### IN THE COURT OF APP EALS OF TENNESS EE AT NAS HVILLE Ja nua ry 7, 200 4 S es sio n
DOM INIC P. PE LLIC AN O v. M ETR OPO LITA N G OVE RN MEN T OF

NA SHV ILLE A ND DA VID SON CO UN TY
Appeal f rom the Circ uit Court for Davidson County No. 00C-3678 C arol Solom on, Jud ge

No. M2003- 00292-COA-R 3-CV - F iled Fe bruary 23, 2004

Plaintiff, who had a pr e-e x isting her niated disk, was r ear -ende d in a vehicula r ac cident seve n wee ks afte r the first injury

. A diskectomy was perf ormed six months late r. Tre ating phy sician equivoc ated wh e n ask e d whe the r the dis ke c tomy wa s nec e ssi tate d by the se c on d injury , tes tif ying , “ma y be y e s; may be no.” T rial cour

t found that Plaintiff’s nee d for surg ery was cause d by incident and aw arde d Plaintiff judgment a g ainst Defe ndant for a ll medical expenses re lated to the surg ery , lost wag es and pa in a nd su ff e ri ng . Pl a int if

f did no t pr e se nt s uf

fi c ie nt p ro of

to e sta bli shthat in c ide nt w a s c a us e in fac t of nee d for surg ery

for phy sician could not state wit h rea sonable de g ree of medica l cer tainty that need f or surg ery

was the r esult of the incident. F urther, la y test i mony

of Plaintiff and Plaintiff’s brother w as insufficie nt to prove ca use in fact o f P l ai n tiff’s nee d for surg ery . Acc ording ly , we re ve rs e the tr ia l c ourt

.

Tenn. R. App . P . 3 Appeal as of Right; Judgme nt of th e Circ uit Court Reve rsed, Modified an d Rem anded

F RAN K G. C L EME NT , J R ., J ., delivere d the opinion of the cour t, in which W I L L I AM C. K O CH , J R ., P.J ., M.S., and P ATR I C I A J. C O T T RE LL , J ., joined.

L or a A. B ark e nb us , Na sh vil le , Te nn e sse e , fo r the a pp e lla nt, Me tr op oli tan Go ve rnme nt o f N a sh vil le

an d D a v i d s o nC o u n t y. Robert H. Plummer, J r., F ranklin, Tenne ssee, f or the a ppellee, D ominic P. P ellicano.

OP IN ION

The issue is whether the pl aintiff, who suffe red f rom a pre -existi ng herniated disk, prese nted sufficie nt proof to establish that the incident with the defe ndant’s ambulance was the cause in fac t for surg ery

to repa ir the her

niated disk a

nd 100% of the r esulting me dical expenses, lost wag es and p ai nan d s u ff er i n g.A w o rk e rs ’ co m p e n sa tio n a c tio n , D a v id so n C o u n ty C irc u it C o u rt D o c k e t N o . 0 0 C -2 7 0 6 , w a s fil e d b y D o m inic 1
P el l i cano agai nst A

- H M echanical C o nt ract o rs , Inc. T he reco rd d o es not ind ic a te w h et her P el l i cano recei ved any
reco very f

rom t hat act i o n.

D r. G u ill e rm in p e rfo rm e d the d isk e c to m y. 2

-2- Plaintiff/Appellee, Dominic Pellicano (P ellicano) was involved in an on- the-job ac cident on November

2, 1999 while workingfor A-H Mechanica l Contractors, I nc., when a one hundred pound pipe fe ll o n h is neck a

nd shoulder. Pellicano soug ht medical ca re, a nd X-ra y s were taken whic h
reve aled a

herniated disk. Pellicano filed a w orker s’ compensation cl ai m and alleg ed that he sustained the her

niated disk as a result of the November 2, 1999 on-the-job injury

. His employ er a nd
wo rk e rs ’ c omp e ns a tio n c arr ie r c on te ste d th e c la im. 1

Seven we eks later, on Dec ember 27, 1999, Pellicano was involved in a “re ar- end” inc ident in which his v eh i cl e was struck from behind by a Na shville Fire D epar

tment ambulance . The ambulance was drive n by Wil liam J ones. Rick y W i l s o n , a par amedic, w as in the re ar of the ambulance treating two patients. The ambulance was moving slowly in bumpe r-to-bumpe r traf fic,

a t a pp ro xima te ly fi ve (5 ) mil e s pe r ho ur . Jon e s atte mpt e d to sto p th e ambu lanc e slo wl y so a s n ot t o throw the patients and Wil son around in the bac k of the ambulance; howe ver, he was una ble to stop befor e hit t i n g P el l icano’ s vehicle f rom the re ar. Wilson, who was standingin the rea r of the ambulance when the wre ck occur red, testified that the incident was so subtle that he was not knocke d off his fe et. J ones and Wil son spoke t o Pellicano immediately afte r the a ccide nt. Pellicano stated to them that he was not hurt a nd did not need nor d es i re m edica l car e. No one in the ambulance
su sta ine d a

ny inj ur ie s a s a

re su lt o f t

he inc ide nt. Following the incident at issue, Pellicano continued to work a nd did not seek medica l car e until four months later. Pellicano first soug ht medical ca re f or injuries re lated to the re ar- end incident on May

4, 2000; howeve r, he did not return to the doctor who tre ated him for the on-the-job injury . I nstead, Pellicano went to Dr . J ohn P. Guillermin. Following a brief pe riod of conse rvative treatment, Dr. Guill ermin re commended sur g ery to repa ir Pellicano’s he rniated disk. The surg ery was pe rfor

med on J une 19, 2000. After surg ery , Pellicano remained off work until September 18, 2000 when he was re lease d to return to work. Pellicano has not receive d any medical tre atment since t h e s u r g e r y.

