P le a d ing s fil e d b y the D e fen d a n t state the c o rr e c t na m e is “S h e a E a r C linic , P .A .” 1 

### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON A ssi gne d O n B ri ef

F eb ru ary 28, 200 5
DOUGLAS McPHERSO N v. SH EA EAR CLI NIC, P.A.

Direc t Appeal from the Circ uit Court for Sh elby County No. CT-003839-03 R ita L. Stotts, Judge

No. W2004-00690-C OA-R3-C V - F iled May 18, 2005

The trial c ourt g rante d Def endant’ s motion to dismiss for failure to state a claim upon which relief can be g rante d. Having revie wed the c omplaint, we disag ree and re verse
. Te nn. R . A pp. P . 3 App e al a s o f Rig ht ; J udgm e nt of t he Ci r c uit

Co ur t R e ve r se d; and Rem anded

D AVI D R. F ARMER , J. , d e li v e r e d th e o p in io n o f th e c o u rt, inw h ic h W. F RAN K C RAW FORD , P.J ., W.S ., and H OL L Y M. K I RBY , J ., joined. Doug las McPherson, Pro Se

. J eff rey A. L and, Memphis, Tenne ssee, f or the a ppellee, Shea

Ear Clinic, P.A.
OP IN ION

Th is a pp e a l r e su lts fr om an o rd e r o f the tria l c ou rt g ranti ng the De fe nd a nt’ s motio n to dis mis s fi le d p ur su a nt t o Ru le 12 .0 2 o f the Te nn e sse e Rul e s o f C ivi l Pr oc e du refo r f a ilu reto s ta te a

c la im upon which re lief can be g rante d. This matter beg an in g ener al sess i o n s co u rt when the Plaintiff, Doug las McPherson ( Mr. McPherson or Plaintiff), filed a civil w arr ant desig nating the Def endant as “Shea Ear Clinic, c/o: John J . Shea, Jr., M.D” (Shea Clini c or Def endant)

. J udg ment was e ntere d 1 fo r the De fe nd a nt andMr

. Mc Phe rs on app e a le d to c ir c uit c ou rt . M r. Mc Phe rs on app e are d p ro se thr ou g ho ut the se pr oc e e din g s.
A civil a ction in the g ener al sessions c ourts is c ommenced by a civil warr ant. Tenn. Code An n. § 1 6- 15 -7 22 . T his statut e se ts f orth the fo rm

to be us e d. Th e c ivi l w arr a nt i n th e ins ta nt c a se states in the ar ea pr ovi d ed fo r a s tatement of the cause of ac tion the following: “ See attac hed
c omp la int date d 5-5 -0 3. ” Atta c he d to the c ivi l w arr a nt i s a do c ume nt s ty le d c omp la int wh ic h s ta te s, in p e rt ine nt p art , a s f

oll ow s:-2- CAUSE OF ACTI ON & BA SI S OF THI S COMP LAINT

1. Plaintiff suffer s hearing loss, tinnitus and re lated symptoms. On J anuary 13, 2003, Plaintiff was sche duled and e x p ec t ed to re ceive corr ective la ser injec ted treatment known as “xy locaine perf usion” at Shea Ear Clinic. Plaintiff is not awar e o f a n y o t h e r f

a c i l i t y w h e r e t h i s h i g h l y s p e c i a l i z e d “ o t o l ar y n g o l o g y ” tr e a t m e n tis available . This treatment is pr ofessionally classified a s “CPT code 69801” service s for billing pur

poses.
2. De fe nd a nt S hea Ear

Clin ic , c /o: John J. She a , Jr. , M .D ., is o r w a s, o b l i g ated unde r a Private Hea lthcare Sy stems (PHCS) understanding with Care Entree , T h e C ap ell a Gr oup, I nc., P. O. B ox 200368, Arling ton, TX 76006. The Capella Gr oup, I nc. is a c orporation parent c ompany of “Car e Entre e” medical plan that enrol l s m em bers on a monthlyfee , providing acc ess to saving s for medic al service s throug h a contr acte d network of medical “ Providers.” TheCare E ntree medic al p la

