### IN THE COURT OF APP EALS OF TENNESS EE AT NAS HVILLE N ove mb er

7, 200 7 S es sio n
KATH ERI NE DELO RIE SE OL ING ER, ET AL 

### . v. UNIVERSI TY MEDI CAL CENTER, ET AL 

### . Appeal from t he Circuit Court for Wilson County No. 12423 John D. Wootten, Jr., Judge

No. M2006- 02312-COA-R 3-CV - Filed Janu ary 17, 2008

Th is me dic a l malp ra c tic e a c tio n wa s file d b y K a the ri ne De lorie se Ol ing e r andPe rry M ic ha e l H a le (“Plaintiffs”) afte r their son wa s born wit h brac hial plexus palsy. Plaintiffs claim the injury occ urre d beca use t h e d ef

en dants failed to take the prope r medica l steps to resolve a de livery complication kn o w n a s s h o u ld e r d y s to c ia

. Fo ll o w in g a tria l, th e ju r y r e tu r n e d a v e r d ic t in f a v o r of all of the defe ndants. Plaintiffs appea l claiming the Trial Court er red w hen it gave a

jury instruction on the
su dd e n e me rg e nc y d oc tr ine , a ndfu rthe r e rr e d b y r e fu sin g to pe rm it c ro ss- e xa min a tio n o f a wi tne ss by the us e of

me dic a l li te ratur e wh ic h Plai nti ff s mai ntain ha d be e n est abli sh e d as a r e lia ble auth ority pu rs ua nt t o T e nn . R. Ev id. 61 8. W e a ff ir m.
Te nn. R . A pp. P . 3 App e al a s o f R igh t; Judg me nt of th e Circuit Court

Affir med; CaseRem anded

D. M I CHAEL S W I NEY , J., delivere d the opinion of the court, in which A NDY D. B ENNETT , J., and R O SS H. H I C KS , S P

. J., joined.

David R. Smit h an d Edmund J. Schmidt, III, Nashville, Te nnessee , for the A ppellants, Kathe rine Delorie se Olinger and Perry Michae l H ale, individually and a s next frie nds of Michae l Eugene H ale, a minor.

Jo hn F. Fl oy d a ndMa nd y L a ng fo rd , N a sh vil le , T e nn e sse e , f or the Ap pe lle e , St arM e d H e a lth Personnel, Inc

. C. Ben ne tt Harriso n, Jr ., a ndBr ia n W . H olm e s, Na sh vil le , T e nn e sse e , f or the Ap pe lle e , Ch arl e s B. Lanning, Jr., M.D.

Mark T. Smith and André e Sophia Blumstein, Nashvi l l e, T ennesse e, for the Appellee , National Medica l Hospital of Wilson County, Inc., d/b/a University Medica l Center.-2- OP IN ION

Bac kgr ound

Th is i s a me dic a l ma lpr a c tic e a c tio n su rr ou nd ing the birth of Mic ha e l E ug e ne Ha le (“ the Chi ld” ), wh o w a s p e rm a ne ntl y in jur e d whe n he wa s born on Sep te mbe r 27, 20 00

. Th e la ws uit was filed by the child’s par ents aga inst the University Medical Cent er i n Leba non, Tenne ssee, a s well as Charles B. Lanning, Jr ., M.D., and StarMed Hea lth Per sonnel, Inc. ( “StarMed” ). StarMed employed Sheila Sturgill, R.N., who was the nurse involved in the delivery.

Dr. Lanning was the treating gyne cologist and obstetrician for the birth of plaintiff Kathe ri ne Ol ing e r’ s f

ir st c hil d. Ms. Ol ing e r’ s f ir st c hil d w a s b orn w ith ou t c omp lic a tio ns in A ug us t of 19 95 . W he n M s. Ol ing e r b e c a me pr e gn ant wi th her se c on d c hil d in19 99 , D r. Lann ing a ga in
se rv e d a s h e r t

re atin g g yn e c olo gis t a ndob ste tr ic ia n. Ms. Ol ing e r w a s a dmi tt e d to the Un ive rs ity Medica l Center for

delivery of

her se cond child, Mi chae l Eugene Hale. A complication known as shoulder dystocia oc curr ed during the de livery. S houlder dystocia oc curs a fter the head of the infant is delivered and one of the infant’s shoulder s then bec omes lodged under the mother’s pubic bone. The Ch il d s u f

f e r e d s ig n if

ic a n t a n d p e r man e n t d a ma g e to h is r ig h t ar m a s a r e s u lt o f the shoulder dystocia. He was diagnose d with brac hial p lexus palsy and ha s since under gone seve ral surgic al pr oc e du re s.
Af

te r this lit igatio n p ro gr e sse d a nd the iss ue s we rena rr ow e d, thec a se pr oc e e de d to trial solely on the i ssues relating to the conduct of Dr. Lanning and Nurse Sturgill once they were c on fr on te d w iththesh ou lde r d ys toc ia . Pl a int if fs e sse nti a lly c la im that ha d Dr

. La nn ing a ndNu rs e Sturgill acte d in a medica lly reasona ble manner

in acc ordance with the a cce ptable standa rd of profe ssional prac tice, their son would not have suffe red any injuries. We note that as the de livery of the Child was videotape d, t h e j u ry was able to assess the testimony of the witnesse s in light of what the jury c ould see on the vide otape.