Pe lli c ano fi le d thi s pe rs on a l inj ur y a c tio n a g a ins t the Me tr op oli tan G ov e rnme nt o f N a sh vil le

and Da vid so n County , Te nn e sse e (D e fe nd ant) , the Na sh vil le F ir e De pa rtme nt a nd Willi a m R. Jone s, the ambulanc e drive r. B y ag ree d order , Wil liam J on es an d t h e Nashville F ire De partment we re dismiss ed fr om the lawsuit.

The c ase w as tried without a jury . Wi t n es s es at trial included Pellicano; his brother, Peter Pellicano; the ambulanc e driver, William J ones; and the othe r par amedic in the a mbulance, Ricky Wils on . T he te sti mony of Dr

. Gu ill e rm in, Pe lli c ano ’s tr e a tin g ph y sic ian, wa s p re se nte d thro ug h h is deposition. 2-3-

The trial court held t hat P ellicano’ s pre- exis ting neck injury was e x ace rbate d by

the incident and that the incide nt was the sole c ause in fac t f or Pellicano’s need for a diskectomy

. Def endant wa s held liable for

100% of the me dical expenses re lated to the surg ery , plus lo s t wage s and pain a nd suffe ring . Specifica lly , Pellicano was a war ded $41,580 for medical bill s, $5,500 for lost wag es and $45,000 for pa in and suffe ring for a total awar d of $92,080. The tr ial court did not allocate any of Pellicano’s dama g es to the pre -existi ng injury or to Pellicano’s e mploy er.

Standard of Re view

An a pp e llate c ourt ’s re vie w of a tr ia l c ourt ’s fi nd ing s of fa c t is de novo upon the re cord of the trial cour

t acc o m p anied by

a pre sumption of the corre ctness of the finding s, unless the preponde ranc e of the evidenc e is otherwise . Tenn. R. App. P. 13(d). Unless there is an err or of law , we must aff

irm the trial cour

t’s decision as long as the evidenc e does not preponde rate ag ainst the finding s. Umstot v. Umstot , 968 S.W .2d 819, 821 (Tenn. Ct. App. 1997).

The we ight, f

aith and cr edit to be g iven to a witness’ te stimony lies with the trial judge in a non-jury case beca use t he trial judge had an opportunity to observe the m anner and demeanor of the witness duri ng their testimony

. Ro be rts v . R ob e rts , 827 S.W .2d 788, 795 (Tenn. Ct. App. 1991); W eave r v. Nelms , 750 S.W .2d 158, 160 (Tenn. Ct. App. 1 9 8 7 ). I n revie wing documentar y proof such as de position t estimony which wa s prese nted to the t rial court, “all impressions of we ight a nd
cre dibilit y

are draw n from the c ontents of the evidenc e, and not from the a ppear ance of witnesses

an d o r a l t e s ti mo n y

a t t r ia l. ” W e lls v . Te nn esse e Bo ar

d o f R e ge nts , 9 S.W .3d 779, 783-784 (Te nn. 1999). An a

ppellate co u rt “may

make a n independe nt assessment of the c redibility of the documentar

y proof it re views without aff ording defe renc e to the trial c ourt’s finding s.” Id . at 783. When the proof i s p r e s e n te d thr o u g h a

d e p o s it io n , th e a

p p e ll ate c o u rt c anju s t a s w e ll ju d g e the
c r e d ib il it y o f th e w it n e s s a s th e tr ia l c o u rt. Id. 78 4. Th e re is n o p re sumpt ion of c or re c tne ss w ith respe ct to the trial cour

t's c onclusions of law. Campbell v. Flori da Steel Corp., 919 S.W .2d 26, 35 (Tenn.1996) and Te nn. R. App. P. 13(d).

An a ly sis

The de fenda

nt contends that it is not responsible for 100% of Pellicano’s injuri es and resulting damag es beca

use Pellicano had a pre- exis ting herniated disk; e mphasizi ng the fa ct that the pre- exis ting injury

occur red a mere seven w eeks pr ior to the incident at issue. Moreove r, De fenda nt contends that while the incident may have e x ace rbate d a pre -existi ng injury , the cour t should have

a pp or tio ne d th e dama g e s b e c a

us e the pr oo f wa s insu ff

ic ie nt to es ta

bli shthat th e inc ide nt w a s th e so le and proximate cause of P ellicano’ s need for the diskectomy

. Def endant therefor e concludes that the proof wa s insufficient to hold Def endant liable f

or all expenses re lated to the surg ery , lost wag es
r e s u l t i n g f

r o m t h e s u r g e r

y, an d p a i n an d

s u f f e r i n g r e l a t e d

t o t h e s u r g e r

y an d r e c o v e r y f r o m s u r g e r

y.

