### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON N O V E MB E R 2 8, 200 6 S es sio n

DAVID PREWI TT v . SEMMES -MURPHEY CLI NIC, P.C., ET AL


### .

Direc t Appeal from the Circ uit Court for Sh elby County No. CT-000235-03- 3 Kar en R. Williams, Judge

No. W2006-00556-C OA-R3-C V - F iled March 23, 2007

The plaintiff w as rende red a quadripleg ic afte r a ca r ac cident, and he rec eived c are at The Reg ional Medica l Center at Me mphis. The hospital staff included U nivers ity of Tenne ssee School of Medicine r esidents, private phy sicians who we re dua l employ ees of a p rivate c orporation and the University

of Tenne ssee as part of its residenc y training prog ram, and nurses employ ed by another pr ivate c or

po ratio n. Th e du a l e mpl oy e e ph y sic ians tr e a te d p a tie nts ind e pe nd e ntl y in t he ir c a pa c ity as employ ees of

the private corpor ation an d supervised r esident phy sicians in their ca pacity as employ ees of

the Univer sity

of Tenne ssee. A U niversity of Tenne ssee r esident phy sician intended to perfor m a lumbar punc ture proc edure on the plaintiff, and he left a written reque st for a nur se for a lumbar punc ture kit for sa id proce dure. The nurse pro v i d ed t h i s k i t, but did not i nclude a n antis ep t i c. T h e day

of the proc edure , the re sident phy sician lower ed the plaintiff’ s bed ra il and place d the plaintiff on his side in anticipation of pe rfor m i n g t h e l umbar punc ture, but whe n he

no tic e d th a t an a

nti se pti c wa s mis sin g fr om t he kit , h e br ie fl y

le ft the pla int if

f u natte nd e d to ob ta in the antiseptic. When the resident phy sician returne d to the room, the plaintiff had f allen off the bed onto the floor. The plaintiff rupture d his spleen from the f all, requiringmajor surg ery which re sulted in subsequent complications. The pla intiff filed suit in both the Tenne ssee Claims Commissi on and the c ir c uit c ourt a g a ins t the re sid e nt, the Un ive rs ity , the ho sp ita l, the nurs e , an d the pr e se nt c or po rate defe ndants, alleg ing c laims of medical malpr actice and neglig ent s upervision. The liability of the resident a nd the Univer sity

was stipulated by

the par ties in the Claims C ommissi on, and these parties

wer e dismissed from the c ircuit court pr ocee ding on the basis of immunit y . The pre sent defe ndant corpor ations remaine d in the circ uit court action. After discovery , the plaintiff moved f or summary judgme nt in the circ uit c ourt. The defe ndant phy sicians’ c orporation moved for summary judgme nt based upon immunity

and the plaintiff’ s lack of e x pert testimony , and the de fe n d ant nurse’ s corpor ation moved for summary judgme nt based upon the pl aintiff’s lack of expert testimony . The trial court g rante d both defe ndants’ motions for summary judgme nt and ce rtified the judg ments as final. The pla intiff filed a timely notice of a

ppeal to this Court. W e af firm.-2-

Tenn. R. App . P . 3; Appeal as of Right; Judgme nt of th e Circ uit Court Aff irm ed

A L AN E. H I G H ERS , J ., delivere d the opinion of the court, in which D AVI D R. F ARMER , J ., and H O LLY M. K I RBY , J ., joined.

Gar y K. Morre ll, Memphis, TN, for Appe llant

Al be rt C. H arv e y , M arc y

L . D od ds , M e mph is, TN , f or Ap pe lle e , Se mme s- Murp he y Clin ic

W. L e e Ma dd

ux, T . Ry an M a lon e , Ch a ttan oo g a , T N, fo r A pp e lle e s, Ki nd

re d Pu lmo na

ry Un it, Kindred H ealthca

re Ser vices, Inc., Kindre d Hospital-Chattanoog a and Ma rcia Glover, R.N.

OP IN ION

I. F ACT S AND P R OC EDU R A L H I S T ORY

T h i s i s an appea l from a medic al malpra ctice c ase in whic h the trial cour t gr anted the defe ndants’ motions for summary judgme nt. The plaintiff’s pr e-e x isting medica l co n d ition of quadripleg ia is not disputed, nor ar e the substantive f acts re lated to how the plaintiff’ s subsequent injury occur red. O n April 30, 2002, the plaintiff, Da vid Prewitt (“Plai ntiff” or “Appe llant”), wa s involved in an automobile ac cident on Interstate 55 in Mississippi. After beingtransporte d by

a mbu lanc e to a

Mis sis sip pi h os pit a l, h e wa s a ir lif te d to Th e Re g ion a l Me dic a l Ce nte r at Me mph is (“The Med”) wher e his sever e spinal i n j u ries we re tre ated in the Tr auma Intensive Care Unit by

nume ro us me dic a l pr ov ide rs

. Mr

. Pr e wi tt wa s e ve ntu a lly dia g no se d wi th q ua dr ipl e g ia

and pa ra ly sis

.

On J une 8, 2002, Mr. Pre witt was transfe rre d to the Kindred Pul m o n ar y Unit at The Med. On J une 17, 2002, Dr

. Ke l l y S cr antz, a neurosur g ery resident phy sician at the U niversity of Te nn e sse e Sc ho ol o f Me dic ine (“ UT ” ), pe rf or me d a lum ba r p un c tur e pr oc e dure on

Pla int if f w hil e being supervised by

a senior U T reside nt, Dr. B aner g ee. T his nonsurg ical invasive proce dure w as perf ormed without incident. Dr. Scrantz schedule d a repe tition of this procedur e four day s later. On the m orn ingof

June 21 , 2 00 2, Dr . Sc ra

ntz l e ft the fo llo wi ngwr itt e n o rd e r f or the nurs ingsta ff

in prepa ration for a sec ond lumbar puncture on Appell an t : “Lumbar Dra in kit to bedside[ .] L umbar Pun c tur e kit

to be ds ide [.] bo x 4 x 4[.] #7 ste ri le g lov e s[.]” Nu rs e Marc ia

Gl ov e r s ig ne d o ff

on thi s
or de r at a pp ro xima te ly

10 :45 A. M. , a

nd sh e pu t th e re qu e ste d it e ms i n Mr

. Pr e wi tt’ s ro om s ome tim e prior to the proc edure

.
At a pp ro xima te ly

3:1 5 P. M. that after no on , D r. Sc ra ntz e nte re d M r. Pr e wi tt’ s r oo m to perf orm the l umbar puncture proc edure . Dr. Scra ntz l ower ed Appe llant’s bed ra ils on the side where he wo uld be wo rk ingduri ngthe pr oc e dure and po sit ion e d the patie nt on his sid e a g a ins t th e be d r a ils on the opposite side. Dr. Scran t z place d the items provided by Nurse G lover on the be d, and he noticed that B etadine, an an tiseptic, was not pre sent. Dr. Scr antz imm ediately left the room a

nd be g an w a lki ngto t

he su pp ly c los e t, wh e re he loc a te d an d obta ine d a bo ttl e of B e ta din e . D r. Sc ra

ntzA s a res ul t o f t he o p erat i o n, P l ai nt i f

f f urt her al l eges t hat he “ sus t ai ned s evere ab d o m i nal dis f i gurem ent and 1

a lar g e ve n tra l he rn ia ” w h ic h stil l ha v e no t he a le d

.

P la intiff

vo lun ta rily d ism isse d N u rs e A v a n t f ro m the a c tio n o n M a rc h 1 0 , 2 0 0 6

. 2

T he aff

i l i ati o n a gre em en t b etwe en T h e U n iv e rsi t y of T en ne ssee S ch o o l o f M ed i cine an d T he S em m es3

M urp he y C l i nic ch ara cterize s t he na t ure o f t he relati o nship b etwe en t he t w o en t i t i es a s f o l l o w s:

Th e C o l l e g e o f

M e d i c i n e , Un i v e r s i t y o f Te n n e s s e e , M e m p h i s ( UT M em p hi s)
, and t he Se m m es- M urphey C l i ni c (S M C ) have had a close and
p rod uct i ve rel at i o nshi p i n t he neurologi cal and neurosurgi cal dis ci p l i nes f o r many y ears. U T M em p hi s and t he SM C unde rs t a n d th a t t he exi st ence o f a s t rong D ep art m ent of N eurosurgery i n t he C o l l ege o f M ed i ci ne (C O M ) enhances t he

o v e ra ll e x c e llen c e o f S M C , U T M e m p h is a n d the M e m p h is M e d ic a l C e n te r. W ith the re a liza tio n tha t o u tstan d ing p ro g ra m s in ed u c a tio n , re se a rc h a n d p a tien t ca re in N e u ro lo g y are a wort hy co m m o n ob ject i ve, U T M em p hi s and t he SM C de d i cate t h e m s e l v e s j o i n t l y t o p u r s u e e x c e l l e n c e i n t h e d e v e l o p m e n t o f a j o i n t C O M- S MC D epar t ment of

N eur ol ogy t hr ough a c oo pera t i ve i ni t i at i ve.