The de fendants filed a motion in lim ine bef ore the t ri al s eeking to exc lude the testimony of Plainti ffs’ e xpert witness, Dr . Bruce Bryan. The de fendants claimed, int e r a lia , that Dr. Brya n’s testimony did not satis fy the loca lity rule. The Tria l Court denied the motion in lim ine and permitted Dr. Bryan to testify at trial via de position.

One of Plaintiffs’ allegations wa s that Nurse Sturgill improperly applied f undal pre s s u re d u ri n g the delivery. Fundal pressure is pressure on the mother’s a bdomen. Plaintiffs claimed the f

undal pre ssure should not have be en applied and cause d or contributed to the Child’s injuries. At trial, Plaintiffs sought to cross-e xamine Nur se Sturgill usi ng an article which they a rgue had bee n established as a re l i ab l e au t hority during the testimony of one of Plaintiff’s e xpert wi t n es s es

. The de fendants objected to this line of questioning for seve ral re asons, and the T rial Court ultim ately sustained the obje ction.

Prior to the jury being i nstructed, all of the defe ndants reque sted a jury c harge on the sudden eme rgenc y doctrine. Plaintiffs strongly opposed such a char ge. The Trial Court concludedA t t he t i m e t he pr es ent O pi ni on w as r el ea s ed, t he t i m e i n w hi ch t o fi l e a Tenn. R. A pp. P. 11 a ppl i ca t i on f or 1
perm i s s i on t o app eal i n t he W h ite c as e had not ye t e xpi r ed.
-3- that there was sufficient proof in the rec ord to permit a jury c harge on sudden eme rgenc y, and the jury was so c harge d. The jury e ventually re turned a verdic t for all def

endants.

Plaintiffs raise tw o issues on appea l. First, P laintiffs claim the Trial Court erre d when it c ha rg e d th e jury o n s udden eme rge nc y. Se c on d, Pla int if fs c la im the Tria l Co urt e rr e d w he n it prec luded them from c ross-examining Nurse Sturgill usi ng certain medical literature wh ich they argue had bee n established as a reliable authority. Def

endants raise as a se parate i ssue t heir position that the Trial Court e rre d in a llowing Plaintiffs’ experts, Dr. Bryan and Martha E akes, R.N., to testify beca use their testimony did not satisfy the locality rule a nd was not scientific ally reliable

. Discussion

The re cent c ase of White v. Pre mier Me dical Group , No. M2006-01196-COA- R3- CV, 2007 WL 4207868 (Te nn. Ct. App. Nov. 28, 2007) involved the propriety of a jury instruc tion 1 in a medica l malprac tice ca se. In Wh ite , the defe ndants succe ssfully sought to have the jury cha rged
on the defe nse of super seding cause. Id. , at *3. Fol low ing a jury ve rd ic t in fa vo r of the de fe nd a nts , the plaintiffs cla imed on appea l that the trial court e rre d in giving that p ar t i cu l ar instruction. We ult imate ly c on c lud e d th a t th e jury in str uc tio n w a s a

pp ro p ri a te . I n s o d oin g w e dis c us se d th e re qu isi te amount of proof

neede d to support a jury i n s t ru ct i o n and the a pplicable standa

rd of r eview. W e stated:
It is proper f or a c ourt to char ge the law upon an is sue of fact within the scope of the pleadings upon whic h there is evidence , which even though slight, is “sufficie nt to sustain a verdict.” R ey n o l d s v. Ozark Motor Lines, Inc. , 8 87 S.W .2 d 8 22 , 8 23 (T e nn . 1 99 4) ; Norman
v. Fisher Marine, Inc

. , 672 S.W.2d 414, 421 (Tenn. Ct. App. 1984); Ringer v. Godfrey , 362 S.W.2d 825, 827 (Tenn. Ct. App. 1962); Monday v . Millsaps , 2 64 S .W.2d6 ( Te nn . Ct . A pp . 1 95 3) ; Hurt v. Coyne Cylinder Co. , 956 F.2d 1319, 1326 (6th C i r. 1992). For the
ev i d en ce to be “suff

icient to sustain a ver dict,” ther e must be evidenc e which i s “material” to the issue. Turner v. Jordan , 957 S.W .2 d 8 15 , 8 24 (T e nn . 1 99 7) ; Cra btr e e Ma so nr

y Co. v . C & R Constr., Inc. , 5 75 S.W .2 d 4 , 5 (T e nn . 1 97 8) ; City of Chat tanooga v. Ro ge rs , 29 9 S.W .2 d 6 60 (T e nn . 1 95 6) ; D.M. Rose & Co. v. Snyder , 206 S.W.2d 897 (Tenn. 1947)

. The Te nnessee Supreme Court has described “ materia l evidenc e” as “evide nce material to the que stion in controversy, which must nece ssarily enter

into the consideration of the controve rsy and by itself, or i n connec tion with the ot her evidence , be dete rminative of the c ase.” Kno

x v ill e Tra c tio n Co. v . B ro wn , 89 S.W. 319, 321-4- (T e nn . 1 90 5) ; Fuller v. T

ennesse e-Carolina Transp. C o. , 471 S.W.2d 953, 956 (Tenn. Ct. App. 1970). Blac k’s Law Dictionary de fines “material evidenc e” a s “evide nce ha ving some l o g i cal c onnection with the conseque ntial fac ts or the issues.” Bl ack’ s Law Dic tionary 45 9 ( 7the d. 20 00 ); see Sm ith v. Tennessee Furniture Indus., Inc. , 369 S.W