A ca use of a ction for ne g lige nce r equire s that five ele ments be established : (1) a duty of ca re owed by the def endant to the plaintiff; (2) conduct t hat falls below the applicable standard of car e such that there is a brea ch of t h e duty of ca re; (3) an injury

or loss; (4) ca

usation in fact; (5) and-4-

proxi mate or le g al ca

use. McClenahan v . Cooley , 8 06 S.W. 2d 76 7, 77 4 ( Te nn . 1 99 1) . I n th is c a se Def endant c oncede s that it is responsible for exacer bating Pellicano’s condition; thus, we nee d not addre ss the first three elements a nd beg in our inquiry

with a focus on the fourth e lement, ca usation, to d e te rm ine if

the inc ide nt w a s th e c a

us e in f a ct fo r P e lli c ano ’s surg e ry . “ Ca us a tio n, or

c a us e in fac t, means that the injury or har m would not have occ urre d ‘b u t fo r’ the def endant’ s neg lige nt conduct.” Kilpat r i ck v . Bryant , 868 S.W .2d 594, 598 (Tenn. 1993) . I n situations where two independe nt cause s are prese nt which alone c ould have produce d the injury , the “but for ” test may not be as e ffe ctive and the court may consider whether

the def endant’ s conduct wa s a “substantial fa c tor ” in bri ng inga

bo ut t he ha rm

. W as te Ma nage me nt, In c . o

f Te nn esse e v . S

ou th C e ntral B e ll Telephone Company , 15 S.W .3d 425, 431 (Tenn. Ct. App. 1997). The plaintiff has the “ burden of introducing evidenc e that af fords a rea sonable ba sis for conc luding that it is more likely than not that the def endant’ s conduct wa s a ca use in fac t of their injury .” W as te Ma nage me nt at 4 3 3 (c i t i n g Cook v. Spinnake r’s of Rivergate, I nc. , 878 S.W .2d 934, 939 (Tenn. 1994)

.
Th e iss ue of

c a us a tio n in fa c t sh ou ld b e re so lve d b e fo re un de rt a kin g the iss ue s o f l e g a l c a us e or allocating f

ault. W as te Ma nage me nt at 433. “Onc e it is established that the def endant’ s neg lige nt conduct wa s, in point of fact, the a ctual ca use of the pla intiff’s injury or har m , t h e fo cus t hen become s whether

the policy

of the lawwill ex tend re sponsibili ty for t h at neg lige nt conduct to the conseque nces that have oc curr ed.” Kilpat rick at 598. Thus, we must first find that the incident wa s the ca use in fac t for the surg ery

as opposed to a

n injury to a lesser

extent before c onsideringwhether the final e lement, that of proximate cause , has bee n satisfied.

Pellicano insists t hat his injuries, specific ally the need for surg ery , resulted f rom the incident with Defe ndant’s ambulanc e, not the prior injury . He testified that the prior injury was not ca using him any pain at the time of the incident with the ambulanc e, and that he wa s succe ssfully rec overing from the pr ior injury , though he was more vul n er ab l e t o i njury . Pellicano furthe r testified that he missed no work as result of the prior injury and wa s only

place d on “lig ht duty

status” as a

result of that injury

. Pellicano’s brother, Peter Pellicano, te stified, stating that after the prior injury

Pellicano
was we aringa nec k brac e but g etting be t t er and that Pellicano, “ did the normal thing s around the house, he did the shopping , mowed the lawn, whateve r, play ed footba ll with the guy s, . . . . ”
The liability

of one w ho neg lige ntly

or unl awf ully injures t he person of anothe r is not to be measur ed by the phy sical st reng th of t he party injured or his capac ity to endure suffe ring . One of

weak phy s i ca l s t ru cture , or small vitality , or in ill health, has as much rig ht to protection from violenc e as a robust athlete, a

nd in either case the phy sical injury , the bodily harm, whic h is actua lly cause d by the vi olence , whether one be strongor wea

k, healthy or sick, is the natura l conseque nces of the wrong . The defe ndant is responsible for all ill ef fec ts which natura lly

and nec essar ily

follow the injury in the condition of hea lth in which the plaintiff was at the time of the fall, and i t i s no defe nse that the injury might have been a g g ravated and r ender ed more difficult to cure by

rea son of plaintiff' s state of he alth at that time, or that by rea son of latent disea se the injuries we re rende red more serious to he r than they would have be e n to a pe rs on in ro bu st he a lth . I f t

he a ff lic tio ns wh ic h p la int if

f h a d b e fo re the fa ll-5-

did not cause he r pain a

nd suffe ring , as she sa

y s they did not, but afte r t he fa ll they did cause pain and suff

ering , the fall is the proxim ate c ause of the injuries sustained. The defenda

nt is not entit led to rec eive a reduc tion of the damag es which pla intiff
su ff e re d o n a c c ount o f s uc h in fi rm iti e s. Th e fo re g oingstate me nt o f t he ru le is supported by

a g reat preponde ranc e of a uthority

.
El ro d v . To wn o

f F ra nk lin , 204 S.W . 298, 301 (Tenn. 1918)

. An often state d principle is that a tort fea sor must a cce pt the person as he finds him and the person injured by the t ort fea sor i s entitled to rec over all damag es proximately cause d by

the ac ts of the tort fea sor. A defendant is not “re sponsible for plaintiff’s previous condition, except to the extent of ag g ravation or enhanc ement by defe ndants’ ac ts.” Haws v. Bullock, 592 S.W 2d. 588, 591 (Tenn. Ct. App. 1979). Thus, a plaintiff may re co v er for a n incre ase in disability , but not for the total disabilit y wh i ch resulted f rom the pre -existi ng condition plus ag g ravation of the pre- exis ting condition cause d by

the ac cident. Kin c aid

v . Ly e rla , 680 S.W .2d 471, 473 (Tenn. Ct. App. 1984).

A conc ise statement of the law reg arding the ag g ravation of a pre- exis ting condition is found in t he Te nn e sse e Pa tte rn

Jury I ns tr uc tio ns

. A per son who has a c ondition or disabilit y at the time of a

n injury is entitled to rec over da

mag es only

for a ny ag g ravation of the pre- exis ting condition. Re cover y is allowed eve n if the pre- exis ting condition ma de plaintiff more likely to be injured

an d e v e ni f a n o r m a l , h e a l t h y p e r s o nw o u l d n o th av e s u f

f e r e d s u b s t an t i a l i n

j u r y. A plaintiff with a pre-existi ng condition may rec over damag es only for a ny additional injury

or har m resulting f

rom the fa

ult y ou may

have fo u n d in this case. Damag es shall include a ll the additi onal harm or di sability even thoug h it is gre ater bec au s e of the pre- exis ting c ondition [ and eve n though the pre- exis ting c ondition
c a u s e d n o h ar m o r d is a b il it y b e f o r e th e o c c u r

r e n c e ].