-3- walked ba ck towar d Mr. Prewitt’s room, and as he approa ched it, he sa w that Mr. Prew itt had fallen

on to t he fl oo r, and

that tw o h os pit a l st a ff

me mbe rs ha d c ome int o the ro om, on e of wh om wa s N ur se Glover, who had hear d the patient fall from his bed. Mr. Pre witt was bleedingfrom his fore head a nd appea red to be in pain, and he was place d back onto the be d. A CAT sca n was pe rfor

med on Mr. Prewitt, and his condition later wor sen ed
, as h e went int o shock and be came hy potensive and unresponsive. Mr . Pruitt’s spleen had ruptured during t he fall, causing internal hemorrhag ing, a nd he re qu ir e d a

blo od tr ans fu sion and

re su sc itatio n. Mr . Pr e wi tt und e rw e nt e me rg e nc y surg e ry to

remove his spleen, during which a ne crotic g all bladder was a lso discovere d and re moved. 1

On Dece m b er 2 7 , 2002, Plaintiff filed a c omplaint in the Tennessee Claims C ommissi on alleg ing ne g lige nce by

the UT re sident, Dr. Scra ntz. P laintiff also filed a complaint on J anuar y 15, 2003 in the Shelby County Circuit Court ag ainst The Med and D r. Scra ntz. P laintiff later

amende d the c ir c uit c ourt c omp la int to a dd Se mme s- Murp he y

Clin ic , P. C. a

nd Se mme s- Murp he y

Ne ur olo g ic & Spine Institut e (“Semmes- Murphey”); Kindre d Pulmonary Unit, Memphis; Kindred Hea lthcare
, I nc .; K ind

re d H os pit a l – C hatta

no og a (“ Ki nd re d” ); Nurs e Gl ov e r, and

Nurs e Da

na Av ant, Nurs e

2 Glover’ s supervisor, a s defe ndants. Plaintiff’s claim ag ainst Semmes-Murphey was ba sed upon the

a lle g a tio ns that

Dr . Sh e lly

Ti mmo ns and

Dr . M ic ha e l Mu

hlb a ue r, wh o w e re e mpl oy e d b y bo th Se mme s- Murp he y

a s p ri vate ph y sic ians and by UT a s supe rv isi ng fa c ult y fo r the re sid e nc y

pr og ra m, had fa iled to properly

supervise the resident Dr . Scrantz during the attempted lumbar puncture on J une 21, 2002, and that these defe ndants acte d within the scope of their ag ency and employ ment by Semmes-Murphy

. Plaintiff alleg ed that Nur se Glover was ne g lige nt by

leavinghim unattended and 3 fa ili ngto p ro c ur e the su

pp lie s n e c e ssa

ry fo r t he lum ba r punc tur e pr oc e dure , a

nd that sh e a c te d w ith in the scope of her

ag ency and employ

ment by Kindred. Semmes- Murphey filed an a nswer in whic h it admitted that Dr. Scrantz was a resident phy sician employ ed by the State of Te nnessee , denied that Semmes-Murphey , Dr. Timmons, or Dr. Muhlbaue r h ad em p l oy ed or othe rwise a cted a s the principal for

Dr. Scra ntz under the circ umstances g iving r ise to Plainti ff’ s cause of ac tion, and alleg ed seve ral a ffirmative defe nses. Kindre d and The Med also filed answe rs denying liability and-4-

al l eg ing a ffirmative defe nses. On Nove mber 6, 2003, in the c ase of D a v id P r e wi tt v

. State of Tennessee (Claim No. 20-300-854) , the Claims Com mission gra nted Mr. P r e w it

t’ s mo ti on for pa

rtial summary judgme nt reg ardingthe liability of the State, whic h the State did not contest.

Pla int if f f ile d a mot ion fo r s umm ary

jud g me nt w iththe c ir c uit c ou rt a s to K ind

re d a nd Nurs e Glover on O ctober

20, 2005. Plaintiff also filed for summary judgme nt as to Semmes-Murphey , and

on De c e mbe r 1 4, Pla int if

f f iled a mo ti on req

ue sti ngan o rd e r t

hat im mun ity

sh ou ld n ot a

pp ly to Semmes-Murphey

.
On Octobe r 28, 2005, the trial court e ntere d an orde r consolidating the Claims Com mission

case , Prewitt v. State of Tennessee (docke t number CT-004086-05) , with the cir cuit court a ction. On No ve mbe r 18, 20 05 , the tr ia l court e nte re d a sch e du lin g or de r b y c on se nt o f t

he pa rt ie s th a t a ll

wr itt e n a nd fa c tua l di sc ov e ry

be c omp le te d a

nd fi le d by Janu ary 15 , 2 00 6, that a ll e xpe rt s w e re to be identified and their interrog atories provided by J anuar y 31, and that any expert that P l aintiff int e nd e d to us e a t tria l be de po se d by F e br ua ry 28

. I n De c e mbe r of

20 05 , Pl a int if

f d e sig nate d h is own expert witnesses as Er ic Tol oza, M.D., Ph.D., of Duke Unive rsity Medica l Center, and D an Smi th, M.D., of Emory

University

School of Medicine, both of whom wer e B oard- cer

tified specia l i s t s i n s u rg ery

and experts in lapar osurg ery , trauma sur g ery , and g ener al surg ery . At the de po sit ion s fo r the se tw o e xpe rt s, Pla int if f’ s c ou ns e l e xpre ssl y state d that he did no t in te nd

to r e ly upon either of

these witnesse s at trial t o establish the s tandar d of ca re or brea ch of suc h standard, but rathe r, only

to establish causation of the injuries from P laintiff’s fall. Plaintiff filed a supplementa l disclosure in January

of 2006, stating that he intended to prese nt the depositions of Dr. Muhlbaue r, Dr . T imm on s, Dr . Sc ra

ntz, Nurs e Gl ov e r, and Nu rs e Av ant at tr ia l. I

n th is d oc ume nt, Pla int if

f d id not express any

indication that these pa

rties wer e to be r elied upon as e x pert witnesse s.

On J anuar

y 11, 2006, Semmes-Murphy fi l ed a motion for summary judgme nt, citing P l ai n tiff’s alleg ed fa ilure to prese nt any competent e x pert pre pare d to testify in support of the neg lige nt supervision claim, and fur ther a lleg ing that Dr. Timmons a n d D r . Muhlbauer w ere immune from suit acc ording to their g ener al superv i s o ry au thority over D r. Scra

ntz as faculty

for the U T residenc y prog ram. The se motions were argued bef ore the Honora

ble Kar en R. Wi lliams in t he She lby County Cir c uit Court on F e br ua ry 2, 20 06 . A t th e su mma ry jud g me nt h e ari ngin t

he c ir c uit court, Plaintiff’s c ounsel ar gu ed in s upport of Semmes-Murphe y ’s liability in two alternative

r e s p e c t s : “ f

o r d i r e c t l i a

b i l i ty i nf a i l i n g t o s u

p e r v i s e t h e r e s i d e n to nJ u n e t h e 2 1 s t , 2 0 0 2 ; an d
, s e c o n d l y, for vicar ious liability beca use Semmes-Murphey had the rig ht a nd duty to control its ag ent, the UT resident, Dr . Scrantz.” In support of the fir st claim, Plainti ff c ited our dec ision in Hayden v. Waller , No. 02A01-9511- BC-00241, 1996 Te nn. App. L EXI S 867 (Tenn. C t

. Ap p. Dec . 31, 1996), in an attempt to bolster the contention that immunity did not a pply to D rs. Timmons and Muhlbauer. As to Kindred a

nd Nurse Glover, P laintiff arg ued that Nur se Glover ’s neg lige nce “ in failing to respond to t he do c tor ’s wr itt e n o rd e r o n th e date of the inc ide nt, c a

us e d th e fi rs t do min o to fa ll i n th is c a se and ca used the c hain of e vents which led to the patient’s fall and his injury .”-5-

By corr espondenc e to the par ties on M ar ch 3 , 2006, the trial cour t announce d its ruling as fo llo ws :

1. P lai nt iff’s M ot ion for Sum m ar y J udgm e nt ag ain stth e

Kindred H ealthcar e Defend ants and Marc ia Glover , R.N.

Th e M o ti o nis d e n ie d

. T h e r e is n o e xp e rt p roof ind ic a t i n g t h a t N u r s e G l o v e r f a i l e d t o d o h e r d

u ty to bring the [lum bar punc ture] tray to the patient’s bedsi d e

. Sh e w a s n o t p e r mi tt e d to e xa mi n e the contents of the tr ay as i t was sterile. She ha d no kn ow le dg e that thi s tr ay did no t c on ta in the anti se pti c Be tadine. F urther, e ven if she w ere neg lige nt in not

s u p p ly in g anan ti s e p ti c , th is w a s n o t t h e c a u s e of pla int if f’ s f a ll. Dr . Scr antz fa ile d to ide nti fy him se lf or che ck in with the nurses w hen he came to the floor and then to Plaintiff’s room. Upon finding that there

wa s no anti se pti c , he c ou ld have c a lle d fo r a nurs e to assist h i m but he did not. He could have called f or help from the se nior reside nt or a supervising doctor but he did not. When Dr. Scrantz decide d to ge t the

anti sep ti c him se lf

, h e fa ile d to ra ise the be d r a ils

. These inter

vening actions we re the cause of Plaintiff’s trag ic fa ll.

2. P laintif

f’s Motion f

or an Order t hat Claim s Com m ission Im m u n i t y D o e s N o t A p p l y t o t h e D e fe n d a n t , S e m m e sMurphey P lai nt iff’s M ot ion f

or Sum m ar y J udgm e nt Ag ain stth e Sem m es-M urphey Defend ants De fend ant [’ ]s M ot ion for Sum m ar y J udgm e nt on Be hal f of Defend ant Sem m es-M urphey

These thr ee motions are all related. There are materia l fa c ts at is su e re la tin gto t

he re la tio ns hip of

Se mme sMurphey and the UT residenc y prog ram a nd whether Dr. Scrantz was being proper ly supervised on June 21, 2002.