. 2 d 7 2 1 , 7 2 8 ( T e n n

. 1 9 6 3 )

. T h is Co u r t h a s d e s c r ib e d “ mate r ia l evidenc e” to be “such rele vant evidenc e as a rea sonable mind might
a c c e p t a s a d e q u a t e t o s u p p o r t a r a t i o n a l c o n c l u s i o n a n d s u c h a s to furnish a r easona

bly sound basis for the action under c onsideration.” Se x ton v . A nd

e rs on Cou nty , 587 S.W.2d 663, 666 (Tenn. Ct. App. 1979)....

When de termining whethe r t here is material evide nce sufficie nt to sustain a verdict, the appellate courts “do not determine the cr edibility of witnesses or we igh e vidence on appea l from a jury verdic t.” Rey nolds , 8 87 S.W .2 d at 823

. In ste a d, the app e llate c ou rt s

“ are lim ite d to de te rm ini ng wheth e r the reis m a te ri a l e vid e nc e to support the jury’s ve rdict.” Id . If we determine the re cord c ontains materia l evi d ence supporting the ver dict, we a re not to disturb the verdic t. Id

. Acc ordingly, without judgi ng the cr edibility of witnesses or weighing the evide nce, w e must d et er m i n e whe ther ther e is any materia l evidencesufficie nt to sustain the defense o f superseding
cause . To make this determination, we must identify the superse ding
cause contende d by Def

endants a nd d et er mine whether there is any
ma te ri a l e vid e nc e in the re c or d th a t pe rt a ins to e a c h el eme nt of thi s defe nse.
Wh ite , 2007 WL 4207868, at *4 (footnote omitted). We a lso note that “[w] e should not set aside a jury’s ver dict beca

use of an err oneous i nstruction unless it aff irmatively appea

rs t hat the er

roneous instruction actually misled the jury.” Grandstaff v. Hawks , 36 S. W. 3 d 4 8 2 , 4 97 (Tenn. Ct. App. 2000).

Our Supreme Court e xplained the sudde n emer gency doc trine in McCall v. Wilder , 91 3 S. W .2 d 1 50 (T e nn . 1 99 5) a s f oll ow s:
Th e su dd e n e me rg e nc y d oc tr ine , w hic h h a s n ow be e n s ub su me d in to Tenne ssee’ s comparative f ault scheme , Ea ton v . M

c Lai n , 891 S.W.2d 587, 592 (T enn. 1995), recogniz es that a pe rson conf ronted with a
su dd e n o r u ne xp e c te d e me rg e nc y w hic h c a lls fo r imm e diate a c tio n is not expec ted to exer cise the same accura cy of judgment as one a cting under normal circ umstances who has time for r efle ction and thought“[T ]h e b asis of th e ru l e is m e r e ly t h a t th e a cto r i s l eft n o t i m e fo r ad eq u ate th o u g h t , o r i s rea so n ab l y so 2
di s t urbed or e xci t ed t hat t he act or c anno t w ei gh al t er nat i ve cours es of act i on , and m ust m ake a s peedy deci s i on , bas ed

v e r y l a r g e l y u p o n i mp u l s e o r g u e s s

. U n d e r s u c h c i r c u ms t a n c e s , t h e a c t o r c a n n o t r e a s o n a b l y b e h e l d t o t h e s a me
ac cur ac y of

j udgm ent or c onduct a s one w ho ha s ha d t he ful l oppor t uni t y t o r ef l ec t , eve n t hough i t l at er appe ar s t hat t he

a c to r m a d e th e w ro n g d e c isio n , o n e w h ic h n o re a so n a b le p e rs o n c o u ld p o ssib le h a v e m a d e a fte r d u e d e lib e ra tio n .” P ro sse r a n d K e e to n o n th e L a w o f T o rts , § 196.

-5- befor e ac ting. Se e You ng v . Cl ar k , 814 P.2d 364, 365 (Colo. 1991);

se e als o P ro sse r a nd

Ke e ton on the Law o

f To rts , § 196. 2

The doc trine no longer c onstitut es a de fense as a matter of law but, if at issue, must be considere d as a fac tor in the total comparative fault ana lysis. Ac cordingly, the doctrine of sudden eme rgenc y does not negate de fendant’s liabilit y i n t h e ca se bef ore us a s a matter of law.

Mc Cal l , 913 S.W.2d at 157 (footnote in the original).