ne ng ag ed in a multi-state business including doing busine ss in Tennessee with the Def

endant. Pursuant to the Car e Entre e medica l plan contra ct, Def endant was obli g ated to provide “CPT code 69801” s ervic es t o individuals enrolled in the medical plan for a “contr acte d char g e” fee , while Care Entree marke ted “Provider ”
se rv ic e s in a ma nn e r that inc lud e d u sin g int e rn e t e xpos ur e . Pl a int if f w a s e nr oll e d in the Care Entree medical plan f or P HCS covera g e (inc luding “ CPT code 69801” service s) pursuant to his Member I D: 900226171, which was in effe ct at all re levant times (Ex hibit A).

3. Def endant’ s “CPT c ode 69801" Provider services at a “c ontrac ted cha rg e” fee wer e mar

keted a s being available to Pl ai n t i ff o n Dec ember 09, 2002, when he made a rra ng ement with Def

endant to sche dule hi m the “ea rliest surg ery

opening avai la b le

. ” Pl a in ti f

f w a s a d v is e d th e e ar li e s t d a te a v a il ab le w a s Ja n u ar y 1 3, 2003. Plaintiff’s understanding with Defe ndant (Exhibit B) was that “C P T code 69801" service s were to be paid for by Plaintiff on J anuary

13, 2 0 0 3 at t h e “c ontrac ted char g e” f ee pur suant to the Care Entree PHCS medical p l an , in which Def endant pa rt ic ipate d a s a “ Pr ov ide r” un de r a sp e c ia lty he a din g of

“ Ot ola ryng olo g y ” (E xhibi t C). Be foreDec ember

09, 2002, there had bee n previous corresponde nce, communication and c ontact betwe en De fendant and P l aint iff since early that y ear
. J ust a couple of

day s prior to the January 13, 2003 schedule d s u rge ry , Plaintiff reconfirme d by

phone, his upcoming appointment with a Shea Ea r Clinic appointment Secre ta r y ( 9 1 0 /7 6 1

- 9 7 2 0 ) w h o d id n o t a d v is e o f a n y c h a n g e in th e c h ar g e s o r any problem in pre- certification and re g istration proce ss. Plainti ff wa s also assure d by Care E n t re e”Member Ser vices” (888/411-3888) and I nterne t marketing (Care Entree .com), that De fendant is a part i cipating “Provider ” in the Care Entree medical plan ne twork under the spec ialty

heading of “O tolary ng ology .”-3- 4. De fe n dant harmfully

failed to notify

Plaintiff prior to the af

ternoon of J anuary 13, 2003, and only

afte r pre-surg ery testing had been done , that “CPT code 69801" se rvice s were no longe r available at the ag ree d upon “contr acte d char g e” f ee beca u s e of a c hang e in Def

endant’ s arr ang ement as a participating Provider

in the Care E ntree PHCS medical plan. T his chang e ca used Plaintiff to be denied the muc h neede d medical attention, which he could not affor d due to the unsche duled incre ase[] i n cost. After Plaintif f h ad u n derg one pre -surg ery testing, D efe ndant ref used to perf

orm the sche duled af

ternoon surg ery

for the pre- arr ang ed fee that since Dec ember

09, 2002, had bee n quoted and budg eted f or, and Plaintiff wa s prepa red to p a y a ft e r the a nti c ipate d s e rv ic e s h a d b e e n c omp le te d. B e fo reDe fe nd a nt w ou ld
commence the sche duled afte rnoon surg ery , an additional $3,031 wa s [] added to the cost s , i n addition to the pre-a rrang ed fe e Plaintiff was e x pecting to pay . Plaintiff
c ou ld n ot a ff

or d th is u ns c he du le d a dd iti on a l c os t of $3 ,0 31 , a nd wa s th us un able to rec eive the hig hly

anticipated sur g ery
. Our standard of re view is set forth in Dobbs v. Gue nther , 846 S.W .2d 270 (Tenn. Ct. App. 19 92 ), a s f

oll ow s:
Th e so le pu rp os e of a Te nn
. R. Civ

. P. 12 .0 2( 6) mot ion to dis mis s is t o te st the leg al suffic iency

of the c omplaint. Sand er s v. Vinson , 558 S.W .2d 838, 840 (T e nn . 1 97 7) ; Ho llo wayv . P utn um Cou nty , 534 S.W .2d 292, 296 (Tenn. 1976)

