### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON N O V E MB E R 1 9, 200 8 S es sio n
TOMMY McDANI EL, ET AL 

### . v. AMAL RUSTO M, M.D., ET AL 

### .
Direc t Appeal from the Circ uit Court forShelb y County No. CT-003373-04 Je rry Stokes, Judge

No. W2008-00674-C OA-R3-C V - Filed May 5, 2009

The plaintiffs f

iled a complaint alleg ing me dical malpra ctice a g ainst emerg en cy room phy sicians who treated their daug hter. The defe ndants filed motions for summary judgme nt, claiming that the pla in t i f f s ’ o n l y e xp e rtw a s n o tqu a l i f

i e d t o t e s t i f y a s t o t h e r e c o g n i z e d

s t an d ar d o f a c c e pta ble profe ssional pr actice in the defe ndants’ profe ssion a nd specia lty in the ir community or in a simil ar
c omm un ity . T he tr ia l c ourt

g ra nte d s umm ary jud g me nt to the de fe nd ants , fi nd ing that th e pla int if fs ’ expert did n o t m ee t the qualifications of Tennesse e Code Annotated sec tion 29-26-115. The pla int if fs a pp e a l. We a ff

ir m.

Tenn. R. App . P. 3; Appeal as of Right; Judgment of the C ircuit Court A ffirm ed

A LA N E. H I G H ERS , P.J.,W.S., delivered the opinion of the court, in which D AVI D R. F ARMER , J., and J. S TE VE N S TA FF O RD , J., joined.

W ill ia m B. Ra if

or d, II I, Cla

rk sd a le , M S, f

or Ap pe lla nts J. Kimbrough Johnson, Elizabeth T. Collins, Memphis, TN, for Appe llee Amal Rustom, M.D.

Dar rell E. Baker, Jr., Debor ah Whitt, Susan V. Thomason, Memphis, T N, for Appellee s David Piper, M. D. a ndPe diatr ic Em e rg e nc y Sp e c ia lis ts, P.C.

OP IN IONSha nt el w as a l l er gi c t o Pe ni ci l l i n. 1

Pl ai nt i f f ’ s e xper t de s cr i bed St eve ns J ohns on Syndr om e as ve r y r ar e, w i t h a n i nci denc e of “one i n a m i l l i on 2

or l es s

. ” H e fur t her de s cr i bed St eve ns J ohns on Syndr om e as “ an i m m unol ogi c r ea ct i on w her e t her e’ s a r ea ct i on on t he par t of t he body t o f or ei gn c om pounds and r educ t i on of ant i bodi es , des t r uct i on of t he epi der m i s a nd s l oughi ng of t he epi derm al t i s s ue off

of t he s ki n – o f f

of t he derm i s

. Th e e pi derm i s s l ou gh s off of t he derm i s

. ”

-2- I. F A C TS & P R OC EDU R A L H I S T ORY

On J une 13, 2003, fifte en-y ear -old Shantel McDa niel prese nted to the emerg ency room at Methodist H o s p it a l

- G e r ma n to w n w it

h f e v e r , b a c k p a in , an d o th e r s y mp to ms

. Sh an te l was dia g no se d w itha

ur ina ry tr a c t in fe c tio n, g ive n an anti bio tic c a lle d L e va qu in, and dis c ha rg e d w ith 1

a pr e sc ri pti on

. Th e fo llo wi ng mor nin g , on J un e 14 , Shante l r e tur ne d to the e me rg e nc y

ro om b e c a

us e her e y es we re bur

ning, itching , water ing, a

nd slightly

red, he r fa ce w as swelling , and she had a ver y fine ra sh on her ba ck and c hest. On this occa sion, Shantel was ex amined in t he eme rg ency room by Dr. Ama l Rustom . Dr. Rustom concluded that Shantel was havingan aller g ic re action to the

m e d i c a t i o n an d

i n s t r u c t e d h e r t o s t o p t a k i n g t h e L e v a qu i n

. D r

. R u s t o m g a v e S h an t e l a

B e n a dr yl ta ble t and dis c ha rg e d h e r w itha

pr e sc ri pti on

fo r a dif fe re nt t y pe of anti bio tic c a lle d Se ptr a .Sh e a lso tol d Sh ante l to re tur

n to the e me rg e nc y ro om or to s e e he r p ri mary

c are ph y sic ian if

he r s y mpt oms
worsene d within twenty -four hours.
At approximately

1:10 a.m. on J u n e 1 5 , Shantel prese nted to the emer g ency room at Methodi s t H o s p it a l

- L e B o n h e ur w it h f e v e r an d a r a s h “ a ll o v e r

. ” Sh an te l w a s e xa mi n e d in the

emer g ency room by Dr. David Piper. Dr. Piper g ave Shantel additional medications t o t re at the allerg ic re action, which he believed w as due to t h e p reviously presc ribed a

ntibioti cs, and he

rec ommended that she c ontinue takin g the Septra to tre at the urina ry trac t infection. She wa s discharg ed fr om the emer g ency room at appr ox imately

4:15 a.m.

L a te r t hat e ve nin g , Sh ante l r e tur ne d to the e me rg e nc y

ro om at Me tho dis t H os pit a l - L eB onheur w ith worsening sy mptoms, and she was admitted to the hospital a nd diag nosed with a

rar e condition known as Steve ns J ohnson Sy ndrome. T h e Stevens Johnson S y ndrome late r 2 prog resse d to T ox ic Epidermal Nec roly sis. On J uly 3, 2003, Shantel was transfe rre d to the Reg ional Medica l Center in Memphis, wher e she r emained until her death on Septembe r 3, 2003.

On J une 11, 2004, Shantel’s pa rents, Tommy

McDa niel and W i llie Mae McD aniel (“Plaintiffs”) , filed a c omplaint in S helby County Circuit Court ag ainst numerous phy si cians a nd medical e ntities invol ved in Shantel’s tre atment. The only defe ndants at i ssue i n this appeal a re D r. Rustom, Dr. Pi per, a

nd Pediatric Emer g ency

Specialis t s , P

. C

. , the g roup with which Dr . Piper prac ticed. Plaintiffs alleg ed that the de fenda nts wer e neglig ent i n administering the antibi otics and otherwise tr eatingShantel’s condition, and they soug ht damag es pursua

nt to Tennessee ’s Wrong ful Death Act, Tenn. Code A nn. § 20-5-113. The defe ndants filed answers asserting that their treatment of Shantel fully

confor med to t he re cog nized standard of c are for e merg ency room phy sicians prac ticing in Me mphis and Shelby County , Tenne ssee.-3-

Dr. Piper a

nd Pediatric Emer g ency

S p ec i al ists, P .C., subsequently filed a motion for summary judgme nt along with Dr. Piper’s aff idavit. Dr. Piper’s aff

idavit stated that he was a boar d

cer tified pediatric ian, fully

li c e n s e d to p r actice medicine in Memphis and Shelby County , Tenne ssee, and that he had prac ticed in the field of pediatric emerg ency medicine for m ore than one y ear prior to the date of

Shantel’s treatment. Dr. Piper stated that h e wa s familiar with the standa rd of pr of e ssi on a l pr a c tic e e xpe c te d of a pe diatr ic ian p ra c tic ingin a n e me rg e nc y

de pa rtme nt i n M e mph is and Shelby

County , and h e s t at ed that his car e and tr eatment of Shantel complied with such standards i n al l respects. Dr. Piper state d that he examined Shantel for sy mptoms i ndicative of Stevens Jo h n s o n Sy

n dr o me an d f

o u n d n o s u c h s y

mp to ms

. D r

. Pi p e r a ls o s tate d th a t he

rec ommended that Shantel continue taking Septra beca use he believed that her allerg ic re action wa s due to the pre viously

presc ribed a

ntibioti cs rather than Septra . I n their motion for summary jud g me nt, Dr . Pipe r an d Ped iatr ic Em e rg e nc y Spe c ia lis ts, P.C. , ar g ue d that Plai nti ff s we re un a

ble to support their alleg ations of neg lige nce w ith c ompetent expert testimony as re quired by

Tenne ssee Code Annotated se ction 29-26-115.