It is important to note that Plaintiffs c hallenge only w hether the sudden e merge ncy instruction should have been given in the first place . Plaintiffs do not claim that the instruction as given was le gally defic ient. The sudden e merge ncy instruction g i v en b y t h e Trial Court in the pr e se nt c a se wa s a s f

oll ow s: A phys ician/nurse w ho is face d with a sudden or une xpecte d
emer gency that calls for immediate action is not expec ted t o use the
same a ccur acy or

judgment as a p erson acting under normal circ umstances who ha s time to thi nk and re flec t b efor e ac ting. A physician/nurse f

ace d with a sudden em er g ency is re quired to ac t within the rec ognized standa rd of car e applicable to that physician or
nu rse. A sudden emer gency w ill not excuse the a ctions of a pe rson whose own ne gligence c reated the eme rgenc y. If you f ind that there was a sudden emergenc y that was not caused by
a ny fa ult of thepe rso ns wh os e a c tio ns yo u a rejud gin g, yo u mu st
c on sid e r this fa c tor

in d e te rm ini ng a ndc omp ari ng fa ult

. The de fendants argue that the sudden eme rgenc y confr onted by Dr. La nning and the delivery r oom nurses wa s not the occur rence of shoulde r dystocia, but the f act that the shoulde r dy sto c ia wa s n ot r e so lve d a ft e r the typ ic a l ste ps us e d to re so lve that c omp lic a tio n f a ile d. At tr ia l, Dr. La nning describe d shoulder dystocia and acknow ledged that he has be en tra ined to deal with that
c omp lic a tio n. Dr . La nn ing te sti fi e d tha t he h a s d e liv e re d “ pr ob ably 4, 00 0" b abie s o ve r the c ou rs e of his c are e r a s a n o bs te tr ic ia n. Of thos e 4, 00 0 d e liv e ri e s, he e nc ou nte re d s ho uld e r d ys toc ia
app ro xim ate ly 100 tim e s. Dr . L a nn ing state d th a t th e “ Mc Rob e rt s mane uv e r” a nd“ su pr apu bic-6-

pr e ssu re ” aretheba sic pr oc e du res us ed to re so lve the sh ou lde r d ys toc ia . Su pr apu bic pr e ssu re is pressure applied above the pubic bone in the groin are a. Suprapubic pre ssure is a pr oper pr ocedur e to help resolve shoulde r dystocia. Supra pubic pre ssure is qui te di ffe rent from fundal pre ssure whic h,
a s me nti on ed pr e vio us ly, is p re ssu re app lie d to the abd omi na l are a . T he jury w a s p re se nte d w ith
c on fl ic tin g te sti mon y a s to wh e the r N ur se Stu rg ill didor didno t app ly fun dal pre ssu re . I n s ho rt , Plaintiffs’ proof wa s that she did and De fendants’ proof wa s that she did not. Dr. Lanning describe d the Mc Rob e rt s mane uv e r a s f oll ow s:
[T he Mc Rob e rt s mane uv e r i s wh e re ] yo u take mom ’s le gs or thi gh s, fl ex them bac k towards he r abdome n, and then a bduct them away from her abdomen, too. That decr ease s the angle betwee n the spinal column and it’s ca lled a sac rum, it flat t en s you[r] angle out and
make s th e he a d, make s the sh ou lde rs de liv e r m or e e a sil y. It a lso
ro ta te s th e pu bic bo ne ba c k to wa rd s mo m’ s he a d, a ndus ua lly it relieve s the shoulder dystocia. And it’s suc cessf ul almost 90 perce nt of the time, that and a combination of supra pubic pre ssure. And that goes along with my e xperie nce, too, that 99 out of 100 of mine we re relieve d with those two maneuve rs.
When as ked if a n obstetrician c an pra ctice his e ntire ca ree r and not ha ve to do
maneuve rs beyond the Mc Roberts maneuve r and supr apubic pr essure , Dr. La nning stated that he

“ [a ]l mos t di d. ” Ac c or din g to Dr

. La nn ing ’s te sti mon y, if the Mc Rob e rt s mane uv e r andsu pr apu bic pre s s u re d o n o t resolve the shoulde r dystocia, the ne xt step is to perform interva ginal rotational
maneuve rs. The goal during intervagina l r otational maneuve rs is to turn the baby and “onc e you get the sh ou lde r o ut f

ro m un de r the pu bic bo ne , the sh ou lde rs wi ll de liv e r sp on ta ne ou sly , wi th the a id of some downwa

rd gentle tra cti on.” Whe n Dr. Lanning performed the interva ginal rotational
maneuve r, he r otated the baby in a countercloc kwise m anner and the baby then came out “fa st.” Dr. La nn ing de sc ri be d s ho uld e r d ys toc ia a n “ a n o bs te tr ic ia n’ s n igh tma re ” be c aus e it’ s “ un pr e dic ta ble ... [and] unavoidable” and can result in death. Dr . Lanning adde d that in his 21 years of pr acticing medicine a s an obstetricia n, Ms. Olinger’s de livery wa s the first time he enc ountere d shoulder dystocia that wa s not resolved by the Mc Roberts maneuve r and supr apubic pr essure

.