T.P.I . 3-Civil 14.14.

I t is undisputed that Pellicano had a pre- exis ting injury . Moreove r, De fenda nt has conc eded that the incident “e x ace rbate d” Pellicano’ s pre- exis ting condition a nd that the medical e x penses f or conser vative ca re by Dr. Guill ermin from the date of the incident up to the date of the surg ery , in the amount of $1,277.20, we re r easona ble and ne cessa

ry

. Whil e Def

endant does not c ontest this portion of the a war d for medic al expenses, it vigor ously contends that Pellicano failed to present competent evidenc e suff

icient to establish that the surg ery was ne cessitated by

the ex ac erb at ion of the pre

exis ting injury , arguing that the evidenc e established that it is just a s likely that Pellicano would have neede d the surg ery

if the incident ha d not occur red.
The testimony

of Dr. Guillermin is centr al t o the i ssue of whether there is sufficient evide nce to establish that the s urg ery was necessitated by the i ncident. Dr. Guillermin did not treat Pellicano-6-

for the injury

that o cc u rr ed p rior to the incident. More over, D r. Guillermin did not see Pellicano befor e the incide nt and did not see nor tr eat him for a ny condition u n t i l M ay 4 , 2002, some four months a fter the incident at issue. Dr. Guillermin init ially treated Pellicano conse rvatively and then
re c omm e nd e d a

dis ke c tomy . H e pe rf

or me d th e dis ke c tomy

on June 19, 2000 . D r. Gu ill e rm in tes t i fi ed b y d eposition. The following are pertinent pa rts of his testimony

from the f

irst of two de po sit ion s: Q Do c tor , c an you

te ll m e so me mor e ab out w hat c a us e d th is m an’ s in

jur ie s? Can we sa y whether his he rniated disc was c aused by the work c omp acc ident
or by the a uto a c c ide nt? A The diag nostic imag ing, which conf irmed the diagnosis of a herniated disc, was done prior to the auto a ccide nt. So it doesn’t make any differ ence what
cause d that. How it stands there , in relation to the au t o ac cident, is of qu e sti on . H e ha d a

rup tu red di sc be fo re the a uto a c c ide nt, so the a

uto
acc ident did not cause a

ruptured disc ; it ex ace rbate d his sy mptoms. Q I ’m

so rr y , w hat ki nd

of te st d id you

sa y sh ow e d th a t he ha d a

ru pt ured dis c befor e? A my elog ram, followe d by a CT sca n. Q So the work comp a ccide nt actually cause d the her

niated disc? A Well, it hasn’t bee n decide d what ca u s ed the her niated disc. It makes no differ ence what ca

used the he rniated disc, be cause whateve r caused it, it was proved to be prese nt on th at day , and ther efor e any thing that ha

ppens the re a ft e r w ou ld e xac e rb a te it. Q Okay . But the a

uto acc ident didn’t actua lly cause the her

niation? A Th a t’ s c or

re c t. I me an h e ha d a

he rn iate d d isc be fo re the a uto a c c ide nt. Q And is it possi ble he would have had to have a diske ctom y re g ardle ss of wh e the r h e ha d th e a

uto a c c ide nt? Mr. P lummer: Object to the form of that. You may

g o ahea d and answ er.

MS. BARKENB US: (CONTI NUI NG) Th e Witn e ss: Ye s. Q Do y ou know whether he would have had to have a diskectomy reg ardle ss of t h e a u t o a c c i d e n t ? I’ m a s k i n g t h e s a m e qu e s t i o na d i f f e r e n tw ay. Mr . Pl umm e r: Iob

je c t. The Witness: There a

re no statistics on that to base a statement. The a nswer is may

be y es; may

be no.

Dr

. Gu i l l erm i nwa s d ep o s eda s ec o n d t i m e, s ev er al m o n t h s l at er , i nwh i ch t h e f o l l o wi n g ex ch an ge took place:
Q I n y our last deposition y ou said that he mi g ht have ne eded a diskectomy

even if he ha d n e ve r h a d th e a

uto a c c ide nt; is that c or

re c t?-7-

. . . . .
B Y M S. B ARKENB US: Q Do y ou

re c a ll s ayingthat? A Ibe lie ve that w a s th e qu e sti on and I sa id m ay be , y e s. Q May

be, y es, that he mig ht have ne eded the diskectomy , even if he had ne ver ha d th e a uto a c c ide nt? A I b e l i e v e t h a tw a s t h e an s w e r t o t h e qu e s t i o np r e v i o u s l y. Q I s that still y our answe r? A Exa c tly

a s it wa s in the pr e vio us de po sit ion , y e s. Q T h a th e m i g h th av e n e e d e d i tan yw ay? A Cor

re c t. Q So y ou can’ t sa

y with medical-- a re asonable deg ree of medica l cer tainty that the auto ac cident ca

used him to have the diskec tomy , can you? A Repeat that question, please. Q Do we kn ow that the

-- I ’m so rr y , let me sta

rt ov e r. Do we kn ow that th e a uto
a c c i d e n tw a s t h e a

b s o l u t e r e a s o nt h a th e n e e d e d t o h a v e t h e d i s k e c t o m y? A I t wasn’t the a

bsolute rea son. Q Ok ay . A nd

he may have ne e de d to have on e e ve n if he ha dn ’t had the a

uto
a c c ide nt; ri g ht? A Cor

re c t.