I n o pp os iti on

to t he mot ion fo r s umm ary

jud g me nt, Pla int i f

fs fi le d th e a ff

ida vit of Dr . D on a ld Har vey Marks. Dr

. Marks’ aff

idavit stated that he was lice nsed to prac tice medicine in the states of Alabama , Mississ ippi, and New York, and that he was prac ticing medicine in Alabama duringthe y ear prior to Shantel’s medica l treatment. Dr . Marks fu rt her state d that he wa s “familiar with the

acc eptable sta

ndard of profe ssional prac tice of phy sicians pra cticing in the emer g ency depar tment in c omm un iti e s s uch as Ho ov e r, Al a bama , a nd B ir min g ham, A la

bama , f or patie nts wi th a lle rg ic

rea ctions t o an t ibiotics and sy mptoms such as those prese nted by Shantel . . . .” Dr . Marks stated that he had r eviewe d statistical information about Memphis and a de scription o f the re source s available t o p h y s i cians in Memphis, and that, in his opinion, Hoover a nd Birming ham, Alabama,
wer e similar to Memphis, Tennesse e. Dr . Marks fur ther opined that Dr. Piper and D r. Rustom violated the acceptable standa rd of pr ofessional pra ctice in c ommuniti es similar to Memphis by starting and continuing Shantel on Septra. As support for his statement, Dr. Marks cited infor mation which he stated “should have been known to any rea sonable prude nt phy sician.”

Th e tr ia l c ourt su

bs e qu e ntl y e nte re d sc he du lin g or de rs re qu ir ing the pa rt ie s to de sig nate a ll expert witnesses they intended to call at trial. Plaintiffs identified Dr . Marks a s their only medical expert and stated that they “may call Dr . Marks a s an ex p ert on e merg ency medicine a

nd p h ar m a c o l o g y. ” D r

. M ar

k s ’ d i s c o v e r

y d e p o s i t i o nw a s t a k e no n A u g u s t3 1 , 2 0 0 7 , b y t h e a t t o r n e ys for both def

endant phy sicians. Dr. Ma rks testified that he w as boar d cer tified in internal medicine , and that he had previously prac ticed medicine in New Jersey and California . He state d that he beg an prac ticing me dicine in Alabama in 2002 at a g ener al clinic located i n Hoover , which he describe d as a subur

b of B irmingha m

. Dr

. Marks said that he worke d at the clinic one day per w eek a

nd “cove red” for a

nother phy sician whe n he went on vacation. Dr. Marks explained that he continued this practice of “pa

rt-time medicine” betwee n 2 002 and 2004, but spent most of his time “doing litigation support.” At

the tim e of

his de po sit ion , D r. Ma

rk s’ pr a c tic e c on sis te d o f s e e ingpatie nts two to two and a ha lf day s per we ek at a hepatitis clinic locate d within a hospital, and conduc ting clinical rese arc h during the rema inder of the wee k. Dr. Mar ks admitted that he had ne ver pr actice d

a s an emergency ro om p hy sic ian a nd tha t he ha d n ot w or

ke d in an e me rg e nc y

ro om s inc e his-4-

re sid e nc y , w hic h e nd ed in 19 83

. Cou ns e l f or Dr . Ru sto m th e n q

ue sti on e d D r. Mark s a s to his fa mil iari ty wi th t he sta nd ard of c are a s f oll ow s:
Q. All rig ht. Okay

. Are y ou g oing to g ive an opinion as to what the s tandar d of

car e re quired the e mer gen cy room phy sicians to do, even thoug h y ou’ve

ne ve r b e e n in

an e me rg e nc y

ro om?

Couns e l f or Pla int if fs : O bje c t to the fo rm

.
A. My opinion about the standard of ca re wi l l re fer to what all phy sicians ar e require d to do when the y en co u n t er a drug s rash. And that is – and the sta nd ard of c are is univ e rs a l, n ot j us t for e me rg e nc y

ro om p hy sic ians . So my opinion will go to what the standard is for a ny phy sician, eme rg ency

room or not. A n d

Id o n ’ t t h ink th a t I s h o u ld h a v e to li mi t my

o p in io nto w h at
emer g ency

room phy sicians ar e re quired to do, since e merg ency room phy sicians ar e re quired to adhe re to the standard of c are for dr ug induced

rea ctions that all phy sicians ar e re quired to do, to do here

. Q. So the n y our o pin ion is t o th is is [ si c] wha t th e st andar d o f c are is of a ll

s p e c i a l i s t s an d

a l l a c r o s s t h e c o u n t r

y? A. Ev e ry

wh e re , T e nn e sse e and

the re st o f t

he c ountr y . Y e s. Q. And so is it y our opinion that any one who is a phy sician would adher e to the same standa

rd of c are ? A

. Ye s. An y

ph y s i c i an w o u l d a dh e r e t o t h e s t an d ar d o f c ar e wh ic h is tha t,
numbe r o ne , b a se d on the ir tr a ini ng the y wo uld kn ow that if a pat ie nt ha s a
rea ction to a drug , that they need to stop the drugunless it’s require d for the

ma int e na nc e of su sta ini nglif

e . A nd numbe r t

wo is that a ll p hy sic ians , including e merg ency

room phy sicians in Tennesse e, ar e re quired to re ad the presc ribing information for the medicines t h ey presc ribe a

nd follow the

rec ommendations of the manuf actur er. Q. So y our opinion isn’t about what specific ally is done in Memphis, it’s a bout what’s done ever

y wher e? A. Ye s. B ut i t in c lud e s Me mph is. Q. Wel l, t

hat w ou ld b e Me mph is o r C a lif or nia or Ne w Y or k o r T e xas? A. B ir

min g ham. Q. An d a ll tho se oth e r p la c e s, c or re c t? A. Ye s.

