pitocin titration."

Carroll's answer to Marble City and Dr. Garris's petition at 32. Despite

this knowledge, it is undisputed that Carroll did not amend her

complaint to include a claim related to the administration of Pitocin until

16 months after Dr. Garris's deposition, 13 months after Nurse Skinner's

deposition, and after fact discovery had closed.

To justify this delay, Carroll first argues that § 6-5-551 "expressly

allows amendments based on newly discovered acts or omissions,

provided they are filed at least 90 days before trial." Carroll's answer to

Marble City and Dr. Garris's petition at 20. Then, Carroll argues that

her second amended complaint was timely because it "follow[ed]

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extensive discovery and expert review" and was filed more than 90 days

before trial. Id.

Carroll misinterprets this statute. While this statute prohibits a

plaintiff from amending her complaint within 90 days of trial, it also

provides that the plaintiff "shall amend [her] complaint timely upon

ascertainment of new or different acts or omissions upon which [her]

claim is based." § 6-5-551 (emphasis added).This portion of the statute is

mandatory, as evidenced by the Legislature's use of the word "shall." See

Ex parte Prudential Ins. Co. of America, 721 So. 2d 1135, 1138 (Ala. 1998)

(recognizing that "[t]he word 'shall' is clear and unambiguous and is

imperative and mandatory"). The 90-day requirement identified by

Carroll is an additional requirement that cannot be used to render the

mandatory portion of the statute inoperative or meaningless. See Ex

parte D.B., 975 So. 2d 940, 954 (Ala. 2007) (" ' " 'A statute should be

construed so that effect is given to all its provisions, so that no part will

be inoperative or superfluous, void or insignificant ….' " ' ") (citations

omitted)).

Carroll then argues, without citing any caselaw, that her delay was

justified because she wanted to collect more evidence so that she could

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"present a fully substantiated complaint based on the culmination of fact

discovery and expert review, consistent with the intent of § 6-5-551."

Carroll's answer to Marble City and Dr. Garris's petition at 33 (noting

that, after Nurse Skinner's deposition, Carroll continued to collect

evidence from her husband regarding her injuries, to seek evidence from

her pediatric-neurology expert, and to take the depositions of her

colorectal surgeon and gastroenterologist).

However, Carroll's argument regarding the "intent of § 6-5-551" is

mistaken. There is no indication in the text of the statute that a plaintiff

can delay filing an amended complaint to allow for the "culmination of

fact discovery and expert review" so that the plaintiff can file a "fully

substantiated" amended complaint. 2 Instead, the text of § 6-5-551

2In fact, we note that § 6-5-540, Ala. Code 1975, of the AMLA --

which is titled "Legislative intent" -- does not include any language that
would support Carroll's argument here. Rather, it expressly states that
"a crisis threatens the delivery of medical services to the people of
Alabama" and that "it is the declared intent of this Legislature to insure
[sic] that quality medical services continue to be available at reasonable
costs …." It also states that the "Legislature finds and declares that the
increasing threat of legal actions for alleged medical injury causes and
contributes to an increase in health care costs … and that [the AMLA]
should be given effect immediately to help control the spiraling cost of
health care and to insure [sic] its continued availability." § 6-5-540.

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requires a plaintiff to "timely" amend her complaint "upon ascertainment

of new or different acts or omissions upon which [her] claim is based."

(Emphasis added.) Stated simply, a plaintiff must amend her complaint

when she becomes aware of the new or different acts or omissions upon

which her claim is based.

Carroll failed to timely amend her complaint with respect to her

claim related to the administration of Pitocin against Dr. Garris and

Marble City. Carroll had a copy of her medical records and possessed the

information required to assert a Pitocin claim when she initially filed her

original complaint. And she does not dispute that she ascertained "new

or different acts or omissions" relevant to her Pitocin claim during Dr.

Garris's and Nurse Skinner's depositions. In fact, as noted above, Carroll

admits that Nurse Skinner's deposition revealed "key communications"

relevant to her Pitocin claim.