I n most cases medic al ca usation and per

manenc y must be establi shed by

expert medical testimony

. Thomas v. Aetna Life & Cas. Co. 812 S.W .2d 278, 283 (Tenn. 1991) . I f such testimony is speculative in natur e, it is insufficient to establish causation. Primm v. W icke s Lumber Co. , 845 S.W. 2d 76 8, 77 1 ( Te nn . Ct . App . 1 99 2) . T he fo re g oin g re ve a ls that Dr

. Gu ill e rm in, in r e sp on se to
s e v e r a l s i m i l ar

qu e s t i o n s p e rt a i n i n g t o w h e t h e r t h e i n c i d e n tb r o u g h t a b o u tt h e n e e d f o r s u r g e r y, of fe re d th e fl e xible op ini on : “ may be y e s; m ay

be no ” or wo rd s to that e ff e c t. Whe n c a lle d u

po n to consider what is and is not sufficient proof to establish causation, our Supreme Court stated:

"T he plaintiff must introduce e vidence which af fords a re as onable ba sis for the
c on c lus ion

that it is m or e lik e ly

tha n n ot th at th e condu c t of the de fe nd ant w a s a cause in fac t of the re sult. A m er e possibility of such c ausation is not enoug h; and when the matter re mains one of pur e spec ulation or conjec ture or the probabilities are at best eve nly

balanc ed, it becomes the duty of the c ourt to direct a

verdic t for the defe ndant. . . . Prosser, Sec . 41, p. 269.

. . . . .

" A doc tor ' s te sti mony

tha t a c e rt a in t hin g is po ssi ble is no evidenc e at all. His opinion

a s to wh a t is po ssi ble is n o mo re va lid tha n the jur y ' s o wn sp e c ulatio n a s to wh a t is
or is not possible. A lmost any thing is possible, and it is thus imprope r to a llow a jury to con si der and bas e a verd ict up on a 'pos si bl e' caus e of d eat h. " Palace Bar, I nc. v.T he co urt i n Tayl or v. D yer r ec og n i ze d t h at i t was de r i v i n g t h i s r ea s on i n g r eg ar di n g c au s at i on a n d t h e u s e of 3
l ay t esti m o ny f

ro m w o rke r’ s co m p en sati o n case s b ut o p i ne d t ha t t he p rincip l es wo uld also ap p l y t o an au t o ac cid en t ca se
as was i nvo l ved i n Tay l or

. -8- Fe ar no t, 269 I nd. 405, 381 N.E.2d 85 8 , 8 6 4 (1 978). " The mer e possibility of a
causa l relationship, without more, is insuff icient to qua lify

as an a dmissibl e expert op in io n. " Kirschner v. Broadhead, 671 F.2d 1034, 1039 ( 7th Cir.1982).

. . . . .
N e v e rt h e l e s s , a m e r e p o s s i b i l i t y i s n o t a n a f f i r m a t i v e b a s i s f

o r a f i n d i n g o f f a c t

. " In the langua g e of

the law o f e vid e nc e, [ a med ica l op ini on su g g e sti ng ] that w hic h is
me re ly po ssi ble , s tand inga lon e and no t of fe re d a s auxil iary

or re butta l te sti mony

is immaterial to the ascertainment of the fac t and so is inadmissibl e as e vidence of that fact ." Ma rti n v . U

nite d S tates, 2 8 4 F. 2 d 2 17, 219 (D.C. Cir. 1960). Kirschner v. Broadhead, supra, 671 F.2d at p. 1039-1040.
Lindsey v. Miami De velopme nt Corp. 689 S.W .2d 856, 861-862 (Te nn.1985).
Dr. Guillermin’s testimony perta ining to the important iss ue of whether the need f or surg ery was c aused by

the incident with the ambulanc e, “ma y be y es; may

be no,” is the e pitome of being
e qu ivo c a l. A c c or din g ly , w e fi nd tha t D r. Gu ill e rm in’ s tes tim ony , stand ing a lon e , is ins uf fi c ie nt t o establish that Def

endant is liable for damag es attributable to the surg ery . Howeve r, an infe renc e of
causation may

be dra wn by the trial co u rt wh er e equivoca l medical proof is combined with other evidenc e which suppor

ts a finding of ca

usation. Taylor v . Dye r , 88 S.W .3d 924, 926 (Tenn. Ct. App. 2 0 0 2 ) ( qu o t i n g Tindall v. W a r i n g P a rk A s soc. , 725 S.W .2d 935, 937 (Tenn. 1987) ). “Causation 3 may be established by a combination of medica l and lay testimony .” Id. at 926. Thus, our ne x t step is to analy

ze whether

any other e viden ce p rese nted by Pellicano is sufficient to show that the

a mb u l an c e a c c i d e n tc a

u s e d t h e n e e d f o r s u r g e r y.

Pe lli c ano and

his br oth e r, Pe te r, te sti fi e d th a t he wa s in jur e d p ri or

to t he a mbu lanc e a c c ide nt, when a pipe fe ll on his neck and shoulder at work, but he did not mis s any work be cause of the prior injury . Peter Pellicano te stified that Pellicano had r ecove red f rom th e o n -t h e-job inj ury and wa s doing the shopping, mowingthe y ard a nd playing football “with the g uy s,” but that afte r the incide nt he could not do wor

k around the house, pick up heavy items when shopping or mow the lawn. He also testified that Pellicano wa s in gr eat pa in after the incident and was losing a g reat deal of slee p afte r the incide nt.