The cas e of Hayde n v. W aller , 1996 Tenn. App. L EXI S 867, Te nn. App. No. 02A01- 9511-B C-00241 (D e c e mber

31 , 1 99 6) is d ist inguis ha ble be c a us e in-6- H a y den t he doctor

actua lly treated the patient on the day of the in

j u ry . In the ca se at ba

r, neither Dr. Timmons nor D r. Muhlbauer treated Plaintiff on J une 21, 200 2

. T h u s , there can be no claim for dir ect

n e g l i g e n c e a g a i n s tS e m m e s

- M u r p h e y.

The c laim of neg ligen ce ag ainst the joint UT/Semmes-Murphe y

residency

prog ram ba sed on the fa ilure of

Dr s. Simm on s [si c ] an d M uh lba ue r t o appropr iately supervise Dr. Scrantz is still at i s sue. Th e Cla ims Com mis sio n Immu nit y c ov e rs Se mme sMurphey when they wer e performing their duties for the [Col leg e of Me dicine/Semmes-Murphe y Clini c] D e p art m e n to f

N e u r o s u r g e r

y.

On Ma rc h 1 0, the tr ia l c ourt

e nte re d a

n o rd e r e ff

e c tuatin g thi s r

uli ngand dis mis sin g Se mm e sMurphey from the p ro ceeding orig inally filed in the circ uit court. The or der state d that “[i] ssues
conce rning the duties of Semmes-Murphey phy sicians in the ir capa city as members of the staff of the Un ive rs ity

o f T e n n e s s e e f

o r r e s i d e n ts u

p e r v i s i o nr e m a i na ti s s u e t o b e r e s o l v e d i nt h e c a se orig inally filed in the Tenne ssee Claims Commi ssion, CT004086-05.”

Also on Marc h 10, the trial cour t held a hea

ring on Plaintiff’s motion for clar ification of the court’s or der. Reg ardingthe trial co u rt ’s fi ndings r elated to Plaintiff’s motion for summary judgme nt ag ainst Kindred and Nurse G lover, whic h had bee n denied ba sed upon Plaintiff’s fa ilure to present e x pert proof of the standard of car e and its brea ch by Nurse G lover, a s well as the a ctions of Dr . Sc ra ntz be ing an int e rv e nin g c a us e of Pla int if f’ s in jur y , Pl a int if f’ s c ouns e l st a te d a s f

oll ow s:

Your Honor , first of all, let me state for the r ecor d that Iam not

su g g e sti ngto the Co urt that I ’m in f a vo r o f s umm ary

jud g me nt i n favor of the K i ndred de fenda

nts. W hat I ’m saying is, if that is the ine vit a ble – if the Court

ha s d e c ide d that Ki ndre d is e nti tle d to summary judgme nt, then what I would like to do is packa g e this along wi th Sem me s- Murp he y to the Wes te rn se c tio n a nd le t th e m a dd

re ss the issue as we ll as long a s we’ re g oing the re a ny way , as long as the Court sta y s th e pr oc e e din g be low un til we g e t re so lut ion a s to t he se oth e r i ssu e s, bu t by no mea ns a m I statin g that I

thi nk Ki nd re d is entitled to summary

judgme nt.
At that point in the procee dings, the trial court made clea r that Kindred and Nurse Glover would be g rante d summary

judgme nt as well, and she instructed the pa rties to en s ure that the rec ord wa s “cle aned up” in anticipation of our review. Kindred and Nurse Glover filed a mot ion for summary judgme nt on March 21, a nd on Marc h 28, the trial cour t entere d an orde r g ranting the motion.-7-

Plaintiff filed a timely

notice of a

ppeal to this C o u rt as to Kindred a nd Nurse G lover on Marc h 2 8. On

Marc h 31 , 20 06 , the tr ia l c ourt e nte re d a n o rd e r s tay ingfu

rt he r p ro c e e din g s a g a ins t the State of Te nnessee and The Med, neither of whom ar e invo lved in this appeal, pe nding our decision. The tr ial court e ntere d an ame nded orde r g ranting summary judgme nt as a fina l order a s to S e mme s- Murp he y

on Ap ri l 11 , and Pla int if

f su pp le me nte d his no tic e of

a pp e a l to inc lud e the se defe ndants on April 18.

II. I SSU ES P R ESENTED
On appe al, Appellant pr esents the f ollowing issues for

our re view:

1. Whether the trial co u rt err ed in g ranting Semmes-Murphey ’s motion for summary jud g me nt, on

the ba sis of i mm un ity

un de r t he Cla ims Com mis sio n A c t, a nd in d e n yi n g P l a i n t i f

f ’ s m o t i o n t h a t S e mm e s

- M u r

p h e y s h o u l d

n o tb e e n t i t l e d

t o i m m u n i t y. 2. Whether the trial c ourt err ed in denying Plaintiff’ s motion for summary judgme nt as t o l i a b i l i t y a g a i n s tS e m m e s

- M ur p h y. 3. Whe the r the tr ia l court e rr e d in gr anti ng Ki nd re d’ s motio n for su mma

ry jud g me nt, by dismiss ing K indred a

nd its employ ee, N urse Glove r. 4. Whether the trial c ourt err ed in deny ing Plaintiff’ s motion for

summary judgme nt as to liabilit y

ag ainst Kindred a

nd Nurse G lover.

F or the fo llo wi ngre a so ns , w e a ff ir m th e jud g me nt o f t

he c ir c uit c ourt

.

III

. S TA N D A R D O F R EVIEW

Ac c or din g to t

he Te nn e sse e Rul e s o f C ivi l Pr oc e dure , su mma ry jud g me nt is a

pp ro pr ia te if the “plea dings, de positions, answers to interrog atories, a nd admissions o n fi l e, tog ether with the

a ff ida vit s, if any , sh ow that the re is no g e nu ine iss ue a s to any ma te ri a l fa c t and tha t th e mov ingpa

rt y is entitled to judgment as a matter of law.” Tenn. R. Civ. P. 56.04 (2006). “The c ases c onstruing Tenn. R. Civ. P. 56 m ake c lear that the summary judgme nt proce ss is designe d to provide a quic k, inexpensive m ea n s of conc luding c ases, in whole or in part, upon issues as to which the re is no g enuine dispute re g ardingmateria l fac ts.” By rd v . Ha ll , 847 S.W

. 2 d 2 0 8 , 2 1 0 (Tenn. 1993)

. “[S] ummary

judgme nt is not a disfavored pr ocedur al shortcut b u t rathe r an important ve hicle for concludingcase s that can a nd should be resolve d on leg al issues alone.” Id.
The pa rty moving f or summary

judgme nt must aff

irmatively neg ate a

n essential ele ment of th e n o n mo v in g p arty ’ s c la im
, o r c o n c lu s iv e ly

e s ta b li s h ana f

f ir mati v e d e fense

. Pa tte rso n v . Arif , 1 7 3 S

. W

. 3 d

8 , 1 1 (T en n

. C t

. Ap p

. 2 0 0 5 ) ( ci t i n g McCarley v . West Quality Food S erv. , 960 S.W .2d 585 (Tenn. 1998)). I n deter mining whether or not a genuine issue of mater ial fac t exi sts for purposes of su mma ry jud g me nt, c ourt s in this state have ind ic a te d tha t the tr ia l court mus t take the str on g e st le g iti ma te vie w o f the e vid e nc e in favo r of the no nmo vin g pa rt y , a llo w a ll r e a so na

ble inf e re nc e s in favor of that party , and discard all counter vailing e vidence

. By rd , 8 47 S.W. 2d a t 21 0- 11 . “ On c e it-8-

is s ho wn by the mov ingpa

rt y tha t t here is no g e nu ine iss ue of ma te ri a l f

a c t, t he no nmo vin g pa

rt y must then demonstrate, by af fi d avits or discover

y materia ls, that there is a g enuine, mate rial fa ct dispute to warr ant a tria l.” Id. a t 21 1. Sum mary jud g me nt s ho uld

be g ra nted only wh e n th e fa c ts and conclusions to be draw n from the fac ts pe rmit a rea sonable person to r eac h but one conc lusion. Go df re y v . Rui z , 90 S.W .3d 692, 695 (Tenn. 2002). The standa rd of r eview f

or a tria l court’s g rant of su mma ry jud g me nt i s de novo , acc ording no p re s u m p t i o n of cor rec tness to the trial court’ s deter mination. Id.

IV. D I S CUS S I ON

A. Su m m ary Judgm ent as to Liabil ity of Sem m es-Murphey
Appellant first c ontends that the trial cour t misapplied our decision in Ha y d e n v

. W all e r when it d e te rm ine d th a t D r. Ti mmo ns and Dr

. Muhlb a ue r we re e nti tle d to Cla ims Com mis sio n im mun ity

a s t o P l a i n t i f

f ’ s c l a i m f o r n e g l i g e n t s u

p e r v i s i o n o f t h e U T r e s i d e n t , D r

. S c r an t z

. S e m m e s

- M u r p h e y,
conver sely , maintains tha t there rema ins no ge nuine, mater ial fac t dispute reg ardingthe nature of these phy sicians’ a ctions or omissions on J une 2 1 , 2 0 02, and that on this date Dr s. Timmons and Muhlb a ue r n e ve r a c te d b e y on d th e sc op e of the ir e mpl oy me nt as UT Clin ic a l A ssi sta nt P ro fe sso rs

.