. . . . Q

. Do y ou ha ve an y o p i n i o n s p e c i f i c a l l y a s t o h o w m e d i c ine is pr a c tic e d in Me mph is i n th e e me rg e nc y ro om? A. Med ici ne in Mem ph is , Ten nes see – pr inc ipl e s o f m e dic ine in Me mph is, Tenne ssee, a

re the same a s the principles of medicine in Par is, Fra nce. It’s

u n i v er s al

. I f s o m eb o dy

h as a r ea ct i o nt o a d ru g, y o us t o p t h e d ru g.-5-

Q. So it’ s no t a

bo ut the fa c t of

Ikn owho w m e dic ine is p ra c tic e d in Me mph is, it’s y our opinion this is just how medicine is prac ticed eve ry wher e? A. I t is. . . . When que stioned by

counsel for

Dr. Piper, Dr . Marks c oncede d that he did not consider himself a n expert in either eme rg ency medicine or

pediatric s. Dr. Ma rk s al s o acknow ledg ed that he did not consider himself competent to te stify about the standard of ca re f or an e merg ency

room phy sician in Birming ham. Pla int if

fs ’ c ouns e l th e n q

ue sti on e d D r. Ma

rk s a s f oll ow s:
Q. Doctor, in 2002 a

nd 2003 wer e y ou treating patients, adolesce nt patients, who prese nted to y our medica l clinic? A. Ye s. Q

. And – well, first of all, on J une 13th, 2 0 0 3 , w h en Shantel McDa niel pr e se nte d to Me tho dis t Ho sp ita l Ge rm anto wn did sh e have wh a t y ou wo uld consider a

n emer g ent condition? A

. D i d

s h e h a v e w h a t , ane m e r g e n c y? Q. Ye s. A. No. She had a nonemer g ent condition and she used the emer g ency room for convenie nce. Q. An d wo uld y ou have se e n a nd tr e a te d p a tie nts su c h a s Sh ante l Mc Da nie l in 20 02 and 20 03 , p a tie nts wh o c omp la ine d o f h e a da c he , f e ve r, back pa in during that time? A. Ye s. Q. And would y ou know the s t an d ar d o f car e of [si c] applicable to phy sicians tr e a tin g a do le sc e nt p a tie nts wi th su c h c omp la int s in B ir min g ham, A la

bama in 2002, 2003?

Couns e l f or Dr . Ru sto m: O bje c t to the fo rm

.
A

. Yes. Ac tu a ll y

it ’ s in d e p e n d e n t o f

w h e th e r s h e w a s s e e nin an emer g ency room or not bec ause she had a none merg ent condition. Q. Ok ay . A nd

wh e the r o r no t y ou ho ld y ours e lf ou t a s be ing an e xpe rt a s to a ll aspec ts of emer g ency

car e, do y ou believe that y ou know the standa rd of c are
a pp lic a ble to any ph y sic ian in any sp e c ia lty that wou ld b e pr e se nti ng– w ith a patient pr es en t i n g with the ty pe of sy mptoms t hat Shantel McDa niel prese nted on the 13th, 14th, and 15th? A. Well, I ’m no[t ] claiming to be an em er gen cy room phy sician, or know the sta ndard of

car e for an eme rg ency

room phy sician for

the ca re of a patient with an emer g ent condition, emer g ency condition. But Shantel did not have

an eme rg ency

condition, so I ’m perf

ectly able to spea

k on the manag ement of he r c a se . Y e s. Following the deposition, Dr. Rustom f iled a motion for summary judgme nt, claiming that Dr. Mar ks was not qualified to testify as to the standar d of ca re a pplicable to her

spec i alt y ofD r

. R ust om furt her as s er t ed t hat D r

. M ar ks w as u nfam i l i ar w i t h t he di s eas e p r oces s i nv ol ved i n t hi s ca s e, 3

as he adm i t t ed du r i ng hi s depo s i t i on th at h e h ad never s een or t r eat ed a pat i ent w i t h St evens J oh nson Sy nd r om e. H o w e v e r, th e p a rtie s d o n o t ad d re ss th is issu e o n a p p e a l.

-6- e m e r g e n c y r o o m m e d i c i n e o r t h e s t an d ar d

o f c ar e a p p l i c a b l e i nM e mp h i s o r

a s i m i l ar c o m m u n i t y. 3 Dr. Rustom had previously testified during her deposition that she had prac ticed on l y emerg ency
me dic ine sin c e 19 98 . D r. Rus tom be c a me bo ard c e rt if ie d in inte rn a l me dic ine in 1 99 9, bu t sh e sa id sh e ha d n e ve r p ra c tic e d in te rn a l me dic ine . D r. Pip e r a nd Pe diatr ic Em e rg e nc y

Spe c ia lis ts, P.C. , a lso fi le d a no the r m oti on

fo r s umm ary

jud g me nt, a g a in a

rguin g that Pla int if

fs ha d f a ile d to su pp or t th e ir alleg ations with c ompetent expert testimony and further adopting the memorandum filed in support of Dr. Rustom’s motion for summary judgme nt.

On No ve mbe r 2 6, 20 07 , th e tr ia l c ourt e nte re d a n o rd e r g ra

nti ng su mma

ry jud g me nt t o a ll three defe ndants, finding that “no g enuine issue of materia l fac t exi sts in thi s case beca use the plaintiff[s’] expert, Dr. Dona ld Marks does not meet the qualifica tions of § 29-26- 115.” Plaintiffs tim e ly fi le d a no tic e of a pp e a l.

II. I SSU ES P R ESENTED On a pp e a l, t he a pp e lla nts argue that th e tr ia l c ourt e rr e d in g ra nti ng su mma

ry jud g me nt i n fa vo r o f t he de fe nd ants . T he de fe nd ants conte nd that summa

ry jud g me nt w a s p ro pe r b e c a us e Plaintiffs’ onl y ex p ert wa s not familiar with the pra ctice of emer g ency

medicine in Memphis or a sim ila r c omm un ity . F or

the fo llo wi ngre a so ns , w e a ff ir m th e de c isi on

of the c ir c uit

c ourt

.
III

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

A m oti on fo r s umm ary

jud g me nt s ho uld

be g ra nte d o nly “ if the ple a din g s, de po sition s,
answe rs to interrog atories, a nd admissions on file, toge ther with the aff idavits, if any , show that there is n o g e nu in e iss ue a s to any mate ri a l f

a c t and that th e mov ingpa

rt y is e nti tle d to a

jud g me nt a s a matter of la

w.” Tenn. R. Civ. P. 56.04. The pa rty seekingsummary

judgme nt has the bur d en of pe rs ua din g the c ourt

that th e re are no g e nu ine iss ue s of m a te ri a l f a c t and that he or sh e is e nti tle d to judgme nt as a matter of law. Martin v. Norfolk S. Ry. Co. , 271 S.W .3d 76, 83 (Tenn. 2008) . “The moving pa

rty may make the r equire d showing and ther efor e shift the burde n of produc tion to the nonmoving pa

rty by either: (1) aff

irmatively neg ating an essential element of the nonmoving pa rty ’s claim; or (2) s h o wi n g that the nonmoving pa rty cannot pr ove an e ssential element of the claim at trial.” Id. (c i t i n g Hannan v. Alltel Publ’g Co. , 27 0 S.W. 3d 1, 5 ( Te nn . 2 00 8) ). Th e mov ingpa rt y must do more than simply asser t tha t the nonmoving pa

rty has no evide nce or

insufficient e vidence

. Id. a t 83 -8 4. “ Th e mov ingpa rt y mus t e ith e r p ro du ce evi den c e or re fe r t o e vid e nc e pr e vio us ly

su bmi tte d b y

the no nmo vin g pa

rt y tha t neg a te s an es se nti a l ele me nt of the no nmo vin g pa

rt y ’s c la im or shows that the nonmoving party cannot pr ove an essential element of the c laim at trial.” Id. at 84 (c i t i n g Hannan , 270 S.W .3d at 5). “ I f the moving party makes a proper ly supported motion, then the nonmoving pa

rty is require d to pr o d

uce e vidence of spec ific fa cts establishing that g enuine issues of mater ial fac t exi st.” Id. (c i t i n g McCarley v. W . Quality Food Serv. , 960 S.W .2d 585, 588 (Tenn. 19 98 ); By rd

v . H all , 847 S.W .2d 208, 215 (Tenn. 1993) ).-7-

The res o l u t i o n o f a moti on for summary judgme nt is a matter of la w, which we revie w de novo with no presumption of corr ectne ss. Ma rti n , 271 S.W .3d at 84. Howe ver, “ we a re r equire d to re vie w the e vid e nc e in the lig ht m os t f a vo ra ble to t he no nmo vin g pa

rt y and to d ra w a ll r e a so na

ble infere nces f

avoringthe nonmoving pa rty .” Id. (c i t i n g Staples v. CBL & Assocs., Inc

. , 15 S.W .3d 83, 89 (Tenn. 2000) ).