Pe lli c ano te sti fi e d th a t he wa s re str ic te d to “ light d uty” wo rk by his fi rs t do c tor , th a t he on ly suffe red f rom pain in his shoulder and that he was “fine ” befor e the incident. He state d that he wa s wea ring a nec k brac e on the da y of the incident but w as not w ear ing it whe n the incident occ urre d. Pellicano admitted that he told the drive r of the a mbulance a

nd the other pa

rame dic (Jones and Wil so n ) th a t h e w a s n o t i n ju r e d

. H e f u rth e r a dmi tt e d th a t h e d id

n o t s e e k me d ic a l c ar e f

o r four-9-

months after the incident, explaining that he di d n ot seek medic al ca re until he be g an suff

ering persistent numbness in his arms and f inge rs, pain, hea dache s and loss of sleep.

Pe lli c ano te stifi ed th a t hi s in jur ie s a nd surg e ry we re the re su lt o f t

he inc ide nt w ith De fe nd ant’ s ambu lance; ho wev e r, on c ro ss e xami natio n th e de fe ns e c ha lle ng e d th e ba sis of his opinion as to causation.

B Y M S. B ARKENB US: Q Okay . Your wor ker’ s comp acci dent was a bout seven we eks bef

ore the

ambu lanc e a c c ide nt; ri g ht? A Ibe lie ve so , y e s. Q An d you

ha d p a in i n your a

rm a s a re su lt of the wo rk e r’ s c omp a c c ide nt, didn’t y ou? A Ye s. Q And I

think y ou testified that y ou had pain from y our shoulder to y our elbow
as a r esult of that -- A Ye s. Q -- worke r’s comp ac cident? And the pipe that f ell on y ou was a

bout 20 fee t lon g , w a sn ’t

it? A Pr e tty

c los e , y e s. Q An d it

wa s a bo ut 1 00 po un ds , w a sn ’t

it? THE COURT: He ha d pain from his shoulder to his elbow? MS. B ARKENB US: Ye s, ma ’a m. B Y M S. B ARKENB US: Q That pipe wa s about 20 fee t long that f ell on y ou-- A Rig ht. Q

-- a t y our w or

k c omp a c c ide nt? A Rig ht. Q An d th a t pi pe we ig he d 1 00 po un ds ; r ig ht? A May

be not that heavy , it was plastic. You know, may be pretty close. I ’m not sure, I don’t know exact we ights on e very pipe. I rea lly don’t know. Q Can I as k y o u t o look at this? That’s the c omplaint that y ou filed in y our wo rk e r’ s c omp e ns a tio n la ws uit , is n’ t it ? A Ibe lie ve so , y e s. Q And ca

n y ou rea d Parag raph 5 f

or me? A Actually

Ican’ t, beca

use I don’t have my

g lasses on. Could y ou rea d that for me?

. . . . . Q Whil e unloadingpipe at a job site, comma, the plaintiff w as injured whe n a larg e piec e of pipe approx imately 12 inches by 20 fee t and about 100 pounds fell and struc k him on the back of th e n ec k an d rig ht shoulder junction. Wou ld you

argue if Isa id t hat’ s w hat it

sa y s?-10-

A No , th a t’ s w hat it

say s. Q An d in

that c omp la int

y ou sai d th at y ou

ha d s uf fe re d p a in a

nd inj ur y a s a re su lt o f t hat a c c ide nt; ri g ht? A Ye s. Q And isn’t it true that y ou also said that y our surg ery had bee n cause d by

that

a c c ide nt? A My

surg e ry wa s c a us e d b y that a c c ide nt? Q B y

y our w or ke r’ s c omp e ns a tio n a c c ide nt? A No, I

don’t believe so.

. . . . . Q I t say s, As a

dir e c t and

a pp ro xima te re su lt o f t

he a c c ide nt t

he pla int if

f h a d to underg o surg ery

and is still recover ing at this t ime. A Hm m. Q That is the complaint that y ou filed in D avidson County Circuit Court, isn’t it? A Ibelieve so. Q F or

y our w or ke r’ s c omp e ns a tio n a c c ide nt? A Ye s.

. . . . . Q M r

. Pe ll ic an o , a s a r e s u lt o f th is w o r k e r ’ s c o mp e n s a ti o na c c id e n t yo uw e re wea ring a nec k brac e, we ren’ t y ou? A Ye s. Q An d you

wo re that a ll the tim e wh e n you wo rk e d; i s th a t c or

re c t? A Ye s. Q And in fac t y ou wer e we aringthat neck br ace o n t h e d ay that y ou had the

ambu lanc e a c c ide nt; ri g ht? A Yes. Well, no, Ididn’t have it on at the time. I took it off to go home

. Q B u tyo uh a d

b e e nw e ar i n g i tt h a td ay? A Ye s. Q And wher e did that nec k brac e g o? A I t’s in my

room rig ht now. Q W h e r e d i d

i tf i to nyo u r b o dy? A Ri g h t a

r o u n d h e r e [i n d ic a ti n g ]. Q An d a ft e r t

he ambu lanc e a c c ide nt you c on tin ue d to we ar t

hat ne c k b ra c e ; is that c or re c t? A I’ m s o r

r y? Q Af

te r t he ambu lanc e a c c ide nt you c on tin ue d to we ar t

hat ne c k b ra c e ; c or

re c t? A No , n ot- -w e ll, in a wa y , y e s, Idid ; in

ano the r w ay , n o, Idid

no t.Sut t on is a w o rk e rs ’ co m p e n sa tio n c a se ; ne v e rth e le ss, the e v id e n tiar y issu e s p re se n te d a re a p p lica b le to this 4

act i o n.
-11- Gene rally , a lay

witness should testify about facts observe d, not about the witness’s opinions or infer ence s. Neil P. Cohen, et al ., Tennessee Law of Evidenc e , § 7.01[4] [a] , (4th ed. 2000 & Supp. 2003). “L ay testimony is c ompetent to e stablish suc h simple but important matters as exis tence of pain, its location, inability to work, etc . but it may not be re ceive d and re lied upon to prove matter s requiringscientific knowle dg e.” Americ a n E n ka Corp. v. Sutton , 391 S.W . 2d 643, 648 (Tenn. 1965). C ausation shoul d be established by medical ex perts in all but simple and routine ca ses– and even the n expert testimony is highly desirable