Te nn . Co de Ann. § 9 -8 -3 07 ( h ) e xp r e s s l y p r o v i d e s i mm

u n i t y fo r s ta te e mpl oy e e s a c tin g wi thi n the scope of their e mploy ment. Hayden v. Waller , No. 02A01-9511-BC-00241, 1996 Tenn. App. L EX I S 86 7, a t *1 1 ( Te nn . Ct . App . De c . 31, 19 96 ). Th a t sec tio n pro vid e s, in r e le va nt p art : “ State office rs and e mploy ees a

re a bsolutely immune from liability

for a cts or omissions withi n the scope of the of fi c e r’ s or em

plo y e e ’s of

fi c e or e mpl oy me nt, e xce pt f

or wi llf ul, ma lic iou s o r c ri min a l a c ts or omissi ons or for a cts or omissions done for pe rsonal g ain. . . .” Te nn. Code Ann. § 9-8- 307(h) (Supp. 2006). “Claims alleg ing pr ofessional malpra ctice by a [ s ]t ate e mploy ee a re w ithin the jur isd ic tio n o f t

he Cla ims Com mis sio n. T. C. A. § 9 -8 -3 07 (a )( 1) (D ). Ho we ve r, the Ac t e xpre ssl y exclude s fr o m Claims C ommissi on cover ag e those ‘a cts done for persona l ga in.’ T.C.A. § 9-8-307( d).” Hayden , 1996 Tenn. App. L EXI S 867 , at *11. Tenn. Code Ann. § 9- 8-307(h) does not ext inguish a claimant’s rig ht of action but me rely immuniz es state e mploy ees f rom individual monetary l i ab i l i t y

. She lbu rne

v . Fr ont ie r He alt h , 126 S.W .3d 838, 845 (Tenn. 2003) (citing Jo h n so n v

. L e Bonh e ur Chi

ldre n’ s Me d. Ctr

. , 74 S.W .3d 338, 345-46 (Te nn. 2002)). “ [I ]n t he Claims C ommissi on there can be no individual liabili ty or punitive damag es and there is a $ 300,000 statutory damag es ca

p; however , in the Circuit Court, indivi dual liability can be i mposed, punitive damage s ar e re cover able a nd there is no cap on potential liability .” Hayden , 1996 Tenn. App. L EXI S 867, at *9.

I n Hayde n , the def

endant phy sician was a dual employ ee of both a private medical g roup and the UT Emer g ency

Medicine Reside ncy

Prog ram. Hayden , 1996 Tenn. App. L EXI S 867, at *4. The defe ndant re ceive d approximately 24% of his i ncome from the university , and the r emaining 76% was pa id by

the private medical g roup. Id. at *5. The de fend an t ’s d u ties as a membe r of the

un ive rs ity fa c ult y inc lud e d th e su

pe rv isi on and te a c hin g of me dic a l re sid e nts and me dic a l st

ud e nts who wer e rotating throug h The Med. Id. at *3. W hen the de fenda nt phy sician provided dir ect c are-9-

to patients, the private medical g roup had the exclusive r ight to bill for these service s. Id. at *6-7.

On October 30, 1992, the plaintiff patient in Hayde n was treated for acute exacer bation of asthma at The Med’s Emer g ency Depa rtment. Id. at 7. The de fenda nt phy sician asse ssed the plaintiff’s condition and a ssigne d her c are to a re sident. Id. Wh i l e t re ati ng another patient, the defe ndant was notified that the plaintiff’s situation had bec ome cr itical, and that the r esident re quired assistance

. Id. The defe ndant then rende red “dire ct, ‘hands on’ ca re” to the plaintiff, including the insertion of a la

ry ng oscope a

nd order ing X -ra

y s and blood studies. Id. at *8. The plaintiff died on that same da

y

. Id. The plainti ff h ad b ee n to The Med f or treatment on two prior occ asions that month, and the private medical g roup had billed for the ea rlier se rvice s that it had provided. Id. The pr ivate me dic a l g ro up a dmi tte d th a t it wa s ent itl e d to bill fo r the de fe nd ant phy sic ian’ s ser vic e s to the plaintiff, and in f

act, it did bill for radiolog ical tre atment provided on the day that she died. Id. The plaintiff’ s husband filed one complaint ag ainst t h e defenda nt phy sician and pr ivate medica l g roup in the circ uit court, and a nother in th e C l ai m s Commi ssion ag ainst the defe ndant phy sician and the UT resident a s state emplo y ee s

. Id. at *8. The c ircuit court pr ocee dings w ere stay ed pending the Claims Com mission’s determination of t he phy sician’s status. Id. a t *9 . T he Cla ims Commi ssion entere d an orde r finding that the def endant phy sician wa s not acting in his capac ity as a state e mploy ee w hen he treated the plaintiff, but that he pe rfor med this treatment as a

n employ ee of the private medica l gr oup. Id. at * 1 0

. T hus, the Claims Com mission found im munity did not apply to the phy sician, and it wa s without ju risdiction to hear the claims ag ainst him. Id. The defe ndant phy sician appe aled to this Court. Id.

On appe al, our inquiry was whether “the Claims C ommissi on corr ectly deter mined that [t he defe ndant] was actingwithin the scope of employ ment with his private practice g roup, . . . and not within the scope of employ ment with the University of Tennessee, in the care and treatment of [the plaintiff] at The Med on October 30, 1992.” Id. I n our ana ly sis of this is sue, we focuse d on whether the private medical g roup could be said to have e x trac ted per sonal g ain from the treatment provide d to the plaintiff on the date in que stion. Id. a t *12- 21

. Part ic ula rl y re le va nt to our de te rm inatio n in this reg ard w as the a

bility of the private medica l g roup to bill the plaintiff for the alleg edly neg lige nt treatment. Id. W e looked to Medicare require ments, as well as the exis ting billing policy of the University

for tre atment of patients through this par ticular re sidency

prog ram. Id. at *17. The de fe nd ant p hy sic ian d id n ot d isp ute that he ha d p ro vided dir e c t c are to t he pla int if

f i n r e sp on se to the re sident’s reque st for assistance , nor did he c ontrovert the f act that the private group w as entitled to bill, and did in fact bill, for servi ce s re n d ere d to the plaintiff on that date. Id. a t* 1 7

- 1 8

. In aff irming the Claims C ommissi on’s deter mination, we stated:

Dr. Hay d e nw a s a

d u a l e mp lo y e e o f

b o th th e U n iv e r s it

y an d o f the Medica l G roup. When he worke d in the emer g ency depar tment at The Med, he did so as a

n employ ee of

both the University

and of the Medica l Group. At The Me d, Dr. Ha y den ser ved the U n i v ersity

by supervising medical students and residents such as Dr. Dunca n, and he se rv e d th e Me dic a l G ro up by re nd e ri ngdir e c t patie nt c are to patients such as Mr s. Waller. The Unive rsity di d not employ

Dr.-10- Hayden to perf

orm direc t patient car e ser vices at The Med; That was the Me dic a l G ro up ' s o bli g a tio n. For tr eatin g pa tie nts su c h a s Mr s. Waller, the Medica l Group paid Dr . Hayden in excess o f $ 80,000

annua lly , w hic h is c le arl y a pe rs on a l g a in t o h im.

I t is no t hi s ser

vic e to t he Un ive rs ity

that a ff or ds him a bs olute immunit y in this case. Rather , it is hi s service to the Medica l Group which re moves the shield of a bsolute immuni ty

.

Id. at 21-22.

Ap pe lla nt ar g ue s tha t the tr ia l court e rr e d in fin din g that so ve re ig n im mun ity a pp lie d to Dr s. Ti mmo ns and

Muhlb a ue r, and in u lti ma te ly grant ingSe mme s- Murp he y su mma ry jud g me nt. Plaintiff urg es that evide nce in the r ecor d demonstrates that at the times re l ev an t t o his cause of

a c tio n, Dr s. Ti mmo ns and Muhlb a ue r w e re a c tin g a s p ri vate pr a c tic e ph y sicians of Se mme sMurphey , rathe r t h an as age n ts of UT. Appe llant asserts seve ral fa cts in support of this positi on, including, that when Mr. Pre witt was initially admitted at The Me d an d t re at ed for spinal injuries fr om t he c ar a c c ide nt, he wa s b ill e d $ 29 ,1 82 fo r s urgery and fo llo w- up tr e a tme nts a lle g e dly perf ormed by these phy sician s , that Semmes-Murphey sometimes billed patients for treatment

occur ring when their

phy sicians supervise d residents, a nd that Dr. T immons and Dr. Muhlbauer

rece ive d 1 00 % o f t

he ir inc ome fr om S e mme s- Murp he y . App e lla nt c or re c tly c ite s Hayde n for the pr op os iti on

that if the du a l e mpl oy e e ph y sic ians mig ht h a ve bil le d f or the se rv ic e s p ro vid e d to him
, then these phy sicians ar e not entitled to immunit y for these service s.

Th e de po sit ion s o f D r. Sc ra ntz, Dr . T imm on s, Dr . M uh lba ue r, an d Nu r s e G l o v e r w e r e h e a vil y relied upon by

all the par

ties throug hout this case. Dr

. Muhlbauer testified at his de position t hat he perf ormed the initial spinal surg ery on Plaintiff in May of 2002, af ter he had pre sented to The Me d be c a us e of his c ar a c c ide nt in Ap ri l of 20 02

. Th e re c or d ind ic a te s that Se mme s- Murp he y di d b ill Plaintiff $29,182 for this surg ery and ce rtain followup ca

re, a nd the final date of treatment refle cted

on that bill w a s M ay

2 2 , 2 0 0 2

. Se mm e s

- M u r p h e y d id n o t b il l P la inti f

f f o r th e lumb ar

p u n c tu re proce dure c onducted on June 17, or the attempted pr ocedur e by Dr. Scra ntz on J une 21, 2002.