IV. D I S CUS S I ON

A. St andards A

pplicable to Medical Malpractice Cases
We beg in with an examination of the re q u i reme nts for establishing a medica l malprac tice action in Tenne ssee. “ Medica l malprac t i ce claims have stric t substantive and proc edura l require ments.” Hessm er v. Miranda , 138 S.W .3d 241, 244 (Tenn. Ct. App. 2003). Apatient filing

a m ed i ca l m al p ra ct i ce ac t i o nh as t h e b u rd en o f p ro v i n g: (1) The rec og nized standard of acc eptable pr ofessional pra ctice in the pr ofession and the spec ialty

there of, if any , that the def endant pr actice s 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 occurr ed; (2) That the defe ndant act ed wi t h l es s than or fa iled to act with ordinar y and

rea sonable c are in acc ordanc e with such standa rd; and (3) As a proxi mate re sult of th e d ef en d ant' s neg lige nt act or omission, the plaintiff suffe red injuries w hich would not otherwise ha ve occ urre d.

Tenn. Code An n. § 29-26-115( a) (Su pp. 2008). Subject to the “common knowledg e” e x ception, wh ic h is ina

pp lic a ble in thi s ca se , pla int if

fs fi lin g me dic a l ma lpr a c tic e a c tio ns c ann ot r e c ov e r u nle ss the y pr od uc e c omp e te nt e xpe rt

e vid e nc e e sta

bli sh inge a c h o f t

he se thr e e statut o r

y i n gr e die nts of

the ir claim. Hessm er , 138 S.W. 3d a t 244 (c iti ng Te nn . Code Ann. § 2 9- 26 -1 15 (a ); Se av e rs v . M e tho dis t Me d. Ctr

. , 9 S.W .3d 86, 92 (Tenn. 1999)). I n addition, a healthca re profe ssional must satisfy stringe nt require ments of licensure and pra ctice be fore they ar e p ermitted to testify as to the

nece ssary elements. Merce r v. HCA Health Servs. of Tenn., Inc. , 8 7 S. W.3 d 5 00 , 5 07 (T e nn . Ct

. Ap p. 20 02 ). Th e me dic a l ma lpr a c tic e statut e pr ov ide s:

No pe rs on

in a he a lthc are pr of

e ssi on re qu ir ing lic e ns ur e un de r t he laws of

thi s st a te shall be compe tent to testify in any court of la

w to establish the fa cts requir ed to be

e sta bli sh e d b y

su bs e c tio n ( a ), un le ss the pe rs on wa s lic e ns e d to pr a c tic e in t he state
or a contig uous border ing state a profe ssion or specia lty which would m ak e t he pe rs on ’s e xpe rt

te sti mony

re le va nt t o th e iss ue s in

the c a se and

ha d pra c tic e d th is pr of e ssi on or sp e c ia lty in o ne (1 ) o f t

he se st ate s dur ingthe y e ar p re c e din g the date that the alleg ed injury

or wrong ful ac t occur

red.
Tenn. Code Ann. § 29-26-115(b) ( Sup p. 2008). Fur thermore , the health car e prof essional offe ring the opinion must, l ike any other e x pert, demonstrate that he or she is qua lified to rende r an e x pert“Pr el i m i nary ques t i on s concer ni ng t he qu al i f i cat i on of a per s on t o be a w i t nes s , t he exi s t ence of a pr i vi l ege, 4

or t he adm i s s i bi l i t y of evi dence s hal l b e d et er m i ned by t he court

. . . . ” T en n. R

. E v i d. 10 4 (a). A w i t nes s qual i f i ed as

a n e x p e rt b y k n o w le d g e , sk ill , e x p e rie n c e , tra in in g , o r ed u c a tio n m a y te stify in th e fo rm o f a n o p in io n o r o th e rw ise if

s ci ent i f i c, t echni cal , or ot her s peci al i zed kno w l edge w i l l s ub s t ant i al l y as s i s t t he t r i er o f fact t o un ders t and t he evi dence

o r to d e te rm in e a fa c t i n issu e

. Tenn. R

. Evi d. 702.

-8- opinion a nd that his or her opinion will substantially assist the trier of f

act. Chu rch v. Pe rales , 39 S.W .3d 149, 166 (Tenn. Ct. App. 2000) ( citing T enn. R. Evid. 104(a) , 702). 4

“ I n th is d ay

and tim e , p a tie nts fi lin g a

me dic a l ma lpr a c tic e c a se sh ou ld r e a so na bly anti c ipate that their cla im will eventually be tested by

a motion for summary

judgme nt , particula

rly when discovery reve als a we akness in the qua lifications of t heir ex pert or in their evidenc e re g ardingthe applicable standard of ca

re or causation.” Kenyon v. Handal , 122 S.W .3d 743, 754 (Tenn. Ct. App. 2003). Phy sicians often file a mot ion for summary judgme nt acc ompanied by their own self

-ser ving aff idavit stating that their conduct neither vi olated the applicable standard of car e nor caused injury that would not otherwise ha ve occ urre d. Id. at 758. By doing so, the phy sician eff ectively neg ates the ne g lig e nc e a lle g a tio ns in t he patie nt’ s c omp la int

and sh if ts the burd e n to the patie nt t o demonstrate the exis tence of a g enuine, mate rial fa ctual dispute wa rra nting a jury trial. Id. “ B e c a

us e the pra ctit i o n er s most often file their summary judgme nt motions befor e much discove ry has

oc c ur re d, the on ly

pr a c tic a l a lte rn a tiv e a va ila ble to m os t patie nts is t o f ile an e xp ert

a ff ida vit contra dicting the ir phy sician’s a ffidavit.” Id. Wit hout opposing e x p er t p ro of, patients ca nnot de mon str a te a

g e nu ine fa c tua l di sp ute re g ard ingwh e the r t he p hy sic ian b re a c he d th e a pp lic a ble standard of

profe ssional prac tice. Id. Stil l, the patient’s cla im may not survive a summary judgme nt motion eve n when the patient does file an opposingaff idavit. Id. at 759. I t is now commonplace for medic al pra ctitioners to challeng e the a bility of the patient’s medical e x pert to satisfy the mandatory

qualifications in Tennessee Code Annotated se ction 29-26-115. Id.