. These motions ar e not fa vored, se e Mo ore v . B e ll , 187 Tenn. 366, 369, 215 S.W .2d 787, 789 (1` 948), and a

re now rar ely g rante d in lig ht of the libera l pleading standards in the Tenne ssee Rules of Civil P roce dure. See B arish v. Metropolitan Gov’t , 627 S.W .2d 953, 954 (Tenn. Ct. App. 1981); 5A Charles A. Wrig ht & Arthur R. Mill er, Fe de ra l P ra c tic e & Pr

oc e du re §§ 1356 & 1357 (2d ed. 1990) ( “Wrig ht & Miller” ).

Te nn . R. Civ . P. 12 .0 2(6 ) m oti on s a reno t de sig ne d to c or

re c t in art fu lly worde d pleading s. Wright & Miller § 1356, at 296. And so a c omplaint should not be dis missed, no matter how poorly draf ted, if it states a c ause of

action. Pa sc ha ll’ s, Inc. v . Dozier , 2 19 Te nn . 4 5, 50 -5 1, 40 7 S. W.2 d 1 50 , 1 52 (1 96 6) ; Colli er v. Slay den Br os . Lt d. Pa rtn e rsh ip , 712 S.W .2d 106, 108 (Tenn. Ct. App 1985). Dismissal under Tenn. R. Civ. P. 12.02(6) i s wa rr anted onlywhen no se t of fac ts will entit le the plaintiff to relief

, Pembe rton v. Ame rican Distilled Spiri ts Co. , 664 S.W .2d 690, 691 ( T e n n
. 1 9 8 4 ) , o r

w h e n t h e c o m p l a i n t i f

t o t a l l y l a c k i n g i n c l ar i t y a n d s p e c i f i c i t y. Smith v. Lincoln Brass W orks, Inc

. , 712 S.W .2d 470, 471 (Tenn. 1986)

. Whil e it is not our role to c reate claims wher e n o n e e x i st, Donaldson v. Donaldson , 557 S.W .2d 60, 62 (Tenn. 1977), we must alway s look to the substance of a pleading rathe r than to its form. Us rey v . Le wis , 5 53 S.W. 2d61 2, 61 4 ( Te nn . Ct

. App. 1977). Thus, whe n a complaint is tested by a Te nn. R. Civ. P . 12.02(6) motion to dismi ss, we must take a ll the well-plea ded, material fac tual alleg ations as true, and we must construe the complaint libera lly in the plaintiff’s fa vor. Lewis v. Allen , 698-4-

S.W. 2d58 , 5 9 ( Te nn . 1 98 5) ; Ho llo wayv . P utn am Cou nty , 534 S.W .2d at 296, Lill y v . S mi th , 790 S.W .2d 539, 540 (Tenn. Ct. App. 1990).

Id . at 273-274.

Circuit courts should not dismi ss case s appea led from g ener al s essions court because of “any informality

whateve r, but shall be tried on i t s merits; . . .” Tenn. Code A nn. § 16-15-729 ( Supp. 2004). While the Tennesse e Rules of Civil P roce dure a pply to case s appea led from g ener al sessions
c ou rt to c ir c uit c ou rt , the pa

rt ie s ar e no t re qu ir e d to file fo rm a l pl e a din g s. Th e y ma y , h ow e ve r, fi le ple a din g s, e ng a g e in d isc ov e ry and take a dv a nta g e of the pr oc e du ra l to ols pr ov ide d insa id r ule s. See W are v. M eharry M ed. College , 898 S.W .2d 181, 185 (Tenn. 1995)

. As this Court st ated in Ir v in v . Ci ty of C lar

k sv ill e , 767 S.W .2d 649, 6 5 2 (T enn Ct. App. 1988), “[ p ] ro se lit ig a nts are e nti tle d to the sa me lib e ral it y of c on str uc tio n w ithre g ardto the ir pleading s that Tenn. R. Civ. P. 1, 8.05 & 8.06 aff ord any other litigant.”