Dr. Joseph Brun er w as ca lled as an e xpert witness on be half of D r. Lanning. Dr

. Bruner is boar d certified in obstetrics and gyne cology. Dr. Brune r stated that he has had o v er 60 article s published during his medic al car eer , including an article on shoulder dystocia. A ccor ding to Dr. Bruner : [Shoulder dystocia] is a specia l situation, because it’s an emer gency

situation, there ar e a numbe r of steps or a number of m aneuve rs that have be en devise d over the year s for de alin g with it. Although no
one mane uver ha s been shown to be better tha n an y o t hers or no combination of mane uvers ha s been shown to be better or safe r, the basic standa

rd of c are is that when a physician or a midwife or whoeve r enc oun t er s a shoulder dystoc ia, they have to go through a-7- log ic a l se qu e nc e of the se ste ps to t ry to r e lie ve the sh ou lde r d ys toc ia as saf ely as possible....
[I ]t ’s e a sie st t o th ink

of [the s te ps to re lie ve sh ou lde r d ys toc ia ] i n wave s, so to speak. The re a re some that are rea lly easy to do, and typically those are t he ones that are done first. One is called the McRoberts maneuver ... where you simply flex the woman’s kne es up onto her chest. This helps to flatten out the curve of the spine and it rotates the pelvic gir d l e fo rw ard to make more room f or the delivery of

the baby. The McRoberts mane uver is v er y ea s y to do be c aus e a ll y ou ha ve to d o is mov e the le gs

. Th e se c on d mane uv e r that c a n b e do ne a t th e sa me tim e is s up ra pu bic pr e ssu re . T he pu bic bo ne is rig ht ab ov e yo ur gr oin , a ndif

yo u p us h above that bone, then in the ca se of a shoulder dystocia ... if you’ re doing it correct l y , pressing right on the shoulder of the baby. And this is also fairly easy t o do. And, finally, if you need the room, you can pe rform an episiotomy.

Dr. Brune r adde d that these initial steps usually relieve the s houlder dystocia 90%

- 95 % o f the tim e . I f tho se ini tia l st e ps do no t w or k, the n yo u ge t int o mor e c omp lic a te d mane uv e rs , such as the W oods corksc rew maneuve r, the Rubin maneuve r, or t h e Z av an elli maneuver . Dr. Bruner a lso stated:

In an a vera ge pra ctice in a comm unity about [the size of Leba non], the typical obstetricia n wo u l d run into a shoulder dystocia maybe thr e e or fo ur tim e s a ye ar. Sin c e a lmo st al l of the m arere so lve d w ith the first fe w maneuve rs, it’s possible to g o y o ur entire car eer and
never have t o do more than, f

or example, the McRoberts maneuver and supra pubic pre ssure.

Dr. Bruce Bryan’s deposition f or proof was admitted at trial. Dr. Brya n testified as an expe rt witness on beha lf of Plaintiffs. Dr. Brya n testified that shoul d er dystocia can be very harmful to the c hild. It can c ause de ath or brain damage be cause the umbilical cord ca n be depre ssed, there by cutting off oxygen to the ba by. Ot h er danger s include broke n bones and a brac hial plexus injury. Dr. Brya n testified t hat s houlder dystocia oc curs, on a vera ge, in three perc ent of all deliveries. Dr. Bryan added that the McRoberts mane uver and suprapubic pr essure resolve sho ulder dystocia in 90% of the c ases. Dr . Bryan agr eed that shoulder dystocia wa s a “me dical
e me rg e nc y. ” Dr . Brya n a dmi tte d th a t he te sti fi e d ina no the r c a se a s f oll ow s:
As fa r a s th e ti ming g oe s, wh e n y ou sta rt ge tti ng [a ] c ou ple [of] minutes and you don’t have the baby delivere d, you rea lly start pu sh ing ha

rdbe c aus e yo u’ ve go t abo ut fo ur or fi ve min ute s. An d if yo u d on ’t ha ve theba

by de liv e re d b y f

ou r, yo u a

resc re we d, re a lly
scre wed.-8- As stated, the de fen d an ts argue that the sudden eme rgenc y occur red w hen the McRoberts mane uver and suprapubic pr essure failed to re solve the shoulder dystoc i a. Plaintiffs contend that a s a traine d physician, Dr. L anning should have anticipated those initi al steps not working and his then having to unde rtake additional maneuve rs and, ther efor e, it was not a sudde n emer gency.
This Court had the opportunity to discuss the applicability of the sudden e merge ncy doctrine in a

medical malpr acticecase in Ross v. Vanderbilt U niversity Medic al Center , 27 S.W.3d 523 (Tenn. Ct. App. 2000). I n Ro ss , the pl aintiff we nt to the emerge ncy room be cause of a c ut on he r f ing e r. Th e e me rg e nc y r oo m ph ys ic ia n, Dr . M or gan, in jec ted the plaint if

f’ s f ing e r w ith Lidocaine in order to numb it. Then:

Almost immediately there afte r, Plaintiff, w ho was lying on a gurne y, complained that she felt i ll and her arm jerked up and he r eye s rolled back in h er head. D r. Morga n testified that she wa lked about four fee t acr oss the room toward t h e door, yelled f or help, a nd then returne d at which point Plaintiff’s body began to j er k

. Dr. Morgan pu t he r b od y o ve r P laintif f’ s b od y. De sp ite Dr . M or ga n’ s a c tio ns , Plaintiff fell off the gurney on w hich she lay and onto the floor hea d first. Dr. Morgan reme mbere d it taking only a co uple of sec onds befor e other

medical staf

f ar rived too late to he lp her ke ep Plai n t iff from fa lling....