I n de c id in g w h e th e r to a dmi t e xp e rt te s ti mo n y f o r p u r p o s e s o f r

u li n g o n a mo tion for

summa ry jud g me nt, the tr ia l c ourt

e mpl oy s the same sta

nd ard s it wo uld us e in d e c idi ngwh e the r t o admit the expert testimony at trial. Trav is v

. Fe rra ra c c io , No. M2003-00916-COA- R3-CV, 2005 WL 22 77 58 9, a t *5 (Te nn . Ct . App . Se pt. 19 , 2 00 5) (c iti ngTe nn . R. Civ . P. 56 .0 6; Ra sk in v . W y att Co. , 12 5 F .3 d 55 , 66 (2 d Cir . 1 99 7) ; Donaghey v. Ocean Dril ling & Exploration Co. , 974 F.2d 646, 650 n.3 (5th Cir. 1992)). “The court shall disallow testimony in the form of a

n opinion or infere nce if the underlying fac ts or data indicate lack of trustworthiness.” Tenn. R. Evi d. 703. “ Th e ana ly sis of the qua lifications of the patient’s med ical expert most often enta ils ex amining the expert’s

rec itation of his o r her

qualifications either in an af fidavit opposing the motion for summary judgme nt or in a deposition, if one has be en take n.” Kenyon , 122 S.W. 3d a t 75 9. Al tho ug h c ourt s have instruc ted attorne y s to couch their me dical expert s ’ o pinions in t he languag e of Te nnessee Code Anno tate d s e cti on 29 -2 6- 11 5 in or de r t o avo id s umm ary jud g me nt p ro ble ms, “ a

me re ri tua lis tic incantation of statutory

buzz words evide nces ve ry littl e.” Chu rch , 39 S.W .3d at 166. Ther efor e, when a n expert’s opinion is c h al l enged, c ourts look to the substance of the opinion to determine whether it is based on trustworthy fac t s o r d at a s ufficie nt to provide some basis for the opinion. Kenyon, 12 2 S. W.3 d at 75 9; Chu rch , 39 S.W .3d at 166. We are not to determine the weig ht to be g i v e nt o t h e e x p e rt ’ s o p i n i o n , b u t w e d o e x a m i n e t h e o p i n i o nt o d e t e r m i n e i f i th a s “ s o m e l e g a l l y--9-

acc eptable ba sis from which its conclusions could be r ationally draw n.” Chu rch , 39 S.W .3d at 166. An expert opinion having no basis can be disreg arde d beca use it c annot materia lly

assist the trier of fac t or cre ate g enuine disputes of material fa ct at the summary judgme nt stag e. Id.

“Unde r the ter

ms of [Tennessee Code Annotated se ction 29-26-115] and the law of e vidence g e ne ra lly , th e tr ia l c ourt

e xer c ise s b ro a d d isc re tio n to de te rm ine the qu a lif ic a tio ns of

e xpe rt s and

its deter mination will not or dinarily be reve rsed absent some abuse of discretion.” Cardwell v. Bechtol , 72 4 S. W.2 d 7 39 , 7 54 (T e nn . 1 98 7) . “ Ap pe llate c ourt s s ho ul d p e rm it a dis c re tio na

ry de c isi on to stand if re asonable judicial minds can diffe r conc erningits soundness.” Whit e v. V anderbilt Un iv. , 21 S.W .3d 215, 223 (Tenn. Ct. App. 1999). We w ill set aside a discre tionary decision only

when the tr ia l c ourt

ha s mi sc on str

ue d or mis a

pp lie d the c on tr oll ingle g a l pr inc ipl e s o r a c te d in c on sis te ntl y with the substantial weig ht of the evide nce. Id. I n th e c on te xt of an a wa rd of summa ry jud g me nt, ho we ve r, we mus t vi e w the e xpe rt ’s state me nts in the lig ht mos t f a vo ra ble to t he no nmo vin g pa

rt y and dra w all re asonable infere nces in that pa rty ’s favor. Kenyon , 122 S.W .3d at 759.

A s n o t e d , 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 r e qu i r e s P l a i n t i f f s t o p r o v e , b y e x p e rtt e s t i m o n y,

“ [t]he re c og nize d s tand a

rd of a c c e pta ble pr of e ss iona l pr a c tic e in t

he pr of e ssi on and the sp e c ia lty the re of , if any , th a t th e de fe nd ant pr a c tic e s in the c omm un ity in wh ic h the de fe nd ant pr a c tic e s o r i n a similar community

at the time the alleg ed injury or wrong ful ac tion occurr ed.” Te nn. C ode Ann

. § 29-26-115 ( Sup p. 2008). Th e de fe nd ants in t his c a se argue that th e tr ia l co urt di d n ot a bu se its discretion in concluding that Dr. Mar ks was not compete nt to testify , when his testimony reve aled that he had no basis for his c laimed familiarity with the standard of car e re quired of e merg ency room ph y sic ians

.
Te nn e sse e Cod e Anno tate d s e c tio n 2 9- 26 -1 15 do e s n ot r e qu ir e that an e xpe rt wi tne ss prac tice in the same specia lty as the defe ndant, so long as the e x pert witness de monstrates “suf ficient familiarity

with the standard of car e” of the defe ndant’s profe ssion or specia lty and is a ble to g ive rele vant testimony

on the issue in question. Cardwe ll , 724 S.W .2d at 751. In Se ar le v . Br y ant , 713 S.W. 2d 62 , 6 4 ( T e nn

. 1 9 8 6 ) , f

o r e xamp le , a

n in fe c tio us dis e a se sp e c ia lis t and c lin ic a l mi c ro bio log ist , Dr

. S t ra t t o n , wa s p erm i t t ed t o t es t i fy re gar d i n g t h e s t an d ar d o f c ar e f o r agen er al s u rge o nt re at i n g a surg ical wound. Althoug h Dr. Stratton did not perfor m surg ery

himself, he per formed inf ectious disease c o n s u ltations in a hospital’s department of me dicine, he oc casiona lly attended in g ener al medical se rvice s, and he was ex perie nced in treating and mana g ing sur g ical wound infe ctions. Id. The Supreme Court rejec ted the def endant’ s assertion that only a surge on was competent to testify

as t o t h e r ec o gn i z eds t an d ar d o f a cc ep t ab l e p ro fe s s i o n al p ra ct i ce , s t at i n g:

The statute c ontains no require ment that the witness pra ctice the sam e s p ec i alty as the de fe nd ant.

. . . D r. Str a tto n s tate d th a t he wa s fam iliar wi th t he a pp lic a ble sta nd ard s of s ur

ge on s in t he pr e ve nti on and tr e a tme nt of surg ic a l wound inf e c tio ns , and his testimony supports that statement . His expert testimony was, ther efor e,
re le va nt t o th e iss ue s in

the c a se . F or

th at re a so n, he wa s c omp e te nt t o te sti fy a s to those standar ds, even thoug h he wa s not himself a surg eon.Tenne s s ee Code Annot at ed s ec t i on 29- 26- 118 re qui r es t he pl ai nt i f f i n an i nf or m ed cons ent c as e t o “ pr ove 5
b y e v id e n c e a s re q u ire d b y § 2 9 -2 6 -1 1 5 (b ) th a t th e d e fe n d a n t d id n o t su p p ly a p p ro p ria te in fo rm a tio n to th e p a tien t i n obt ai ni ng i nf or m ed cons ent ( t o t he pr oce dur e out of w hi ch pl ai n t i ff ' s cl ai m a l l ege dl y a r os e) i n a cc or danc e w i t h t he

r ec ogni ze d s t anda r d of a cc ept abl e pr of es s i onal pr ac t i ce i n t he pr of es s i on a nd i n t he s pec i al t y, i f any, t hat t he def enda nt p ra c tice s in th e c o m m u n ity in w h ic h th e d e fe n d a n t p ra c tice s a n d in sim ilar c o m m u n iti e s.”