I t is undisput ed that neither Dr. Timmons or Dr. Muhlbauer wa s prese nt at the attempted lumbar puncture proce dure by the UT resident, Dr. Scrantz, on J une 21. Both Dr . Timmons and Dr. Muhlbauer te stified in dep osition t hat they did not directly

supervise D r. Scra

ntz on t hat date, but that th e y we re re sp on sib le fo r h is g e ne ra l su pe rv isi on in t he ir ro le a s UT facu lty

me mbe rs

. Dr. T im mo n s s tate d

th a t he “ d id

n ’ t th ink an y

b o dy w a s r e s p o n s ib le f

o r d ir e c tl y s u p e r v is in g [D r

. Sc r a n tz ] that da y be c a us e he wa s do ing thi ng s that we re in ke e pin g wi th h is l e ve l of e xpe ri e nc e and

e xpe rt ise and didn’t re quire dire ct supervision that day .”
Hayde n involved treatment in wh i ch t h e dual e mploy ee phy sician def endant, a long w ith a resident phy sician, had pr ovided direc t car e to the plainti ff’ s dece dent. Converse ly , there is nothing-11-

in t he re c or d b e fo re us to s ug g e st that th e du a l e mpl oy e e phy si cia ns were pr e se nt o n th e da y in question, or that they

had dire cted Dr . Scrantz to perfor m the second l u m b ar puncture proce dure. Dr. Scrantz stated in his deposition that he wrote the order for a lumbar puncture kit on the morning of June 21, 2002. Dr. Scrantz testified that he wa s not direc tly supervised by any phy sician during thi s atte mpt e d p ro c e dure , b ut h e re c a lle d th a t a se nio r UT res id ent, D r. B ane rg e e , h a d d ir e c tly supervised the first lumbar punctur e four d ay s ear lier, on June 17th. Although there are sever al

rec ord entries in Plainti ff’ s char t from var ious healthca

re pr oviders betwe en June 17–22, none of the par ties were able to identify

a Semmes-Murphe y

phy sician who was dire ctly prese nt for either of these p ro cedur es, althoug h Dr. Scra ntz s tated that Dr . Muhlbauer w as making rounds on J une 17th.

Drs. Timmons and Muhlbauer wer e dual e mploy ees of

the UT De partment of N eurosur g ery Residency

Prog ram a

nd Semmes-Muprhey . As in Hayde n , in or de r fo r S e mme s- Murp he y to b e a ble to bill for treatme nt of patients throug h the joint prog ram, they had to fulfill cer

tain Medica

re
re qu ir e me nts . T he re le va nt M e dic are statut e pr ov ide s, in r e le va nt p art :
(a) Gene ral rule. I f a re sident participate s in a servic e fur nished in a teac hing se tting, phy sician fe e sche dule pay ment is made on ly

if a teaching physician is present duri ng the ke y portion of any servic e or procedurefor which payment is sought

. (1) I n the ca se of surg ical, hig h-risk, or other complex proce dures, the teac hing phy sician must be prese nt during all critica l po rt ion s o f t

he pr oc e dure and im med ia te ly a va ila ble to f ur nis h service s during the entire service or proc edure

.

(i ) I n the ca se of surg ery , the teac hing phy sician 's prese nce is not re quired during opening and closing of the surg ical field. (ii) I n the ca se of pr ocedur es performed thr oug h an endoscope , the teac hing phy sician must be prese nt dur ing the entire

v i ew i n g. (2) In the c ase of ev aluation and management s ervic es, the teaching physic ian must be present during the portion of the service that determines t h e l ev el of servicebilled. (Howe ver, in the c ase of evaluation and manag ement service s furnished in hospital outpatient de pa rtme nts and

c e rt a in o the r a

mbu la tor y se tti ng s, the re qu ir e me nts of § 415.174 apply .) (b) Doc umentation. Ex cept f or ser vices fur nished as set forth in §§ 415.174 (conc erningan exception for se rvice s furnished in hospital outpatient and ce rtain other a mbulatory

settings) , 415.176 (conc erningrena l dialy sis service s ), and 415.184 (conce rning psychiat ri c s er v i ce s ), t h e m ed i ca l re co rd s m u s td o cu m en tt h e teaching ph y s ic ia n w a s p r e s e n t a t th e ti me th e s e r v ic e is f u r n is h ed. The prese nce o f t h e tea ching phy sician duringproce dures may beAp p el l ant co nt end s t hat i n H ayden , w e he ld tha t i n o rd e r fo r a d u a l e m p lo y e e t o b e e n tit le d to im m u n ity 4

u n der T en n

. Code An n

. § 9- 8- 307( h )
, t h e t wo pr er equ i s i t es wer e t h at t h er e be a pr i or a g r ee men t t h at t h e f ac u l t y doc t or (c o n tinu e d ...)

-12- d e m o n s t r a t e d

b y t h e n o t e s i nt h e m e d i c a l r e c o r d s m a d e b y a phy sician, re sident, or nurse. I n the ca se of e valuation and

mana g e me nt p ro c e dure s, the te a c hin g ph y sic ian mu st p e rs on a lly document his or her

participation in the serv i ce in the medical

re c or ds

.

. . . .

42 C.F.R. § 415.172 (Supp. 2007) (emphasis added)

. Dr. Timmons’s descr ibed the billing pr actice

a s f oll ow s:
Q. How are y ou able to bill for y our supervisory responsibilities

a t T he Me d in

a c a se su c h a s th is? A. Any

car e – any direc t patient c are that I rende r to the patient without the involvement of a re sident, Iwould submit a bill for. Any

c are that I dir e c tly su pe rv ise wi th t

he re sid e nt, Iwo uld

su bmi t a bil l for. So i f I ’m

pr e se nt w iththe m w hi le th e pro cedu re or a vis it i s g oing on, I

woul d b e able to submit a bill for that with the prope r participation on my

part a nd proper documentation on my

part. Q. I s that something that Me dicar e re quires y ou to do? A. Ye s. Q. Yo u h a ve to b e pr e se nt t o b e a ble to b ill ? A. Ye s, that’ s r ig ht.

Simi larl y in r e sp on se to q

ue sti on inga t hi s d e po sit ion in t his re g ard , D r. Muhlb a

ue r s ta te d a s f

oll ow s:
Q. Did y ou bill for the lumbar punc tur e t h at was performe d on J un e 2 1 ? A. Ican’ t. Iwasn’t ther e. Q. And in f

act, you would not be able to bill for a proce dure that y ou we re no t pr e se nt f

or and su

pe rv isi nga c c or din g to Me dic are g uid e lin e s; i s th a t c or re c t? A. Correc t.

The pa rties do not appea

r to dispute that these Medic are gu i d eli nes dictate d Semmes-Murphey ’s ability to bill for treatment of patients through th e UT /Semmes-Murphey Depa rtment of Ne ur os ur g e ry

Re sid e nc y

Pr og ra m. 4(

. . . con t i n u ed) 4
woul d not bi l l f

or a pat i ent ’ s car e and a t r ans f er of t hat f

acu l t y do ct or’ s r i gh t t o bi l l t o t he U ni ver s i t y

. Ap pel l ant ci t es the a b se n c e o f an y s u c h a g re e m e n t in s u p p o rt o f his a rg u m e n t t h a t S e m m e s-M u rp h e y is no t en tit le d to im m u n ity. W e d isa g re e w ith this r e a d ing o f H ayden . In a p p lying the re le v a n t f a c to rs in tha t ca se , w e d e te rm ine d tha t wh e n the p la intiff
p a tien t wa s tre a te d in 1 9 9 2 , un i ver s i t y pol i cy at t ha t t i m e r equi r ed t hes e c r i t er i a t o be m et bef ore a dua l empl oy ee p h ysic ia n c o u ld b e d e e m e d to ha v e im m u n ity. H ayden , 1 99 6 T enn

. A pp

. L E X I S 86 7, at * 18

- 19

. Ap pel l ant ha s ci t ed

n o thin g in the re c o rd b e fo re us to su g g e st tha t suc h a p o licy w a s in e ff e c t i n 2 0 0 2 , t e n ye a rs late r.

-13- Appellant plac es consider able e mphasis on a re cord e ntry ref lected in his medical char t for June 17 , 2 00 2, the date of the su c c e ssf

ul l umb ar p un c tur e , to bo lst e r hi s ass ert ion that Se mme sMurphey staff w as pre sent for this proc edure and eve n order ed the repe at of this proc edure on J une 21 . T he e ntr

y , w hic h is inc lud e d in

the re c or d a s an ex hi bit to N ur se Gl ov e r’ s d e po sit ion , is p r a c t i c a l l y

u n r e a d a b l e , a l t h o u g h t h e l e g i b l e p o rt i o nr e a d s , “ N S S t a f f P r e s e n t f

o r LP

. . . If

r e p e a tLP . . . will require . . . .” followed by an unidentifiable signature that be g ins with the letter “M.” Above this entry

on the same date, a separ ate signed entry indicates the prese nce of a Dr . Ba nerg ee for this first proc edure . Appel l an t co ntends that the for mer e ntry indicates the pr esenc e of a Semmes- M u

r p h e y p hy s ic ia n for the June 17 proce dure, a nd that Semmes-Murphey there fore order ed the re peat pr ocedur e attempted by Dr. Scra ntz on J une 21, as pa

rt of its cont i nuing “ follow-up” treatment stemming fr om Plaintiff’ s initial spinal surg ery the pre vious month. Appellant contends that this indi cate s that Semmes-Murphey was, there fore , entitled to bill for the proce dure attempted on J une 21 and c entra l t o t he litiga tion, and conseque ntly

its dual employ ee phy sicians wer e not entitled to immuni ty

for this treatment.
We believe Appe llant’s argument is c ontradicte d by undisputed fac ts w ithin the rec ord. Dr. Scrantz stated in his deposition that he perform ed t h e first lumbar punc ture unde r the super vision of Dr. B aner g ee, a

senior UT r esident. While he also stated that Dr . M u hlbauer had bee n making rounds that day , there is nothing in the re cord to support Appe llant’s contention that a member of Semmes-Murphey staff was pre sent to provide dire ct supervision for either pr ocedur e. Dr . Scrantz’s deposition testimony

further indicates that he alone sc h e d u le d th e s e c o n d

lu mb a r p u n c tur e proc edure
, that he wr ote the or de r f

or the lum ba r pun c tur e kit on

the mor nin g of June 21 , a

nd that no Se mme sMurphey phy sician eve r sig ned this order

.
Even if we wer e to deter

mine that the entry signe d “M” by a Neurosurg ery staff me mber on J une 17 manife s t s the pre sence of Dr. Muhlba uer f or this first succe ssful proce dure, w e do not believe that this i s the appropr iate date by which to deter mine whether