. Id . at 647 (c iting 2 L arson, W orkme n’s Compensation Law (1961))

. An example of a “simple” injury that would allow testimony by a lay person a s to causation is fo u n d in Varner v. Pe rryman , an auto a ccide nt case . I n Varner , the cour t considere d whether plaintiff’s testimony , that he re ceive d a bruised stomac h muscle as a re s u l t o f the a ccide nt, was sufficie nt to establish causation. The c ourt found that the ex istence of a bruise w ould be the kind of “simple” injury

that would allow a lay

person t o t es t i fy

as to ca usation. Varner v. Pe rryman , 969 S

. W

. 2 d 4 1 0 , 4 1 2 (T en n

. C t

. Ap p

. 1 9 9 7 ) ( ci t i n g American E nka Corp. v. Sutton , 391 S.W . 2d 643 (1965)) . Our Supreme Court addre ssed the important diffe renc es betwe en simple injuries, for w hich lay persons a

re pe rmitted to opine, and more c om p l ex m edical issues, for which only experts are permitted to opine, in American E nka Corp. v. Sutton , 391 S.W .2d 643, 646 - 648 (Te nn.1965)

. The 4 issue the cour

t was dea ling with in Sutton was whe ther t h e inj ured la y person c ould provide competent pr oof as to causation of a nerve injury to his ey e which he claimed to have resulted f rom a che mical ac cident. The court stated:

I t mus t b e r e me mb e r e d th a t w e ar e d e a li n g w it h d e li c a te me c h an is ms o f the ey e, including the optic nerve and to make a n awa rd i n this case based upon c onclusions unsupported by

scientific knowle dg e is not sufficient to mee t the require ment that there shall be mater ial evidenc e to support the aw ard.

Petitioner cites the ca se of Fi de lit y& Cas . Co . o

f New Y or k v . Tr e ad we ll , 212 Tenn. 1, 367 S.W .2d 470 (1963), quoting a stateme nt therein that: ‘* * * the te stimony of an injured pe rson as to the e x tent of his injuries may be believed in pr efe renc e to the opinions of 'a

whole college of phy sicians' testifying to the c ontrary .’ 212 Tenn. at 9, 367 S.W .2d at 474.
This may be true as to the extent of injuri es , b u t it does not apply to causa l
connec tion be tween an acc ident and resultant injury . I n the ca se sub judice the re is
no argument as t o the ex tent of i njury , but rathe r as to the causal connec tion.

. . . . .-12-

I n the re cent c ase of Ma

gn av ox Com

pa ny of T e nn . v . S he ph e rd , 214 Tenn. 321, 379 S.W. 2d 79 1 (19 64 ), we re ve rs e d th e a c tio n o f t he tr ia l c ourt

in gra nti ngan in c re a se to an awa

rd pre viously

made be cause there was no c ompet ent proof of causa l
connec tion between the orig inal injury an d t he alleg ed incr ease d disability . I n the Sh e ph e rd c a se the em pl oy ee an d h e r h us ba nd te sti fi e d th a t he r i nc re a se d d isa bil ity
was due solely to he r orig inal injury

. An expert medical doctor testified the re w as no c a us a l c onne c tio n b e tw e e n the or ig ina l in jur y and the inc re a se d d isa

bil ity . We he ld the re in a nd no w r e a ff

ir m th a t:

L ay testimony

is competent to esta

blish such simpl e but important matters as e x istence of

pain, its location, inabili t y t o wo rk, etc., but it may not be re ceive d and re lied on to pro v e m at t ers r equiring scientific knowle dg e.

Th e on ly c omp e te nt e vid e nc e ba se d u po n s c ie nti fi c kn ow le dg e of fe re d in thi s c a se is ag ainst the awa

rd.

American E

nka Corp. v. Sutton , 391 S.W .2d 643, 646 - 648 (Te nn.1965)

. The testimony

of Pellicano a

nd his brother is the only

testimony , other than Dr. G uillermin’s
e qu ivo c a l op ini on , c on c e rn ingwh e the r Pe lli c ano ’s ne e d fo r surg e ry wa s c a us e d b y the inc ide nt w ith the ambulanc e. Pellicano a nd his brother a

re la y witnesses. I t is well established that Tenn. R. Evid. 701 does not authorize lay testimony on subjects that re quire spec ial skill or knowledg e outside the
rea lm of common experience

. TennesseeLaw of Evidenc e at § 7.01[ 4 ] [ b ]

. “In situations wher e a witness ‘ca

nnot rea dily

and with equal ac cu racy and ade quacy ’ testify

without an opinion, the wi t n es s m ay

s t at e o p i n i o n s re qu i ri n g no e x pe rti se .” Te nn. R. E vid. 701, Advisory Commi ssion Comment. (emphasis added) Whil e their la y testimony

is competent to establish that Pel l i cano inc ur re d p a in f oll ow ingthe inc ide nt a

nd that he ha d pa in an d numb ne ss i n h is a rm s w e e ks late r, the ir l ay t es t i m o n y

is insufficient to establish a ca use in fac t relationship betwee n the incident and the need f or a diskec tomy