-10- Id. at 65 (e mphasis added)

.
I n Bravo v. S um ner Regional H ealth System s, Inc. , 148 S.W .3d 357, 365 (Tenn. Ct. App. 2003), this Court ex plained that “it is not nece s s ar y fo r the prof fer ed expert to have prac ticed the

same sp e c ia lty

a s th e defe nd ant du ri ngthe y e ar p re c e din g the date of the oc c ur

re nc e ,” bu t “ it i s require d that he pra ctice in a profe ssion or s p ec i al t y

‘which w ould make the pe rson’s expert testimony rele vant to t h e is sues in the ca se’ dur ing the y ear prec eding the occ urre nce.” I n Bravo , the plaintiffs sued a

n obstetrician- g y

necolog ist, alleg ing neg lige nce in the de livery of their ba

by

. Id. at 359. The pla intiffs’ expert was c ertified in obstetric s and in gy necolog y , but he had not pra cticed obstetrics for

many y ear s. Id. I n e xami nin g the ba sis fo r t he e xpe rt ’s kn owled ge, we fo un d it “nec essar y to look bey ond the nomenclature of [the ex pert’s] field of specialty ” bec ause the doctor

was not actually

prac ticing in his field of

specia lty

. Id. at 365. Alt houg h we de scribed it as “ a ver y close issue,” we ultimately conclude d that the expert was competent to te stify as to the standard of

car e re quired of a

n obstetrician be cause he had pr actice d obstetrics i n the past for twenty y ear s, he

re ma ine d li c e ns e d in

that sp e c ia lty , a

nd he ma int a ine d his kn ow le dg e a bo ut the sta

nd ard of c are in obstetri c s thr o u g h te a c h in g c la s s e s a t a u n iv e r s it y an d a tt e n d in g s e mi n ar s an d c o n f e r e n c es on obstetrics. Id. at 367.

I n s um, in tho se c a se s whe re an expe rt ha s a suf fi c ie nt b a sis on

wh ic h to e sta

bli shfa mil iari ty with the defe ndant’s fie ld of prac tice, the ex p ert’s te stimony may be ac cepte d as compe tent proof even thoug h he or she specia liz es or pr actice s in another f ield. See, e .g. , Coy le

v . P rie to , 822 S.W .2d 596, 600 (Tenn . Ct. App. 1991) (finding no abuse of discretion whe re the trial court a llowed a critica l car e specia list and emerg ency room phy sician to testify as to the standar d of ca re f or a patho log ist , w he re the e xpe rt state d that he wa s famil iar wit h the sta nd ard of c are fo r p a tho log ist s and had be en involved in the “w ork-up” of 2 0 0 case s involving the disea se at issue); Ledford v

. Mo sk owi tz , 742 S.W .2d 645, 647-48 (Te nn. Ct. App. 1987) (finding that a n eu ro logist wa s
c omp e te nt t o te sti fy

a s to the sta

nd ard of c are fo r a psy c hiatr ist , w he re the ne ur olo g ist wa s a lso

cer tified and tra ined in psy chiatry ); Sto ke s v . L e ung , 651 S.W .2d 704, 706 (Tenn. Ct. App. 1982) (finding no abuse of discretion where the trial court a llowed a psy chiatrist to testify as to the standar d of care for a phy sician specializi ng in internal medicine and cardiolog y , wher e the psy chiatrist taug ht classes on the standard of car e applica

ble to the def

endant at a medica l school).

Howeve r, o ur Supreme Court ha s rejec ted the ar g ument that an expert ca n satisfy the require ments of Tenne ssee Code Annotated section 29-26-115 by simply testifying a s to a g ener al standard of

car e expected of al l p h y s i cians. In Cardwell v. Bechtol , 724 S.W .2d 739, 749 (Tenn. 1987), the plaintiffs sued an osteopath a lleg ing me dical malpra ctice a nd failure to obtain informed consent prior

to treatment. I n attempting to e stablish the standard of car e, the plaintiffs of fer ed the 5 testimony of an or thopedic spec ialist a

nd a neurolog ist, but bot h witnesses admitted that they wer e-11-

unfamiliar with the pra ctices of osteopaths. Id. a t 75 2. Th e pla int if fs ur g e d th e Sup re me Court to ho ld t hat “ a min imum st and ard

of c are re g ard ingmatte rs of c omm on ob se rv a tio n an d e xpe ri e nc e in the hea ling a

rts can be established by

the expert testimony

o f m edical doctors for a ll professions

cover ed by

the Medica l Malprac tice Ac t.” Id. at 7 5 4

. T h e C o u rt re j ec t ed t h ei r ar gu m en t , ex p l ai n i n g: [A]do pti on

of the Pla int if

fs ’ c on te nti on s c on c e rn ing the g e ne ra l sta nd ard of c are to which medica l doctors could testify is c ontrary to the express provisions of T.C.A. § 29-26-115( b) and would be a signific ant departure from t he case law of this State. The statute wa s enac ted in part to preve nt further erosion of the competenc y require ments for e x pert witnesse s in malpractice actions. The statute and ca ses
c ur re ntl y pe rm it some fu

ng ibi lity of e xpe rt s, bu t whe re an e

x pe rt i s u nfa mi lia r wi th the practiceof another field and wit h its s t a n dard of care or whe re material differ ence s betwee n schools have been shown, we do not thi nk it would be consistent with the terms or the policy of the Medic al Malpra ct ice Ac t to permit the kind of g ener alized evidence as that propose d by Plaintiffs in thi s case

.
Id. at 754-55 (empha sis a dded and citations and quotations omitted). The Court r eiterated that the medical malpr actice statute did not require an expert witness to prac tice in the same specia lty as the defe ndant, but “the witness must be sufficiently familiar with the s tandar d of care of the prof ession or spec ialty

and be a ble to g ive re levant testimony on the issue in question.” Id. at 754.

The Court of Appeals has addressed the issue befor e us sever al t imes as we ll. I n Goodm an v. Phythyon , 803 S.W .2d 697, 698 (Tenn. Ct. App. 1990), a patient sued his ophthalmologist af ter the p ati ent bec ame a g itated and unc ontrollable duringcata rac t surg ery , alleg ing that the ophth a lm o lo g is t n e g li g e n tl y s e le c te d an d u s e d anan e s th e ti c a g e n t. T h e p a ti e n t s u b mi tt e d e xp e rt testimo n y fr o m an an es t h es i o l o gi s twh o m ad e “ gen er al i z eds t at em en t s co n ce rning the deviation fr om the sta nd ard of c are fo r m e dic a l pr a c tic e in g e ne ra l,” bu t he c on c e de d that he wa s n ot f a mil iar w ith the standard of car e for ophthalmologists. Id. at 700. The Court of A ppeals distinguishe d Se ar le , Le dfo rd , and Stokes as ca ses in which “the courts acc epted the te stimony of medica l experts in other fi e lds a s c omp e te nt p ro of

on the sta nd ard of c are [be c a

us e ] the e xpe rt s tes tif

ie d a s to the ir

fa mil iari ty wi th t he de fe nd ant’ s fi e ld of pr a c tic e and the sta nd ard of c are re qu ir e d in de a lin g wi th t he sp e c if ic acts involved on the pa

rt of the de fenda

nt phy sician.” Id. at 702. The Court found that the anesthe siologist’s testimony “did not r ise to this level” a nd aff irmed summary

judgme nt in favor of the ophthalmologist. Id.