Semmes-Murphey

might have billed for the c are involved in this l itigation. Instead, June 21
, 2 0 02, is, in our opinion, the de te rm inativ e date of

tr e a tme nt i n c on sid e ra

tio n o f Me dic are ’s bil lin g re qu ir e me nts

. Th a t is the date on which Dr . Scrantz lowere d Plaintiff’s bed ra il and left hi m u n at t en d ed , leadingto Plainti ff’ s injury

. I t is undisputed that neither Semmes-Murphey phy sician was prese nt direc tly supervising the resident on this date, a

nd acc ording ly

Semmes-Murphey

could not h av e bil led for this attempted proce dure.

I n further support of ex cluding Semmes-Murphey from immunity , Appellant empha siz es the importance of the fac t that D rs. Timmons and Muhlbauer rec eived 100% of their salary from-14-

Semmes-Murphey . I n Hayden , 1996 Tenn. App. L EXI S 867, at *21, we stated that “so long as the phy sician i s rec eiving pay ment from an e mploy er othe r than the State of Tenne ssee to per form the

wo rk in q ue sti on , h e is n ot e nti tle d to immun ity .” Ho we ve r, in th is c a se , th e de po sit ion s o f b oth p h ys i c i an s r e v e a l t h a tt h e y d i d r e c e i v e a s a l ar y a s f a c u l t y r e s i d e n ts u

p e r v i s o r s f r o m U T i n d i r e c t l y, which UT pa id to Semmes-Murphey . Semmes-Murphey , in turn, issued this total amount to the dual employ ees. A lthough we did note that the s alar y arr ang ement may be relevant in dete rmining a dual employ ee’ s immuni ty

status in Hayde n , as ex p l ai n ed ab o v e, the a bility to bill t he patient f

or ca re provided is the most conclusive f actor for such an analy sis. I n this case, ther e is no evidenc e in the

rec ord that either

Dr. Timmons or Muhlbauer could have billed for the pr ocedur e attempted by Dr. Scrantz on J une 21, 2002, or that they rec eived pa

y ment from Semmes-Mu rp h ey for a ny work perf ormed on this date.

I n light of Hayde n , we f

ocus on the trial c ourt’s dete rmination that Dr. T i m m o n s an d Dr. Muhlbauer w ere acting in their roles as faculty supervisors for UT re sident phy sicians on J une 21, 20 02 , r a ther tha

n a s p ri vate phy sic ians thr ou g h Se mme s- Murp he y . We fi nd no e rr or in t his de te rm inatio n, and

fi nd that im mun ity

a pp lie d to Dr s. Ti mmo ns and Muhlb a ue r f or any a lle ge dly neg lige nt acts or omissions on that date.
Plaintiff argues alter

natively that even if

this Cou rt finds these two doc tors to be immune thr ou g h th e ir

a ff ili a tio n w iththe UT re sid e nc y pr og ra m, S e mme s- Murphe y

may sti ll b e he ld vicar iously liable for the neg lige nt c onduct of the resident, Dr. Scrantz, applying the principles set forth in Johnson v. LeBonheur Children’s M ed. Ctr. and Sh e lbu rn e v . F ro nti e r H e alt h . I n Johns on
v . Le Bonh e ur Child

re n’ s Med . Ct r. , 74 S.W. 3d 33 8, 34 5- 46 (T e nn . 2 00 2) , th e Te nn e sse e Sup re me Court held that even if a state-e mploy ed phy sician resident wer e entitled to immunity for tre atment of a patient, if that resident a cted a s an ag ent of a pr ivate hospital and c erta in leg al cr iteria we re absent, the private hospital c ould still be held vica riously liable. I n She lbu rne v

. Front ie r He alt h , 126 S.W .3d 838 (Tenn. 2003) , the Court rea ffirme d this principle by holding that a private he althcar e provider c ould be held liable f or the ac t s o f i ts ag ent, a state -employ ed socia l worker , even if that

a g e nt w a s in div idu a lly

immun e fr om s uit

.

“ Ge ne ra lly , w he the r a

n e mpl oy e e is a c tin gwi thi n th e sc op e of his or he r e mpl oy

me nt is a question of fa ct. . . . Howe ver, it bec omes a que stion o f l aw when the fa cts are undisputed and cannot support c onflicting resol u t i ons.” Te nne sse eFar mers Mut. Ins. Co . v

. Ame ric an M

ut. Liabilit y Ins. Co. , 8 40 S.W. 2d

93 3, 93 7 ( Te nn . Ct . App . 1 992) (ci tations omi tte d) . D r. Sc ra ntz te sti fi e d at de po sit ion

that he wa s an e mpl oy e e of UT via his re sid e nc y . App e lla

nt h a s c ite d n o f

a c ts within the re co rd that would support the conc lusion that Dr. Scrantz was ac ting a s an ac tual or appar ent ag ent of Semmes-Mur phey on J une 21, 2002. A court should a war d summary

judgme nt only when a rea sonable pe rson could re ach only one conc lusion based on the fa cts and the infe renc es draw n from those fa cts. Pa tte rso n v . Arif , 173 S.W .3d 8, 11 (Tenn. Ct. App. 2005). U pon revie w of the “ pleading s, depositions, answers to interr og atories, a nd admissions on file, toge ther with the aff idavits” within the rec ord, we find no materia l fac t in disput e that would support a conc lusion that Dr . Sc ra ntz w a s a c tin g in a

ny oth e r c a pa c ity tha n a s an emp loy e e of

the State wh e n h e a tte mpt e d to pe rf or m th e lum

ba r p un c tur e pr oc e dure up on Mr. Pr e wi tt o n Jun e 21 , 2 00 2. Con sid e ri ngthi s-15-

e vid e nc e , a lon g wi th t

he un dis pu te d fa c t th a t ne ith e r D r. Ti mmo ns or Dr . M uh lba

ue r w a s p re se nt t o direc tly supervise the resident on J une 21, we have de termined that Dr . Scrantz was not ac ting on the behalf of S emmes-Murphe y on this date. Bec ause w e have deter mined as a matter of law

that Dr. Scra ntz, the UT resident, was not acting as an ag ent of Semmes-Murphey when pe rfor ming the acts in question, we hold the Johnson and Shelburne decisions to be inapplicable t o the case at ba r.

We f ind that a ny acts or omissions alleg ed in Plaintiff’ s claim for neg lige n t s u pervision

a g a ins t Se mme s- Murp he y thr ou g h it s e mploy ees, Dr . T imm on s a nd Dr . M uh lba

ue r, we re so le ly within the scope o f t h ese employ ees’ duties as supervisors f or the Unive rsity

of Tenne ssee Depa rtment of Ne urosurg ery

Residency

Prog ram. We fur

ther h old as a matter

of law that the UT resident, Dr . Kell y S cr an t z , did not act as a n ag ent of Semmes-Mur

phey on J une 21, 2002, and the re fo re Se mme s- Murp he y may no t be he ld v ic ari ou sly lia ble fo r any ne g lig e nc e a ttr ibuta ble to h im

on that dat e . We fi nd

no e rr or , th e re fo re , in

the tr ia l c ourt ’s de c isi on

to g ra nt s umm ary

jud g me nt t o Se m m es -M urphey

on the issue of liability . Plaintiff’s rema ining issue a s to his own moti on for summary judgme nt ag ainst Semmes-Murphey reg ardingliability

is preter mitted.

B. Su m m ary Judgm ent as to Liabil ity of Kindred
Appellant fur

ther alleg es t hat t he trial court erre d in g ranting summary judgme nt to Kindred and its employ ee, N urse Ma rcia Glover. Mr

. Prewitt contends that the applicable standard of car e require d Nurse G lover to re trieve B etadine in r esponse to D r. Scrantz’s order for a lumbar puncture kit, and that her f

ailure to provide this antiseptic prior to the proc edure was a proxi mate ca

use of Pla int if f’ s su bs e qu e nt i nju

ry . App e lla

nt al te rn ativ e ly arg

ue s tha t Nur se Gl ov e r’ s abs e nc e fr om h is bedside at the outset of the attempted lumbar puncture proce dure c onstitut ed a ne g lige nt omissi on. Appellant maintains that these omissions constituted an ac t of o rdi nary neg lige nce, r ather

than medical malprac tice, and there fore no expert testimony was nece ssary

. Nonethele ss, Ap pellant argues that eve n i f we find this claim to sound in m edica l malprac tice, he satisfied the expert testimony require ment of the Te nnessee Medica l Malprac tice Ac t, T enn. Code Ann. § 29-26- 115 et seq. , throug h Nu rse Glover and N urse Ava nt’s response s to Pl aintiff’s que stions, reg ardingthe

a pp lic a ble sta nd ard of c are , at th e ir

de po sit ion s.