Despite her knowledge, Carroll did not amend her complaint to

include a claim related to the administration of Pitocin until 16 months

after she became aware of the facts related to the administration of that

drug through Dr. Garris's deposition, 13 months after she became aware

of similar facts through Nurse Skinner's deposition, and after fact

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discovery had closed. Carroll's new Pitocin claim in her second amended

complaint thus came too late, in violation of § 6-5-551.

B. Carroll's New Allegations Concerning the Repair of Her
Perineal Tear Were Untimely.

Carroll also alleged in her second amended complaint that "Dr.

Garris breached the standard of care in repairing [her] 4th degree

perineal tear" because, she said, Dr. Garris should have sought "the

assistance of a gynecologic surgeon or general/colorectal surgeon, and the

repair should have been performed in an operating room."

The materials before us indicate that, although Carroll's earlier

complaints made clear that there was a 4th degree perineal tear resulting

from the delivery and that other evidence of the tear was produced during

discovery, Carroll did not allege that Dr. Garris breached the applicable

standard of care with respect to the repair of her perineal tear until she

filed her second amended complaint on July 29, 2024.

We note that the "factual allegations" section in the first amended

complaint states that Carroll suffered a "4th degree tear" that required

"multiple sutures" to repair and "forms part of the basis for the

independent injuries suffered by Rhiannon Carroll," but that complaint

did not include a claim against Dr. Garris related to the repair of the
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perineal tear. In fact, it said nothing about a breach of the applicable

standard of care related to the repair. Section 6-5-551 provides that a

complaint must include "a detailed specification and factual description

of each act and omission alleged by [the] plaintiff to render the health

care provider liable to [the] plaintiff." (Emphasis added.) If Carroll knew

of the acts and omissions that formed the basis of this claim when she

first brought this suit, she should have included them in her original

complaint. 3

If, however, Carroll did not know of the acts and omissions that

formed the basis of this claim when she first brought this suit, she

certainly knew of them by the time she was deposed on January 25, 2023.

3Marble City and Dr. Garris also argue that the repair of the tear

was a separate occurrence and that, therefore, the new allegation (even
if it could be added to the complaint) cannot relate back for statute-of-
limitations purposes. Our Court has held in the context of a medical-
malpractice claim under the AMLA that, when a proposed amendment
"altered what occurrence allegedly caused [the decedent's] injuries and
what conduct … allegedly exacerbated the occurrence that precipitated
[the decedent's] death," the new claims did not relate back and were
therefore barred by the AMLA's two-year statute of limitations. See, e.g.,
Ex parte Affinity Hosp., LLC, 373 So. 3d 180, 190 (Ala. 2022) (emphasis
added). However, we need not reach the issue whether the new
allegations in Carroll's second amended complaint relate back to the date
of the original complaint, because we conclude that these new allegations
are untimely in violation of § 6-5-551.
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Indeed, she discussed Dr. Garris's repair of the tear in that deposition,

and both Dr. Garris and Nurse Skinner addressed the process for

repairing the 4th degree perineal tear in their depositions in March and

June of 2023 respectively.

At the very least, Carroll was required at that time, under § 6-5-

551, to "timely" amend her complaint to include her claim related to the

repair of her perineal tear and the acts and omissions upon which that

claim is based. Instead, Carroll waited for 17 months before amending

her complaint.

Carroll tries to justify this delay the same way she tries to justify

her delay with respect to her claim concerning the improper

administration of Pitocin against Marble City and Dr. Garris.

Specifically, she reiterates her arguments that § 6-5-551 "expressly

allows" amendments filed at least 90 days before trial and that her delay

was justified because she wanted to collect more evidence so that she

could "present a fully substantiated complaint based on the culmination

of fact discovery and expert review, consistent with the intent of § 6-5-

551." Carroll's answer to Marble City and Dr. Garris's petition at 33.

Those arguments are unavailing for the same reasons previously

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discussed.