Simi larly , in Bro wn v

. Kud sk , No. 02A01-9611 -CV-00291, 1998 WL34190563, at *5 (T e nn . Ct . App . W. S. Jan. 2, 19 98 ), we fo un d th a t an expe rt ’s te sti mony did no t “r ise to t he le ve l” of establishing familiarity with the defe ndant’s field of prac tice and the applica ble standar d of ca

re. The defe ndant was a surg eon, and the e x pert, Dr . Sorenson, was a n endocr inologist. Id. at *4. Dr. Sorenson s tated in her affidavit, “Althoug h I am not a surge on, a patient who is less than 12 hour s p o s t- thy r o id s u r g e r y an d c o mp la in in g o f

c h o k in g an d

in a b il it y to b r e a th e w ar

r an ts c li n ic a l a

nd laboratory

evaluation to rule out post-operative c omp l i cations . . . . The sta ndard of car e wa s definitely i n ad eq u at e

. . . .” Id. at *5. This Court affir med summary

judgme nt in favor of

the-12-

defe ndant beca

use, even though Dr. Sorenson testified as to “ the standard of car e for medic al pr a c tic e in g e ne ra l,” sh e “ fa il[e d] to e sta bli sha ba sis fo r e xpe rt ise in t he fi eld of surg e ry so a s to
overc ome [the defenda

nt’s] m otion for summary judgme nt.” Id.

I n Whit tem ore v. Classen , 808 S.W .2d 447, 455 (Tenn. Ct. App. 1991), a p at i ent s ued a surg eon and r elied on the testimony of a radiolog ist, Dr

. Starnes, to e stablish the standard of car e. T h e C o u rt o f Ap p ea l s co n cl u d ed t h at t h e t es t i m o n y o f D r. S t arn es wa s i m

p ro p er l y ad m i t t ed , s t at i n g:

T.C.A. § 29-26-115( b) does not require that evidenc e as to [the] “recog nized standard of

acc eptable professional practice ” come from a phy sician qualified in the same spec ialty

of m edicine as that in which the alleg ed malpra ctice oc curr ed. Se ar le v. Bryant , T e nn . 1 98 6, 71 3 S. W.2 d 6 2. Ho we ve r, it is requ ir e d th a t th e wi tne ss testify as to his knowledg e of suc h standard. Q ualificatio n i n ra d i o logy does not

ne c e ssa ri ly sh owkn ow le dg e of

the sta nd ard s o f s ur g e ry . T his must be shown by evide nce , and it was not shown in the ca se of Dr . Starnes.

Id. at 456 (e mphasis added)

. As previously

noted, cour

ts have in s tr

u c te d a tt o r n e y s to c o u c h

th e ir medica l experts’ opinions in the lang uag e of Te nnessee Code Annotated se ction 29-26- 115 in order to avoid summary judgme nt problems, but w e also rec og nize that “a mere ritualistic inc antation of statutory buzz words evidenc es ver

y littl e.” Chu rch , 3 9 S. W.3 d at 16 6. Co ns e qu e ntl y , w he n a n e xpe rt ’s op ini on

is challeng ed, cour

ts look to t he substance of the opinion to determine whether it is based on trustworthy

fac ts or data suff

icient to provide some ba sis for the opinion. Kenyon, 122 S.W .3d at 75 9; Chu rch , 39 S.W .3d at 166.

For example, in Carm ichael v. Bridgem an , No. 03A01-9904- CV-00124, 2000 WL124843, at *1-2 (T enn. Ct. App. E.S. J an. 26, 2000), the expert, Dr. B lake, wa s a patholog ist, but he state d in his affidavit that he w as “f amiliar w i t h t h e recog nized standards of a cce ptable prof essional pr a c tic e pe rt a ini ngto t

he pr a c tic e of

fa mil y me dic ine

. . . . ” Nev e rt

he le ss, the Court

of Ap pe a ls

a ff ir me d th e tr ia l c ourt ’s de c isi on to e xclu de Dr

. B la ke ’s te sti mony a ft e r e xami nin g the ba sis of his

o p i n i o n , s t at i n g:

We r e c og nize that an e xpe rt in o ne sp e c ia lty

may , in

a pp ro pr iate
c ir c ums tanc e s, be su ff

ic ie ntl y fa mil iar w iththe sta

nd ard of c are of ano the r s pe c ia lty to r e nd e r h is o r h e r t e sti mony re le va nt t o th e re so lut ion

of an is su e c omm on

to b oth sp e c ia lti e s. We a g re e wi th Carm ic ha e l th a t Se ar le and Stokes are prime examples of this principle. We disag ree , howeve r, wit h Carmichae l’s asser tion that the trial court abused its discre tion in declining to find a commonality

here . We are cog nizant of the fa c t th a t B lake be lie ve s h is e xpe ri e nce as a dia g no sti c c on su lta

nt f or fa mil y pr a c tit ion e rs re nd e rs him fa mil iar wi th the sta

nd ard of c are re qu ir e d o f s uc h f a mil y prac titioners. Howeve r, the c laims a gai n s t the def endants he re a

rise fr om the evaluation and treatment of abdominal complaints. I t seems to us that a patholog ist’s-13-

diag nosis, being ba sed primar ily on the laboratory

examination of body

tiss u e or fluid, is a substantially

more na rrow one than that i n v o l v ed in family medicine. A fa mil y pr a c tit ion e r i s f

a c e d w itha

muc h b ro a de r u

niv e rs e of

po te nti a l f

a c tor s to
c on sid e r i n r e nd e ri nghis or he r d ia g no sis . We fi nd

and ho ld that th e tr ia l c ourt did not abuse its discretion in disa llowing Blake’s testimony as to a family prac titioner’s standard of

car e. Carmichae l also relies on c erta in other ca ses to support her a rg ument that Dr. B l a k e ’ s s t an d ar d

- o f

- c a r e t e s t i m o n y s h o u l d

h a v e b e e na l l o w e d

. S p e c i f i c a l l y, Carm ic ha e l a sse rt s th a t th e c a se s th a t ha ve dis a llo we d an e xpe rt ’s te sti mony did so either be cause the expert admitted unfamiliarit y w it h th e a p p r opriate standa

rd of c are , see Cardwell v. Be chtol , 724 S.W .2d 739, 752 (Tenn. 1987) (experts in orthopedics

and ne ur olo g y a dmi tte d unf a mil iari ty wi th s tand ard

of c are of os te op a ths ); Goodman v. Phy thyon , 803 S.W .2d 697, 700 (Tenn. Ct. App. 1990) (a nesthesiolog ist admitt ed

un fa mil iari ty wi th t he sta nd ard of c are re qu ir e d in

op hth a lmo log y

); Johnson v. Lawrence , 720 S.W .2d 50, 54 (T en n. Ct. App. 1986) (a ne urolog ist and a surg eon/family

prac titioner admitted unfamiliarity with standard of car e re quired of chirop ra ct ors), or be cause the expert’s own testimony clea rly indicated a

n unfamiliarity

with the appropr iate standa rd of c are , see Mabon v. J ackson- Madison County Gen. Hosp. , 968 S.W .2d 826, 830 (Tenn. Ct. App. 1997) (expert’s testimony

reve aled his be lief that standard of car e was premised on a national standard of car e
and tha t he ha d n o k

no wl e dg e of

the re le va

nt c omm un ity ); Ay e rs v . R uth e rfo rd Hosp., Inc. , 6 89 S.W. 2d

15 5, 16 3 (T e nn

. Ct. Ap p. 19 84 ) (e xpe rt ’s te sti mony c le arl y
reve aled that he had no knowledg e of the rele vant community). Carmicha el ar g ues that beca use B lake a ffirmatively

profe ssed a f

amiliarity with the applica ble standar d of ca re, a nd beca use hi s testimony does not clea rly indicate other

wise, the trial c ourt
s h o u l d h a v e a l l o w e d

h i s t e s t i m o n y. We f ind no thi ngin t

he c a se s su g g e sti ng that an e xpe rt wi tne ss m

us t di sc re dit himself befor e the tria l co u rt may disallow his testim ony . Fur thermore , we f

ind no support for the pr oposition t hat a witness’ statement that he or she is familiar with the standard of ca re , ipso facto, r ender s that testimony rele vant and a dmissibl e. Ac c or din g ly , w e fi nd

Carm ic ha e l’ s a

rgume nts to b e wi tho ut m e ri t.