The Te nnessee Supreme Court has articulated a test for differ entiating betwee n common law

ne g lig e nc e and

me dic a l ma lpr a c tic e c la ims :

I n distinguishing betwee n the t wo claims, i t should be noted that not all case s involving hea lth or medical e ntities sound in m edica l mal p r a c ti c e

. . . A t t

h e o th e r e n d o f th e s p e c tr

u m, th e me d ical malpract i ce statute may

extend to acts of non-phy sicians, such a s
nurs e s, wh e n th e y

are inv olv e d in the me dic a l tr e a tme nt of a patie nt. . . [W ]hen a claim alleg es neg lige nt conduct which c onstitut es or bear s a substantial relationship t o the rendition of medica l treatment by a me dic a l pr ofession a l, t he me dic a l ma lpr a c tic e statut e is-16- a pp lic a ble . Co nv e rs e ly , w he n th e c on du c t a lle g e d is no t su bs tanti a lly related to the re ndition of medical trea t m en t by a medica l p r o f e s s i o n a l
, t h e m e d i c a l m a l p r a c t i c e s t a tu t e d o e s n o ta p p l y.

G u n t e r v . L a b

. C o r p . o f A m. , 121 S.W .3d 636, 640-41 (Te nn. 2003) (c itations omi tted). This Court has stated that the distinction betwe en common law neg lige nce and medical malprac tice depe nds on “whe ther the acts or omissions complained of involve a matter of medica l science or ar

t requiring specia liz ed skills not ordinarily possessed by lay

persons or w hether

the conduc t complained of c an instead be assessed on the basis of common ever y day experience of t he trier of fa ct.” Graniger v. Me tho dis t Ho sp . He alt

hc ar eSy s. , No. 02A01-9309-CV- 00201, 1994 Tenn. App. L EXI S 513, at *8 (Tenn. Ct. App. Sept. 9, 1994).

Whe n th e me dic a l ma lpr a c tic e statut e a pp lie s, it p ro vid e s in

re le va nt p art :
(a) I n a malpra ctice a ction, the claimant sha ll h av e t h e b urden of proving by

evidenc e as pr ovided by

subsection (b):
(1) The rec og nized standard of acc eptable profe ssional pr actice in the profe ssion a

nd the specia lty there of, if any , that t h e d ef endant prac tices in the community in which the def

endant pr actice s or in a simil ar c ommunity

at the time the alleg ed injury or wrong ful ac tion

occur red;
(2 ) T hat th e de fe nd ant a c te d w ithle ss t ha n o r f a ile d to a ct with ordinary and re asonable car e in ac corda nce w ith such standard; a nd
(3) As a proxi mate result of the defe ndant' s neg lige nt act or omission, the plaintiff suff

ere d injuries which would not otherw ise have

occur red.
(b) No per son in a hea lth care profe ssion requiring licensure under the laws of thi s st a te sh a ll b e c omp e te nt t o te sti fy in any c ourt of law t o
e sta bli sh the fa c ts r e qu ir e d to be e sta bli sh e d b y

su bs e c tio n ( a ), un le ss the per son was license d to pr ac t i ce in the state or a contig uous border ing state a p ro fe ssion or specialty which would make the person’ s expert testimony rele vant to the i s sues in the ca se and ha d prac ticed this profe ssion or specialty in one (1) of

these states dur ing the y ear prec eding the date tha t t h e alleg ed injury or wrong ful ac t

occur red. T his rule shall apply

to expert witnesses testify ing f or the defe ndant as rebuttal witnesses. The court may waive this subsec tion (b) whe n i t d ete rm in es t hat th e app rop ri ate wi tn ess es o th erwis e wo uld not be ava ilable.-17-

Tenn. Co d e Ann. § 29-26-115 (Supp. 2006). More simply , in a medica l malprac tice ac tion, the plaintiff has the bur den of proof on the f ollowing e lements: standard of car e, bre ach of

the standar d of ca re, a nd causation. Payne v

. Shu m ake , N o

. 0 2 A 0 1

- 9 9 0 1

- C V

- 0 0 0 0 6 , 1 9 9 9 T e n n

. A p p

. LE X IS 846, at *8 (Tenn. Ct. App. Dec. 15, 1999). I n order to establish eac h of these e lements, the plaintiff

m u s tp u tfo rt h ex p er t ev i d en ce , u n l es s t h e al l ege d l y n egl i gen t ac t l i es wi t h i nt h e c o m m o nkn o wl ed ge of the lay man. Id. (c i t i n g Bow man v. He nard , 5 47 S.W2 d 5 27 , 5 30 -3 2 ( Te nn . 1 97 7) ; Ayers v. Rut herford Hosp., Inc. , 689 S.W .2d 155, 160 (Tenn. Ct. App. 1984))

.
“Where the ac t of allege d malprac tice li es wit hin the common knowledg e of a lay man, expert testimony is not required.” Bal dwi n v . Kni ght , 5 6 9 S

. W

. 2 d

4 5 0 , 4 5 6 (T en n

. 1 9 7 8 ) ( ci t i n g Bowm an
v . He nard , 5 47 S .W .2 d 52 7 ( Te nn .1 97 7) ; Rura l Ed uc . As s’ n. v . Bus h , 42 Tenn. App. 34, 298 S.W .2d 761 (1956)) . This common knowledg e exception applies to ca ses in wh i ch the medica l neg lige nce is a s blatant as a “ fly flo at i n g in a bowl of buttermilk” so that a ll mankind knows that such thing s are not done abse nt neg lige nce. Graniger , 1994 Tenn. App. L EXI S 513, at *9.

Any alleg edly neg lige nt acts or omissi ons by Nurse G lover re g ardingMr. Prewitt’s treatment on J une 21, 2002 undoubtedly bore a substantial relationship to the rendition of medica l treatment by a medica l professional. We ar e unconvinc ed by Appellant’s a

rg ument that Nurse G lover’s f ailure to i nc lud e B e ta din e in the lum ba r punc tur e kit or he r a

bs e nc e fr om P la int if

f’ s b e ds ide imm e diate ly pri o r t o the attempted pr ocedur e constituted a ne g lige nt act within the common knowledg e of a lay pe rs on , th e re fo re , we fi nd that Pla int if f w a s r e qu ir e d to satis fy

the e xpe rt

te sti mony

re qu ir e me nts of Tenn. Code Ann. § 29-26-115.

I n her a ffidavit, Nu rse Glover stated that at all times pertinent to the litigation, she wa s an
e mpl oy e e of

Ki nd re d a nd that he r c on du c t “ e xce e de d th e re c og nize d s ta nd ard of acc e pta ble profe ssional prac tice in this locale a nd community

in the car e and tr eatment of Mr. Prewitt.” At he r d e p o s it io n , N u r s e G lo v e r s tate d th a t s h e r e a d D r

. Sc r an tz ’ s o r d e r f o r a lumb ar p u n c tu

r e kit and fo llo we d it

a s w ri tte n b y

takin g a se a le d, ste ri le lum

ba r p un c tur e kit

to M r. Pr e wi tt’ s b e ds ide . N ur se G lo v e r r e p r e s e n te d

th a t, a s th e a s s ig n e d

r e g is te r e d

n u r s e f o r Pl a in ti f f
, s h e c h e c k e d

h is c ondition regularly and alwa y s ensure d that his bed rails wer e in the uprig ht position. She stated that bef ore Dr. Scra ntz had entere d Plaintiff’s room on J une 21, 2002, Dr . Scrantz did not not i fy her that he woul d b e t re at i ng Plaintiff at that time. Nurse Glove r cla imed to have f irst noticed Dr. Scr antz’s pr e se nc e wh e n h e wa s le a ving P lai nt if f’s ro om t o o bta in B e ta din e . Sh e state d th a t a s D r. Sc ra ntz walked towa

rd the supply closet, she had procee ded toward Plaintiff’s room when she hear d a loud noise, afte r which she ran towa rd Plaintiff’s ro o m an d fo und him ly ing f ace down on the floor. Nurse G lover stated that upon entering the room and noticingPlaintiff’s condition, she also noticed that his bed rails had be en lower ed, and that when Dr . Scrantz returne d to the room, he informe d her that he had left the bed rails down when he left the room. Dr. Scrantz, in his de position, st ated that he did no t spe c if

y B e ta din e in his wr itt e n ord e r fo r a lumb ar pun c tur e kit , an d tha t nu rs e s “ us ua lly follow the orde rs ver

y specific ally .”

As no te d a

bo ve , Pl a int if

f did no t re ly on his ow n expe rt s’ op ini on s in atte mpt ingto e sta bli sh the standar d of ca

re or its breac h for nurse practitioners assisting in lumbar punc ture proc edure s, but-18-

instead attempted to e stablish thi s s t an d ar d of ca re throug h his questioning of N urses Glove r and Avant at de position wit h reg ard to c erta in internal docume nts o f T h e M ed o r Kindred. When questioning the se nurses in the 2004 depositions, for instance , Plaintiff’s counsel re peate dly relied

u p o na d o c u m e n t

e n t i t l e d “ T h e R e g i o n a l M e d i c a l C e n t e r a t M e mp h i s

– B r o n c h o s c o p y, E n d o s c o p y, Lumbar Puncture – Assistance.” (Ex. 2, Dep. of Glover). The first item of t hat document pr ovided, “1. W as h es hands. Ga

thers re quired e quipment and supplies.” At deposition, Nurse Glover w as qu e sti on e d a s f

oll ow s r e g ard ingthi s d oc ume nt:

Q. B e sid e s D r. Sc ra

ntz[’ s de po sit ion ] a

nd the me dic a l r e c or ds
, have you revie wed any

thing else perta ining to thi s patient, this case,

or thi s in c ide nt s uc h a s a

ny ho sp ita l po lic ie s? A. Ye s. Q. Th e lum

ba r p un c tur e po lic y ; r ig ht? A. Specific – it wa s lumbar puncture , bronchosc opies and other pr oc e dure s. Q. On e pa g e ; r ig ht? A. Yes. Q. And y ou revie wed that sheet in r esponse to this litigation but

no t pr ior the re to; ri g ht? A. Th a t’ s c or

re c t.