.
B a se d u po n th e jud g me nt, it i s o bv iou s th a t th e c ourt fo un d Pe lli c ano ’s te sti mony , a lon g wi th that of his br oth e r, su ff

ic ie ntl y c re dib le and

c omp e te nt t o e sta

bli shthat Pe lli c ano ha d e sse nti a lly
re c ov e red fro m hi s p ri or inj ur y , w iththe e xce pti on

of so me pa in a

nd dis c omf or t, t hat a ll o f h is subsequent proble ms wer e the r esult of the exace rbation of the pr e-e x isting injury and, ther efor e, the damag es should be asse ssed ag ainst Defe ndant and not appor tioned. Since Dr. Guillermin g ave no opinion as to causation (m ay b e y es; may

be no), it is also obvious that the trial court f ound Pe lli c ano ’s te sti mony , a lon g wi th t hat of his br oth e r, su ff

ic ie ntl y c re dib le and c omp e te nt to e sta bli sh that the inc ide nt wa s the c a us e in fa c t of the surg e ry a nd that a ll of Pe lli c ano ’s m edi cal ex pen se s, pain and suff

eringand lost wag es we re attributable to the incident with the ambulanc e.It c o u ld no t b e b a se d up o n the e x p e rt tes tim o n y o f D r. G u ill e rm in fo r h e d id n o t g iv e a n o p in io n a s to 5

c a u sa tio n

.

D u e t o D ef

en dan t c on ce di ng that i t i s l i abl e f or $1, 277. 20 of

Pel l i ca n o’ s me di ca l e x pen s es , w e h av e n ot 6

c o n sid e re d w h e the r th e c a u sa tio n e v id e n c e c o n c e rn ing the se m e d ic a l ex p e n se s is su ff ic ie n t.
-13- The ev i d en ce does not preponde rate ag ainst the trial cour t’s finding that the incident
exacer bated the pr e-e x isting injury ; however , we r espec tfully disag ree with the trial court’ s finding that the incident wa s the ca use in fac t of the nee d for surg ery

. The only basis upon which the tria l court c ould have rea ched that conclusion would be the lay testimony of P ellicano and his brother. 5 I n our opinion, the evidenc e pre ponderates ag ainst the trial cour t’s finding of a c ause in fa ct relationship betwee n the i ncident and the need for surge ry for a number of rea sons. Pellicano failed to provide a c onvincing ex p l an at i o n why he attributed the need f or surg ery

to the worke r’s compensation accide nt and there afte r to the incident with the ambulance in the absenc e of c ompetent
e xpe rt pr oo f, wh ic h un de rm ine d his c re dib ili ty

. Mo re ov e r, the lay te sti mony a s to causat io n i s in conflict with Tay lor for it, in e ssence , constituted an opinion that the surg ery was ne cessitated by

the inc ide nt. Pe lli c ano and

his br oth e r’ s la

y op ini on te sti mony

do e s n ot q

ua lif y fo r t he “ sim ple assessment of me dical ca

usation” exception in Taylor

. Suc h o pin ion te sti mony

re qu ir e s sc ie nti fi c knowledg e which Pellica no and his brother

do not possess. Accor dingly , we hold that the lay opinion testim ony

as to the ca

use in fact for the surg ery was not compe tent and ther efor e wa s insufficient to cur e the de ficienc ies of the e quivocal medica l proof off ere d by Dr. Guillermin.

There fore we f

ind that Pellicano p ro v i d ed sufficie nt competent proof to establish that the incident with D efe ndant’s ambulance exacer bated his pr e-e x isting neck injury to so m e d egr ee; ho we ve r, the e vid e nc e pr e po nd e rate s a g a ins t the tr ia l c ourt ’s fi nd ingthat th e inc ide nt w a s th e c a us e in fac t of the need for surge ry . Thus, the proof w as insufficie nt to hold Defenda nt liable for a ll of the expense of the sur g ery and any damag es attributable the reto. Consequently , we r ever se the trial c ourt’s holding that the inciden t wi th Defe ndant’s ambulance was the c ause in fac t of P ellicano’ s need for surge ry

. Due to our f inding that the inc ident was not prove n to be the ca use in fac t for the surg ery , we al s o v ac ate the tr ial court’s a war d of d a m a g e s f

o r m e d i c a l e x p e n s e s , p a i nan d s u f f e r i n g an d l o s tw a g e s a t t r i b u t a

b l e t o t h e s u r g e r

y. Neve rtheless, in that De fenda nt conce ded that Pellicano is entitled to r ecove r his medical expenses for c onservative car e administere d by Dr. Guillermin prior to the sur g ery in the amount of $1,277.20, we ther efor e modify

and re duce the awa

rd for medical e x penses to $1,277.20. 6

I n that the proof suf

ficiently established that the incide nt exacer bated the pre-e x isting nec k inj ury , p art ic ula

rl y the pa in a

nd su ff e ri nga sso c iate d w iththe e xac e rb a tio n o f t he ne c k in

jur y , th is matter is re manded to the tria l court for deter mination of the plaintiff’s c laim for pain a nd suffe ring to the extent it was e x ace rbate d by the incident.-14-

There fore , this matter is r emande d to the trial court f or appr opriate pr ocee dings c onsistent with this opi nion.
Costs are taxed to Appellee, D ominic P. P ellicano.

___________________________________ FRANK G. CL EMENT, JR ., J UDGE