Dr. W right subseq u en t ly diagnosed Plaintiff as having
s u f f e r e d f r o m a v a s o v a g a l r e a c ti o n w h ic h o c c u r s w h e n a person’ s blood pr essure abruptly lowers. Vasova gal rea ctions are often
acc ompani ed b y a fainti ng episode a nd can, if a per son faints, be
acc ompanied by jerking movements that rese mble seizure s.... He stated that, though he saw a lot of hospital patients and visitors grow faint , a faint ing e pis od e is “ re a lly un c omm on ” fo r s ome on e wh o is lying on a stretc her. Mor eover , only ten to thirty perce nt of those that faint du ri ng a va so va ga l r e a c tio n a lso e xp e ri e nc e c on vu lsi on s. Following her fall in Def

endant’ s emerge ncy room, P laintiff experienc ed changes in persona lity and problems with her memory
a ndde xte ri ty. She wa s eve ntu a lly dia gn os e d with a tr aumatic br a in injury as a r esult of her

fall in the eme rgenc y room.

Ro ss , 27 S.W.3d at 525.

In discussing the sudden e merge ncy doctrine, this Cour t reje cted the plaintiff’s argume nt that sudden emer gency has no application when a defe ndant does not allege compar ative fault on the part of t he plaintiff. Id ., at 527-528. We then discussed the plaintiff’s argume nt that the sudden eme rgenc y doctrine ha s n o a p p li c ation in a medica l malprac tice ca se involving an emer gency room doctor. More specific ally, the plaintiff ar gued that ther e could be no sudden eme rgenc y in an-9-

emer gency r oom because the circumstance s underlying t he sudden e merge ncy doctrine ar e alr eady taken into ac count in an eme rgenc y room setting. We disagr eed:

The standa

rd of car e in a malpractice action is define d in part
a s “ [t ]h e re c og niz e d s ta nd ardof a c c e pta ble pr of e ssi on a l pr a c tic e in the profe ssion and th e s p ec i alt y there of, if any, that the defe ndant prac tices.” Te nn. Cod e An n . § 29-26-115( a)( 1). In e merge ncy me dic ine , “ [t ]h e sp e c ia lis t .. . is tr a ine d inpr ob le ms c omm on ly encounte red in e merge ncy depa rtments.” Da n J. Tennenhouse , Attorneys Medica l Desk

book 3D § 7.8 (1993). “ [M]ost emer gency rooms ... treat[ ] a br oad range of me dical c o n d itions, from life-thre atening trauma, to chest pain, to routine hea lth evaluations.” Erik J. Olson, No Room at the Inn: A S n a p s h ot of an American Emerge ncy R oom , 46 Stan. L. Rev. 449, 453 (1994).

The unde rlying conce pt of negligenc e is an e xpectation that pe op le e xh ib it r e a so na

bly pr ud e nt c on du c t in lig ht o f a ll the ir ci rcumstances. Se e Do ole y v . E v e re tt , 8 0 5 S. W

. 2 d 3 8 0 , 3 8 4 ( T e n n. Ct. App. 1990) (citing Di x on v . Lo be ns te in , 175 T en n

. 1 05, 132 S.W .2 d 2 15 (1 93 9) ); Grady v . Bryant , 5 0 6 S.W.2d 159, 161 (Tenn. Ct. Ap p. 19 73 ). As th os e c ir c ums ta nc e s d if fe r, so do e s r e a so na

bly prudent c onduct. The sudde n emer gency “ doctrine r ecogniz es that when an actor

is face d with a sudden a nd unexpec ted circ umstance
w h ic h le a v e s li tt le o r n o ti me f o r th o u g h t, d e li b e r ation or consideration, or cause s the ac tor to be rea sonably so disturbed that the ac tor must make a spe edy decision without weighing alternative
course s of conduc t, the actor may not be negligent if the actions take n are rea sonable and prudent in the emer gency c ontext.” Rivera v . New York City Tr

ansit Auth. , 5 69 N. E. 2d 43 2, 43 4 (19 91 ). W hil e c arein
an eme rgenc y room may in v o l v e circumstance s that require physicians to m ake immediate decisions without time for deliberation, it often does not. I ndeed, “[i]n a 1991 internal study [of thee me rg e nc y r oo m at a 66 5- be d n on pr of

it c ommun ity ho sp ita l in Southern California], the emer gency r oom administrators found that 14 p er cent of all emerge ncy room visits involved emerge ncy conditions - medical c omplaints requiring immediate eva l u ati on or treat m en t b y a physician.” Erik J. Olson, No Room at the Inn: A Snapshot of an American Eme rgencyRoom , 46 Stan. L. Rev. 449, 453 (1994).
The proble m with Plaintiff’s argume nt is that it assumes that the pra ctice of

emer gency me dicine nec essarily involves sudden and
un e xp e c t e d c i r c u m s t a n c e s w h i c h l e a v e n o t i m e f o r t h o u g h t, d e li b e r a ti o n o r

c o n s id e r a ti o n

. Pl a in ti f f ’ s o w n me d ic a l s itu a ti on-10- disproves her

argume nt: she came t o Def endant’ s emerge ncy room with a cut finge r, the tre atment of whic h appar ently did not require that a doctor

make a speedy de cision without weighing alternative
course s of conduc t. Once in Defe ndant’s eme rgenc y room, the
emer gency that justi fied the sudde n emer gency instruc tion was not Pla int if f’ s c ut f ing e r, bu t he r va so va ga l re a c tio n to be ing giv e n a sh ot. Therewas testimony that Plaintiff’s rea ction was b o t h s udden and unexpec ted. The circ umstance that underlies the sudde n emer gency doctrine, the existence of a sudde n or unexpected e merge ncy which calls for immed i at e action, wa s only present be cause Plaintiff experience d the vasova gal re action. We there fore find that, under the appropriate fa cts, the s udden emergenc y doctrine may and shoul d be applied in the asse ssment of t h e fa u l t of an e merge ncy room doctor....