. . . Q. As of

the date of

Da vid Pr e wi tt’ s lumba

r p un c tur e s, plu

ra l, i n J une of 2002, y

ou hadn’t see n that policy , had y ou? A. No. Q. You wer en’t a

war e of it, we re you? A. No. Q. I f y ou wer e awa

re of it, you would have f

ollowed it, wouldn’t y ou? A. Yes, a

nd to the best of my

knowledg e, I

did follow what wa s on there

. Q. We’ll ge t to that in jus t a minute. A

. O k ay. Q. B e ta din e is a

su pp ly , is n’ t it ? A. Yes.

. . . Q. Th e [lum

ba r p un c tur e ]/br on c ho sc op y po lic y that w e jus t

c ov e re d – the sta nd ard of c are re qu ir e d y ou to fo llo w that, d idn ’t it? A. Repeat that ag ain. Q. The stan d ar d of ca re a s of J une 2002 re quired y ou to follow that po lic y , d idn ’t

it? A. Yes.-19-

Simi larly , in the deposition of Nurse A vant, Plaintiff’s counsel re peate dly used the ter

m “standar d of ca re” while questi oning the deponent, dur ing e x chang es in which it is clear that Nurse A vant was

re fe rr ing to sta

nd ard of c are manu a ls and int e rn a l po lic ie s o f T he Me d, ra the r t ha n th e sp e c if

ic a lly define d “re cog nized standard of a cce ptable prof essional pra ctice” as defined at Tenn. Code Ann. § 29-26-115 ( Supp. 2006).
Undisputed statements made by Nurses G lover a

nd Avant and other s at deposition

e sta bli sh e d th a t, de pe nd ing on the pa rt ic ula r ho sp ita l wh e re the y we re loc a te d, lum ba r p un c tur e kit s
so me tim e s c a me pr e pa c ka g e d w ithB e ta din e . N ur se Gl ov e r t e sti fi e d th a t th is had been the fi rs t lum ba r p un c tur e pr oc e dure in w hic h s he ha d part ic ipate d in tha t par tic ula r u nit a t T he Me d. Nurs e Glover f urther stated that the lumbar punc ture kit s we re s terile a nd seale d, and that she w as not allowed to open the kit to verify its contents bef

ore le aving it for Dr. Scr antz at Plainti ff’ s bedside.

At the summary

judgme nt hear ing on F ebrua ry 2, 2006, Plaintiff’s counsel stat ed t hat he intended to re ly

upon Nurse G lover a

nd Nurse Avant’s depositi on testimony to establish the standar d of ca re a ccor ding to Te nn. Code Ann. § 29-26- 115:

So th e s ta

n d ar d o f c ar e in th is c a s e is e s ta

b li s h e d b y th e h o s p it al po lic y , th e wr itt e n c on tr a c t, t he te sti mony

of the su pe rv iso r [N ur se Av ant], and

the te sti mony

of Nurse Gl ov e r w a s th a t, i n r e sp on se to Dr. Scra ntz’s written o rd er for the lumbar punc ture kit, she wa s require d to retrieve all supplies to the bedside prior to the proc edure
, including a

n antiseptic.

Causation and fore seea

bility issues aside, we believe Plaintiff’s relianc e upon this vagu e hospi tal policy and his questioning of

Nurses G lover a

nd Avant in its r eg ard wer e not suf ficient to satisfy

the

e xpe rt te sti mony

re qu ir e me nts of the Te nn e sse e Me dic a l Ma lpr a c tic e Ac t re g ard ingthe a pp lic a ble standard of

car e.

F i r s t , w e n o t e t h a to t h e r

s t a t e s h a v e h e l d

t h a ti n t e r n a l h o s p i t a l p o l i c i e s , a l t h o u g h p o s s i b ly rele vant when acc ompanying c ompetent expert testimony , do not alone conc lusively establish the standard of

car e for a medica l proce dure. See, e .g. , Moyer v . Reynolds , 780 So. 2d 205, 208 (F la. Di st. Ct. Ap p. 20 01 ); Po

ggev . Ha le , 253 I ll. Ap p. 3d 90 4, 91 5 ( I ll. Ap p. Ct. 19 93 ); Lue ttkev . St

. V inc e nt Me rc

y Me d. Ctr

. , No. L -05-1190, 2006 Ohio App. L EXI S 3828, at *12-13 (O hio Ct. App. July 28 , 2 00 6) ; Wuest v. McKennan H osp. , 20 00 SD 15 1 (S .D. 200 0) ; Reed v . Granbury Hosp. Corp. , 117 S.W. 3d 40 4, 41 4 (T e x. Ap p. 20 03 ); Riv e rsi de Hos p. , Inc

. v . J ohns on, 272 Va. 518, 529 (V a . 2 00 6) ; Auer v. Baker , 63 Va . Cir. 59 6, 60 0 ( Va . Ci r. 20 04 ); Hap pe rse tt v . Bi rd , 222 Wis . 2d 624 (Wis. C t. App. 1998).

F ur the rm or e , w e be lie ve that th e me tho d by whi ch Plai nti ff a tte mpt e d to e xtra

po la te testimony establishing the standard of car e, and the n at u re of

questioning of

Nurses G lover a

nd Avant in this reg ard, failed to satisfy the ex pert proof require ments of Tenn. Code A nn. § 29-26-115-20-

(Supp. 2006). Throug hout his questioning of these nurses a t t h e ir d is cover y depositions, despite later relying on this testimony as expert proof of the standard of car e, Plaintiff’s counse l did not ask either nurse to def

ine the standa

rd of pr ofessional practice for nur ses assisting in lumbar punc ture pr o c e d u r e s in M e mp h is o r s im il ar c o mm u n it ie s , o r to d e s c r ib e th e ir o w n f a mi li ar it y w ith such standard. I

nstead, que stions posed to these deponents by Plaintiff’s counsel reg ardingThe Med’ s policies evince his own belief that these internal standa rds wer e equiva lent to the rele vant standar d of pr of ess io nal prac tic e . A s a

re su lt, rathe r t

ha n a llo w N ur se s G lov e r a nd Av ant e xpre ss t

he ir opinions, he eff

ectively asked the m to acc ede to his own c hara cter ization of the applicable standa rd of ca re.
Appellant argues that this Court’s holding in Mull ins v. Jonas , No. 02A01-9306- CV-00132, 1994 Tenn. App. L EXI S 456, at *11-12 (Te n n

. C t

. App. Aug . 15, 1994), re flec ts a trend of Tenne ssee c ourts to relax the require ment of st rict adherenc e to the statutory lang uag e of Te nn. Code Ann. § 29-26-115 by

parties whe n questioning e x perts as to the r elevan t s t an d ar d of ac cepte d prof e ssi on a l pr a c tic e . We re c og nize , h ow e ve r, tha t in tha t de c isi on , w e fo un d th a t th e ov e ra ll testi m o n y of the e x pert phy sician conf ormed with the re quirements of the Tenne ssee Me dical Ma lpr a c tic e Ac t, a

nd the re fo re we re ve rs e d the tr ia l c ourt ’s g ra nt o f d ir e c te d v e rd ic t to the de fe nd a nt. Id. After a thoroug h revie w of the e ntire re cord, w e ca nnot say that the over all deposition testimony of Nurse s Glover a

nd Avant in this case satisfied these re quirements.

Con se qu e ntl y , w e fi nd

tha t Pla int if f d id n ot pro vi de com

pe te nt e xpe rt

pr oo f t hat N ur se Glover’ s actions in providing a lumba r puncture kit prior to Plainti ff’ s proce dure c onstitut ed a f ailure to a c t w ithre a so na

ble or or din ary c are in a c c or da

nc e wi th the pr of

e ssi on a l stand ard of c are a s it is define d within the Tennessee Medical Malpra ctice A ct, nor did Plaintiff offe r suffic ient expert proof that th e a pp lic a ble sta nd ard of c are re qu ir e d N ur se Gl ov e r t o b e pr e se nt w he n D r. Sc ra ntz i nit ia lly

e nte re d M r. P rewi tt’ s r oo m and pr e pa re d h im f or the lum ba r p un c tur e pr oc e dure . A s a re su lt,

su mma ry jud g me nt w a s a

pp ro pr ia te fo r K ind

re d a nd its e mpl oy e e , Nurs e Gl ov e r. F ind ingthe on ly

rema ining issue to be pr eter mitted, we similarly

aff irm the trial cour

t’s denial of Plaintiff’s motion for summary

judgme nt as to liabilit y

of Kindre d and Nur se Glover

.

V. C ONCL US I ON

F or t h e f o r e g o i n g r e a s o n s , w e a f

f i r m t h e t r i a l c o u rt ’ s g r an t o f s u m m ar y j u d g m e n t a s to Semmes-Murphey , Kindred, a nd Nurse Glover. We also aff irm the trial cour

t’s denial of summar

y judgme nt to Appellant. Cos t s ar e assessed a g ainst Appellant, David Prewitt, and his surety , for

w h i c h e x e c u t i o nm ay i s s u e , i f n e c e s s ar y.

___________________________________

AL AN E. HI GHERS, J UDGE