As we c onstrue the complaint, it a lleg es that Mr. McPherson was enrolled in the Care E ntree me dic a l pl a n f

or Private He a lth c are Sy ste ms ( PHC S) c ov e ra g e . M e mbe rs are e nr oll e d o n a mon thl y fee , providing acc ess to saving s for medic al servic es throug h a contr act ed n etwork of medical “provide rs.” It is further a lleg ed the De fendant participate d as a pr ovider. The De fe n dant was obligated under

this plan to provide “CPT Code 69801” ser vices to individuals enrolled in the plan fo r a c on tr a c te d f

e e . It is a lle g e d th a t th e Pla int if f s uf fe rs he ari ng los s, tin nitus a ndre la te d s y mpt oms and wa s scheduled to rec eive corr ective laser injected treatment know n as “xy locaine pe rfusion” at Shea Clinic. The Plaintiff contac ted the clinic and his surg ery was sche duled. He w as assure d by Care En tr e e that De fe nd a nt wa s a partic ipatin g pr ov ide r. Af te r und e rg oin g pr e -s ur g e ry te sti ng , it is alleg ed that the De fendant refuse d to perform the schedule d surg ery for the p re -a rr ang ed fe e that Plainti ff ha d been quote d. Plaintiff alleg es that he c ould not affor d to pay the incre ased f

ee, an additional $3,031.

Th e brie f f

ile d inbe ha lf

of theAp pell ee state s g e ne ra l pr inc ipl e s c on c e rn ing a

mot ionto dismiss but doe s not a

rticulate why the complaint in this cause fails to state a ca u s e o f action. Appelle e’s brief doe s ref er to a n aff

idavit of Dr. John J . Shea, Jr. However , the brief makes no ref ere nce to the r ecor d and we do not find such af fidavit in the rec ord bef

ore us. Construing this complaint liberally in the Plaintiff’s favor , as weare compelled to do, we are unable to say

that the pleading filed in this cause fails to state a complaint upon which relief may be g rante d. The Appe llant further contends that the tria l court fa iled to gr ant him acc ommodations require d by

the Americans with Disabilities Act. The r ecor d ref lects that Mr. McPher son, on more than one oc casion, notified the trial court, by pleading s and cor

responde nce to the trial court c lerk, that he suffe red from hearing loss a nd require d rea sonable a ccommodations and f acilities. We areB y order of M ar ch 21 , 200 5, t he T en ne s s ee Supre me C our t approved f or i mp l ement at i on t he “ T enn es s ee 2 Jud i ci a l B ranch A m eri cans wi t h D i sabil i t i es Act P o l i cy R egard i ng A ccess t o Jud i ci al P rogram s” es t ab l i shed b y t he A d m i ni st rat i ve D i rect o r o f t he C o urt s. T hi s p o l i cy i s set out i n A p p end i x A t o t hat ord er. I ncl ud ed i n t he p o l i cy i s a fo rm t i t l ed “ R eques t for M od i f i cat i on. ”
-5- un able to dete rm ine fr om the re c or d b e fo reus wh e the r this wa s a dd re sse d b y the tria l c ou rt

. Howeve r, upon re mand, the trial c ourt shall addre ss this i ssue. 2 The Appe llant further

contends that the tria l judge should have re cused he rself. W e find no motion for rec usal in this record and thus find this i ssue to be without merit.

I n view of our

opinion rever sing the order of the trial c ourt dismi s s i ng this cause, the
re m ai n i n g i ssues prese nted by the Appellant a

re pr etermitted. I t results that the order of the trial court g ranting the Def

endant’ s motion t o dismiss is rever sed and this cause is rema nded to t he trial court fo r fu rt h er procee dings c onsistent with thi s opinion. Cos ts of this appeal a re ta x ed to the appellee , Shea Ea

r Clinic, P.A.

___________________________________ DAVID R. FARMER, J UDGE