C. Carroll's New Allegations Against Coosa Valley's Nurses
Were Untimely.

Finally, in her first amended complaint, Carroll alleged that Coosa

Valley's nurses breached the applicable standard of care and that Coosa

Valley is liable under the doctrine of respondeat superior. Specifically,

Carroll alleged that Coosa Valley's nurses breached the applicable

standard of care because, she said, they failed to properly assess the

position of the presenting cephalic part during delivery and did not

attempt to stop Dr. Garris from applying a vacuum device to assist with

the delivery.

In her second amended complaint, however, Carroll added a

significant number of factual allegations identifying new acts and

omissions to support her argument that Coosa Valley's nurses breached

the applicable standard of care. In fact, this section of the complaint more

than doubled in length. For instance, in addition to the allegations in

Carroll's first amended complaint, Carroll's second amended complaint

contains allegations that Coosa Valley's nursing staff "failed to identify,

consider in the care plan, and report maternal risk factors associated

with shoulder dystocia"; "did not adequately recognize or report
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SC-2024-0767 and SC-2024-0770

symptoms of preeclampsia"; "failed to communicate and collaborate with

the physician to provide a plan of care for patient safety, specifically in

the prevention of potential seizures"; "failed to recognize and report

elevated and severe range blood pressures and did not administer the

ordered antihypertensive medication, Hydralazine," which was not

documented in the nursing notes; "failed to adequately assess, recognize,

and respond to changes in the fetal status," including "persistent

Category II fetal heart rate patterns"; "failed to follow written physician

orders, including those related to managing Pitocin administration"; did

not "appropriately manage Pitocin" given the "presence of a persistent

Category II fetal heart rate pattern and uterine tachysystole"; "did not

implement intrauterine resuscitation measures when indicated, such as

repositioning the patient, administering an IV fluid bolus, or providing

oxygen"; and "failed to discontinue or decrease the Pitocin

administration" despite the presence of "excessive uterine activity and

tachysystole."

Because these new allegations clearly refer to "new or different acts

or omissions," they are subject to the "timely" amendment requirement

in § 6-5-551. Coosa Valley argues that Carroll's new allegations are

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based on information that was previously available to Carroll in her

medical records, which Carroll obtained before initiating the lawsuit on

July 1, 2022. Therefore, Coosa Valley asserts, Carroll had knowledge of

the new acts and omissions referred to in her second amended complaint

at the time the case was originally filed.

Coosa Valley also argues that Carroll had knowledge of the newly

alleged acts and omissions at least a year before she filed her second

amended complaint. Specifically, Coosa Valley argues that Carroll's

questioning during Nurse Skinner's deposition reveals that Carroll knew

of these acts and omissions before Nurse Skinner's deposition and that,

at the very latest, Carroll was aware of these new facts at the conclusion

of Nurse Skinner's deposition on June 20, 2023.

In support of this argument, Coosa Valley notes that Carroll

admitted that Nurse Skinner provided "extensive deposition testimony

addressing" the issues of Pitocin administration and preeclampsia

management. Coosa Valley's petition at 25. However, Carroll did not file

her second amended complaint until July 29, 2024, 13 months after

Nurse Skinner's deposition.

Coosa Valley also notes that there was no discovery relevant to

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Carroll's new allegations against Coosa Valley during the 13-month

period between Nurse Skinner's deposition and the filing of Carroll's

second amended complaint. Specifically, Coosa Valley notes that the

discovery conducted during that time included the second portion of

Carroll's deposition, which focused on Carroll's injuries; the deposition of

Carroll's husband, which focused on observations during Carroll's

pregnancy and her injuries; and the depositions of Carroll's colorectal

surgeon and gastroenterologist, who were deposed regarding Carroll's

alleged perineal tear and Dr. Garris's repair. Thus, the scope of this

additional discovery did not include the "new … acts and omissions"

alleged by Carroll against Coosa Valley's nurses. § 6-5-551.

Carroll does not provide an explanation for why she failed to timely

amend her complaint after she ascertained these new acts and omissions.

Instead, Carroll reprises her general argument that § 6-5-551 permits

amendments "if filed at least 90 days before trial." Carroll's answer to

Coosa Valley's petition at 24.