Fin al l y , we a ddress the f actua l question of whether or not there was a sudden emer gency in this case

. Factual findings of a jury in a civil action shall be se t aside onl y if there is no materia l evidence to support the verdic t....

We f ind that there is materia l evidenc e that Dr . Morgan wa s fac ed with a sudde n emer gency. Both Dr. Ha s t y and Dr . Wright testified at length that, while se izure s do occur in the emer gency ro om, it i s h igh ly unu su a l for a patie nt t o s uf

fe r s e iz ur e -l ike a c tiv ity fr om a va so va gal r e a c tio n. Dr . W ri gh t a dd e d th a t su c h a r e a c tio n is
even mor e unlikely to occur with some one who is lying down. Even Plaintiff’s expert, Dr. Ka

rsh, agre ed that Dr. Morgan could not have anticipated suc h an unusual seiz ure- like activity and did no t hing negligent t o cause Plaintiff’s rea ction. Dr. Ka rsh spec ifically agr eed that Dr. Morgan was fa ced with a sudden and unexpe cted e merge ncy and for ced to make a “sna p judgment decision.” In li g h t of the
overw helming amount of testimony indicating that Dr. Morga n was fac ed with a sudde n emer gency, we fi n d that the trial court was
corr ect to instruct the jury w ith this doctrine....
The princ iples underlying the sudden e m er gency doc trine must b e considere d by triers of f act who a re a ssessing the fault of either de fendants, plaintiffs, or both. This is true when those cha rged with fault are staff me m b er s i n an eme rgenc y room setting who are “conf ronted with a sudden or unexpected emerge ncy which c alls for immediate action.” In this case , there was a bundant evidenc e of suc h a sudden and unexpec ted emer gency c alling for immediate act ion. W e the re fo re a ff

ir m th e tria l c ou rt

in a ll r e sp e c ts.

Ro ss , 27 S.W.3d at 529-30.-11- In the pre sent ca se, the jury r eturne d a gene ral ve rdict for all of the defe ndants. We do not know if the jury ac tually found that there was a sudden emergenc y and the de fendants acted appropriately in lig h t o f t hat sudden e merge ncy, or w hether the jury found ther e wa s no sudden
emer gency and the def

endants’ a ctions we re n ev erthe less within the rec ognized standa rd of profe ssional prac tice. The point being, the issue on appea l is not whether ther e ac tually was or wa s not a sudden e merge ncy, only whethe r there was sufficient proof in the record to support the Trial Cou rt ’s de c isi on to s o c ha rg e the jury. Al l of

the me dic a l pr oo f at tria l w a s th a t sh ou lde r d ys toc ia is a somewhat r are but known occur renc e, and shoulde r dystocia not being r es o l v ed by the McRoberts mane uver and suprapubic pr essure is consid er ab l y m o re r are . Even Plaintiffs’ e xpert witness testified that, on ave rage , shoulder dystocia oc curs in 3% of all deliverie s, and 90% of the tim e it is re so lve d by the ini tia l man e uv e rs

. Th us , ba se d on Plai nti ff s’ pr oo f, a typ ic a l ph ys ic ia n w ill encounte r shoulder dystocia that is not relieve d by the i nitial maneuve rs appr oximately 0.3% of the tim e . D r. La nn ing te sti fi e d th a t in his 21 ye ars a s a n o bs te tr ic ia n, he de liv e re d r ou gh ly 4 ,0 00 ba bie s, he encounte red shoulder dystocia 100 times, and the pre sent ca se wa s the first time that it was not resolved w ith the initi al maneuve rs.

We a gree with Plainti ffs’ a rgument that bec ause of a ph y s i cian’s training and ba c kg ro un d, the su dd e n eme rg e nc y doc tr ine ha s a limite d ap pli c a tio n inme dic a l ma lpr a c tic e c a se s. Simpl y beca

use thereis a medica l compl i ca t i o n d o es not nece ssarily mean that there is a sudde n emer gency. W e ar e not, howeve r, willing to go as far a s arg u ed b y P l aint iffs and hold that the
su dd e n e me rg e nc y d oc tr inene ve r i s a pp lic able in a

me dic a l e me rg e nc y s itu a tio n. Ha vin g s a id that,
we c onclude that ther e wa s sufficient pr oof pre sented at trial that the circ umstance unde rlying the sudden eme rgenc y doctrine, i.e., the exist ence of a sudden or unexpec ted emergenc y, was pre sent in this case whe n there was mate rial evide nce pr esente d to the jury that the shoulder dystocia did not resolve a fter a

pplication of t he McRoberts maneuve r and suprapubic pressure , something not seen or expe rienc ed by Dr . Lanning in his twenty-one ye ars a s an obstetrician de livering roughly 4,000 babies. W e, ther efor e, find n o er ro r i n the Trial Court’s de cision that there w as suffic ient proof prese nted at trial to justify char ging the jury on sudden eme rgenc y so as to allow the jury to find whether there was or w as not a sudden e merge ncy in its comparative fault ana lysis.