Carroll also appears to suggest that she needed time for her experts

to review these facts. However, as explained repeatedly throughout this

opinion, § 6-5-551 requires timely amendment "upon ascertainment of

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new or different acts or omissions upon which [her] claim is based."

(Emphasis added.) Here, the ascertainment of the acts and omissions

underlying Carroll's new allegations occurred at least 13 months before

she amended her complaint for a second time. This does not meet the

timeliness requirements under § 6-5-551.

Carroll also argues that Coosa Valley's own conduct delayed

discovery, contributing to Carroll's delayed amendment. Specifically,

Carroll alleges that, at "the August 2023 status conference, [Coosa

Valley] opposed scheduling, citing incomplete discovery." Carroll's

answer to Coosa Valley's petition at 27. However, there is nothing in the

materials before us that indicates what occurred during the August 2023

status conference that would support Carroll's assertion here. See Ex

parte Guaranty Pest Control, Inc., 21 So. 3d 1222, 1228 (Ala. 2009)

(noting that there is no traditional "record" when this Court considers a

petition for a writ of mandamus, though parties may supplement the

"record" before us if they like). More importantly, in her answer, Carroll

does not explain, and cites no cases to support, why Coosa Valley's

opposition to setting the action for trial in 2023 absolves Carroll of her

responsibility under § 6-5-551 to "timely" amend her complaint "upon

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ascertainment of new or different acts or omissions upon which [her]

claim is based." (Emphasis added.)

Finally, in a single paragraph without any citations, Carroll

acknowledges the additional discovery conducted during the 13-month

period between Nurse Skinner's deposition and the filing of her second

amended complaint. However, Carroll does not explain how this

additional discovery was relevant to Carroll's new claims against Coosa

Valley's nurses or why this additional discovery absolves Carroll of her

responsibility to "timely" amend her complaint.

In sum, Carroll's new allegations against Coosa Valley's nurses in

her second amended complaint are untimely under § 6-5-551. Carroll's

second amended complaint refers to significantly more alleged acts and

omissions than did her previous complaints to argue that Coosa Valley's

nurses breached the applicable standard of care. However, Carroll once

again fails to justify why she failed to "timely" amend her complaint

"upon ascertainment" of these "new or different acts or omissions upon

which [her] claim is based." (Emphasis added.)

Conclusion

As demonstrated above, the new allegations in Carroll's second

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amended complaints were untimely under the requirements set forth in

§ 6-5-551 of the AMLA because Carroll was aware of the acts or omissions

underlying those allegations well before she filed those complaints. As a

result, the trial court exceeded its discretion by failing to dismiss the new

allegations in Carroll's second amended complaints. We therefore grant

the petitions filed by the defendants because they have demonstrated a

clear legal right to the relief they are seeking. Importantly, this

conclusion does not require dismissal of Carroll's claims in their entirety;

the remaining, timely asserted claims may proceed.

Accordingly, we issue a writ of mandamus in case no. SC-2024-0767

directing the trial court to vacate its October 2, 2024, order with respect

to Coosa Valley, and to enter an order granting Coosa Valley's motion to

dismiss the new allegations in Carroll's second amended complaint. We

also issue a writ of mandamus in case no. SC-2024-0770 directing the

trial court to vacate its October 3, 2024, amended order with respect to

Marble City and Dr. Garris, and to enter an order granting Marble City

and Dr. Garris's motion to dismiss the new allegations in Carroll's second

34
SC-2024-0767 and SC-2024-0770

amended complaint.4 The remainder of Carroll's claims shall remain

pending in the trial court.

SC-2024-0767 -- PETITION GRANTED; WRIT ISSUED.

SC-2024-0770 -- PETITION GRANTED; WRIT ISSUED.

Stewart, C.J., and Wise, Sellers, and McCool, JJ., concur.

Shaw and Bryan, JJ., concur in the result.

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

4Because we find that Carroll's new allegations in her second
amended complaints were untimely under § 6-5-551 of the AMLA, we
pretermit discussion of the remaining arguments raised by the parties.
See Ex parte Board of Water & Sewer Comm'rs of City of Mobile, 272 So.
3d 635, 638 (Ala. 2018).
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MENDHEIM, Justice (concurring in the result).

I write to highlight what I see as a substantial departure from well-

established Alabama law regarding amendments to complaints in

medical-malpractice actions. Until now, when this Court has addressed

whether a plaintiff's amendment to a complaint is proper or timely, it has

been within the context of the parameters we have spelled out in relation

to Rule 15(a), Ala. R. Civ. P., such as when there is actual prejudice to

the defendant or undue delay, see, e.g., Ex parte Taylor, [Ms. SC-2025-

0164, Nov. 7, 2025] __ So. 3d __ (Ala. 2025), or in relation to Rule 15(c)

and the relation-back doctrine that implicates statutes of limitations.

See, e.g., Ex parte Affinity Hosp., LLC, 373 So. 3d 180 (Ala. 2022). This

case marks the first time this Court has addressed what constitutes a

"timely" amendment under the Alabama Medical Liability Act of 1987

("the AMLA"), § 6-5-541 et seq., Ala. Code 1975 -- specifically, § 6-5-551,

Ala. Code 1975 -- when the plaintiff's amendment occurred more than 90

days before trial.

It is unfortunate that we are drawing this new line using the vehicle

of a petition for the writ of mandamus -- and thus expressly concluding

that "the trial court exceeded its discretion by failing to dismiss

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[Rhiannon] Carroll's second amended complaints" -- even though neither

the trial court nor the parties had any previous guidance from this Court

with respect to the basis upon which we issue the writs today. 5 __ So. 3d

at __.6 The main opinion justifies utilizing a petition for a writ of

mandamus to address the issue before us by citing Ex parte Alfa Mutual

Insurance Co., 212 So. 3d 915, 918 (Ala. 2016), which quotes Ex parte

Liberty National Life Insurance Co., 858 So. 2d 950, 952 (Ala. 2003), for

the proposition that " '[a] writ of mandamus ... will issue to correct a trial

court's ruling regarding the amendment of pleadings ... when it is shown

that the trial court has exceeded its discretion.' " But the context for that

5" ' " '[T]here is something unseemly about telling a lower court it

was wrong when it never was presented with the opportunity to be
right.' " ' " Birmingham Hockey Club, Inc. v. National Council on
Compensation Ins., Inc., 827 So. 2d 73, 80 (Ala. 2002) (citations and
emphasis omitted).

6Unsurprisingly, the petitioners do not provide us with any
previous precedents that entertained a petition for a writ of mandamus
on the basis that a plaintiff's amendment of a complaint was untimely
solely based on § 6-5-551 even though " ' "[t]he right sought to be enforced
by mandamus must be clear and certain with no reasonable basis for
controversy about the right to relief," ' and ' "[t]he writ will not issue
where the right in question is doubtful." ' " Ex parte Coosa Valley Health
Care, Inc., 789 So. 2d 208, 216 (Ala. 2000) (quoting Ex parte Bozeman,
420 So. 2d 89, 91 (Ala. 1982), quoting in turn Ex parte Dorsey Trailers,
Inc., 397 So. 2d 98, 102 (Ala. 1981)).
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proposition in both Alfa Mutual and Liberty National was an amendment

to a complaint under Rule 15(a), not under § 6-5-551. Entertaining a

petition for a writ of mandamus to evaluate whether a trial court has

exceeded its discretion in either allowing or denying an amendment to a

complaint under Rule 15(a) has been permitted by this Court since Miller

v. Holder, 292 Ala. 554, 297 So. 2d 802 (1974). In other words, trial courts

have 50 years of precedent at their disposal to guide their determinations

about the timeliness of an amendment under Rule 15(a).