Pla int if fs ’ s e c on d is su e on app e a l is wh e the r the Tria l Court er re d whe n it

re fu se d to allow Nurse Sturgill to be cr oss-exa mined by using certain m edical literature a s provided for by Tenn. R. Evid. 618. In Ro bin so n v . B ap tis t M e mo ria l H

os pit al- Lau de rd

ale , No. W2006- 01404- COA-R3-CV, 2007 WL 2318185 (Tenn. Ct. App. Aug. 15, 2007), no appl. perm. appeal filed , th is Cou rt no te d th a t:
[A] trial court i s afforded w ide discre tion in the admission or reje ction of evide nce, and the trial court’s action will be reverse d on appea l only when there is a showi n g of an a buse of discr etion. See Otis v. Cambridge Mut. Fire Ins. Co. , 850 S.W.2d 439 (Tenn. 1992) ; Da v is v . H

all , 920 S.W.2d 213, 217 (Tenn. Ct. A p p

. 1 995). The abuse of discretion standa

rd re quires us t o consider: (1) whethe r the decision has a sufficie nt e videntiary foundation; (2) whe ther the tria l court c o rr ectly identified and properly applied the appr opriate le gal principles; and ( 3) whe t h er the decision is within the range ofThe de f enda nt s obj ec t ed t o N ur s e Eake s ’ qual i fi ca t i ons as an expe r t

. A cc or di ngl y, a voi r di r e exa m i nat i on 3

w as cond uct ed ou t s i de t he pres ence of t he j ury. Fol l ow i ng t he exam i nat i on , t he T r i al Co urt det er m i ned t hat N urs e Eakes

w a s q u a lified to tes tify a s a n e x p e rt w itn e ss.
-12-

acc eptable alternatives. State ex re l. Vaughn v. Kaatrude , 21 S .W.3d 244, 248 (Tenn. Ct. App. 2000). W hil e we will set aside a discretionary decision if it doe s not r est on an adequat e e v identiary foundation or if it is contrary t o the governing law, we w ill not substitut e our judgment for that of t he trial court merely because w e might have chose n another alternative.

Robinson , 2007 WL 2318185, at * 4.

Pla int if fs c a lle d M artha

Ea ke s a s an e xp e rt

wi tne ss at tria l. Du ri ng dir e c t- 3 examination, Nur se Eakes identified an a rticle titled “Intr apartum Manageme nt Module” as be ing
a re liable m edica l authority. When Plainti ffs later attempted to cross-e xamine Nur se Sturgill usi ng this article to support Plaintiffs’ position that the application of funda l pressure during the delivery of the Ch il d was a

vio la tio n o f the a c c e pta

ble stand ardof

pr of e ssi on a l pr a c tic e , th e de fe nd a nts objected f or seve ral reasons. First, the defendants claimed that the article had not bee n established
as re liable authority that was used in W ilson County. Second, the defe ndants argue d that Plaintiffs ha d n ot e sta

bli sh e d th a t th e art ic le se t f orth the app lic able stand ard of c are du ri ng the re le va nt t ime fra me. It appe ars the T rial Court ultimately agree d with the latter a rgument. When counsel f or Plaintiffs stated: “So basically your ru l i ng would be the a dditional foundation would have be en nece ssary to link it to t he yea r ...”, theTrial Court re sponded in the af firmative.

In their brief, Plaintiffs foc us entirely on whe ther they n eede d to comply with the locality rule be fore the article could be c onsidered r eliable authority and used for impea chment purp o s es u nder Te nn. R. Evid. 618. Pl aintiffs do not discuss the proprie ty of the Tria l Court’s ultimate ruling that they failed to lay a proper foundation bec ause the re w as not hing linking t he stand ardof

c are dis c us se d in the art ic le to the stand ardof c arethat w a s a

pp lic able wh e n th e Chi ld was born. W e, ther efor e, conside r this issue waived.

Howeve r, eve n i f this issue was not waive d, we ne verthe less would hold any such
err or, assuming there was a ny, to be harmless. The jury wa s prese nted with a gr ea t d ea l of
c on fl ic tin g te sti mon y a s to wh e the r Nu rs e Stu rg ill did or did no t app ly fu nd a l pr e ssu re . Pl a int if fs ’ pr oo f w a s th a t sh e did , a ndDe fe nd a nts ’ p ro of wa s th a t sh e didno t. Th e jury may h a ve qu ite simply found that Nurse Sturgill did not apply fundal pre ssure.

As mentioned ea

rlier, De fendants raise a s a sepa rate issue their position that the Trial Court erre d in allo wi n g P l aint iffs’ e xperts to testify bec ause the ir testimony neither satisfied the loc a li ty ru le n o r w a s s c ie n ti f ic a ll y r e li ab le

. I n li g h t o f o u r d e c is io n a s to th e is s u es ra ised by Plaintiffs, Defe ndants’ issue is prete rmitted.-13- Conclusion
The judgment of the Trial C ourt is aff irmed and this cause is re manded to the Trial Court fo r co llection of the c osts below. Costs on appeal ar e taxe d to the Appellants, Katherine Delorie se Olinger and Perry Micha el Hale , and their sur ety.

___________________________________ D. MICHAEL SWI NEY, JUDG E