The sentence in § 6-5-551 upon which the main opinion relies has

been part of the statute since its adoption in 1987, yet this decision is the

first time we have issued a writ of mandamus on the basis that a trial

court allowed an amendment that we deem to be untimely solely under

that statute.7 Consequently, today we create a road in mandamus

litigation that we have not previously given any indication was available

for parties to travel. I anticipate that an increase in the volume of

7It is all the more perplexing to announce this new standard shortly

after all the Justices concurred in granting a petition for a writ of
mandamus ordering a trial court to grant a motion to strike a plaintiff's
amended complaint in an AMLA action on the ground of "undue delay for
purposes of Rule 15(a)." Ex parte Taylor, [Ms. SC-2025-0164, Nov. 7,
2025] __ So. 3d __, __ (Ala. 2025).
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mandamus traffic will follow in the wake of this decision given that the

main opinion offers no guardrails or analysis for what constitutes a

"timely" amendment other than its proclamation that "the ascertainment

of the acts and omissions underlying Carroll's new allegations occurred

at least 13 months before she amended her complaints for a second time.

This does not meet the timeliness requirements under § 6-5-551." __ So.

3d at __.

The main opinion seems to indicate that the reason this case is

being decided solely based on the "timely" amendment requirement of §

6-5-551 rather than upon Rule 15(a)'s established standards of actual

prejudice and undue delay is that "[t]he AMLA's more specific

amendment requirements in § 6-5-551 supplement Rule 15(a)'s more

general provisions" and that "[t]o conclude otherwise would make the text

of § 6-5-551 a nullity." Id. at __. It is true that, in an AMLA case, the

standards we have enunciated under Rule 15(a) "must be evaluated in

light of the rights of a defendant and the duties of a plaintiff under § 6-5-

551, Ala. Code 1975 …." Ex parte Taylor, __ So. 3d at __. But it does not

follow that electing not to articulate a timeliness standard solely under §

6-5-551 is tantamount to holding that the statute means nothing.

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Instead, it would indicate a desire to be cautious concerning what the

statute itself requires given that the only guidance it provides is that

"[t]he plaintiff shall amend his complaint timely upon ascertainment of

new or different acts or omissions upon which his claim is based …." § 6-

5-551.

Does "timely" mean "immediately"? One would presume it does not

because the legislature could have used that word. Black's Law

Dictionary defines the word "timely" to mean "[w]ithin a specified

deadline; in good time; seasonable." Black's Law Dictionary 1792 (12th

ed. 2024). The only specified deadline in § 6-5-551 is that "any such

amendment must be made at least 90 days before trial." That deadline is

irrelevant to the facts presented in these petitions because Rhiannon

Carroll filed her second amended complaints on July 29, 2024, and the

trial date was set for April 21, 2025, in the trial court's scheduling order.

"In good time" is akin to "a reasonable time," but if that is what "timely"

means, it begs the question of how much time is "good" or "reasonable" in

a given circumstance? After all, litigation is a relatively slow process of

determination. "Seasonable" seems to lack any legal precision.

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The generalized nature of the term indicates that whether an

amendment is "timely" filed after ascertainment of new or different acts

or omissions is within the discretion of the trial court. Cf. Randolph Cnty.

v. Thompson, 502 So. 2d 357, 364 (Ala. 1987) ("Since [Rule 24, Ala. R.

Civ. P., addressing motions to intervene], itself, is silent concerning what

constitutes a 'timely application,' it has long been held that the

determination of timeliness is a matter committed to the sound discretion

of the trial court."). The dearth of previous precedents on this issue is

therefore unsurprising, and the avoidance of enforcing what constitutes

a "timely" amendment under § 6-5-551 through petitions for a writ of

mandamus has been entirely sensible.

The main opinion states that a delay of 13 months between when

Carroll became aware of new or different acts or omissions and when she

amended her complaints is unequivocally not "timely" under § 6-5-551. Is

12 months too long, or 6 months, or 3 months? When does the clock start

ticking? Is it the moment a plaintiff discovers a single new or different

act or omission or is there a threshold of multiple acts or omissions that

triggers the starting point because § 6-5-551 uses the plural "acts or

omissions" when it discusses the requirement to "timely" amend a

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complaint? The main opinion answers none of those questions, but the

Court can be sure that a string of future petitions for the writ of

mandamus will be asking them and others I have not posited. When those

petitions are presented, I hope we have a more concrete idea of how to

answer such questions than what is provided in today's decision.

42