Id. at *3-4. See also, e .g. , Lockard v. Bratton , No. W2007-02820-COA-R3-CV, 2009 WL 275783, at *8-9 (Tenn. C t. App. Fe b. 4, 2009) perm. app. pe nding (finding no abuse of

discretion whe n the trial court e x cluded testim ony from a g y necolog ist who s tated that he was familiar with the standa rd of ca re of a surg eon simply

beca use the surg eon wa s “basica lly providing g y

necolog y service s”); Jo hnso n v

. P ra tt , No. W2003-02110-COA-R3-CV, 2005 WL 1364636, at *9 (Tenn. Ct. App. Jun. 9, 2005) (stating that a ra diologist ’s “b ro ad st atement that he is ‘familiar with the standa rd of pr of e ssi on a l pr a c tic e e xpe c te d o f an or tho pe dic surg e on ’ i s n ot, in i tse lf , s uf fi c ie nt t o q

ua lif y him to testify in this area” ).
Finally , in a

case simil ar to the one befor e us, W a t e r ma n v . D a mp , No. M2005-01265-COAR3-CV, 2006 WL 2872432, at *9 (Te nn. Ct. App. 2006), the Court of Appea ls found no basis for-14-

two phy sicians’ stateme nts that they wer e familiar with the standard of car e applica

ble to emer g ency
ro om p hy sic ians . T he fi rs t e xpe rt , D r. Chi lds , w a s a n o rt ho pa e dic surgeon , bu t he state d in his aff idavit that he was “ familiar with the standa rd o f ac cepta ble profe ssional prac tice of phy sicians prac ticing in e merg ency

depar tments treating orthop ae d i c i n j u ries . . . by

virtue of r ece iving numerous patients on ref

err al from emer g ency depar tment phy sicians . . . .” Id. The Court found the te sti mony

of Dr . Ch ild s in a dmi ssi ble be c a us e his a ff

ida vit really on ly de mon str a te d h is familiarity

with the standard of

car e applica

ble to orthopedists. Id. at *9. The se cond ex pert, Dr

. Easter ling, a lso claimed fa miliarity with the standard of

car e for emer g ency

room ph y s i ci ans, but during h er d i s cover

y deposition, Dr. Easter ling testified that she had not worke d in an emer g ency room in a similar comm unity for more than ten y ear s. Id. at *5. The Court found that Dr. E as terling ’s deposition testimony “[made] clear

her ina bility to assist in t he dete rmination of the appropr iate standa

rd of c are fo r an eme rg ency room doctor,” as it showed “no r eal ba sis for her statements about the a

p propriate standard in a

ny emer g ency

room due to her

remote e merg ency

room experience .” Id. at *9.

Kee ping a ll these principles in mind, we now turn to an e x amination of the issues pre sented in this case.

B. D r. Pi pe r a nd P

e dia tricEmerg

e nc y Spe c ial ist s, P. C.
Dr. Piper a

nd Pediatric Emer g ency Specialists, P.C., filed a motion for summar y judgme nt supported by

Dr. Piper’ s own aff

idavit, in which he st ated that he was a board c ertified pe diatrician prac ticing in the f

ield of pediatric eme rg ency medicine f

or more tha

n one y ear

prior to the date of Shantel’s treatment. Dr. Piper also stated that he was f amiliar with the standar d of pr ofessional prac tice expected of

a pediatric ian prac ticing in a n emer g ency depar

tment in Me mphis and Shelby County , and he stated that his car e and tr eatment of Shantel complied in all respe cts with such standards. I n their sum mary judgme nt motion, Dr. Pi per a nd Pediatric Emer g ency

Specialists, P.C ., argued that P laintiffs wer e unable to support their alleg ations of neg lige nce w ith competent expert testimony as re quired by

Tenne ssee Code A nnotated sec tion 29-26-115.

I n response , Plaintiffs submitted the aff idavit of Dr. Ma

rks, which state d that Dr. Mar ks was “fa miliar w i t h the ac cepta

ble standar d of prof

essional pra ctice of

phy sicians pra cticing in the

emer g ency

depar tment in co m munities such as Hoover , Alabama and B irmingha

m, Alabama f

or patients with allerg ic re actions to anti b i o t i cs and sy mptoms such as those prese nted by Shantel . . . .” Howe ver, dur ing his d i s co v ery deposition, Dr. Marks te stified that he had not wor ked in an

emer g ency

room since a

rotation during his residenc y , which ended in 1983, some twenty y ear s prior to t he date of Sha

nte l’ s tre a tme nt. Dr . Mar ks a lso te sti fi e d that he ha d not r e c e ive d a ny tr a ini ngin pediatric s since medica l sc hool. Dr. Marks descr ibed his c linical prac tice in A labama be tween 2002 and 2004 as “part-time m edicine,” in which he saw patients at a local clinic one day per w eek a nd when a nother phy sician wa s on vacation. Dr. Marks conce ded that he did not hold him self out as an expert in either e merg ency medicine or pediatric s, and he admitted that he did not “hold [him self]

ou t a s c omp e te nt t o te sti fy a bo ut t he sta nd ard of c are of an eme rg e nc y

ro om p hy sic ian in B ir min g ham.” Ho we ve r, he ins ist e d th a t “ the sta nd ard of c are is u

niv e rs a l” fo r “ a ll s pe c ia lis ts” a ll-15-

acr oss the country

. Dr. P iper and Pediatric Emer g ency Specialists, P.C ., then re newe d their motion fo r s umm ary

jud g me nt, ma int a ini ngthat Pla int if fs fa ile d to pre se nt c omp e te nt e xpe rt te sti mony

to
su pp or t th e a lle g a tio ns in t

he ir c omp la int

.
Ha vin g re vie we d D r. Mark s’ te sti mony in i ts e ntir e ty , a

nd vie wi ngit i n th e lig ht m os t favor able to Plaintiffs, we f ind no basis for his claimed familiarity with the applica ble standar d of

car e for phy sicians pra cticing in an emerg ency room. Althoug h Dr. Mar ks claimed that the standa rd of care fo r t reating Shante l’s “noneme rg ent” sy mptoms was “universa l” for “ all specia lists,” including e merg ency

room phy sicians, he failed to demonstrate a ny basis for knowingthe standar d of care of emer g ency

room phy sicians. As the Court explained in Carm ichael , 2000 WL 124843, at *3-4, the f

act that a n expert witness states that he or she is f amiliar with the applicable standard of c are do e s n ot, ips o f

a c to, re nd e r t

he te sti mony

a dmi ssi ble . D r. Mark s’ te sti mony wa s si mil ar t o that offe red a

nd excluded in Goodm an , 803 S.W .2d at 698, and Bro wn , 1998 WL 34190563, at *5, reg arding“the standa

rd of c are for medic al pra ctice in g ener al.” I n Cardwe ll , 724 S.W .2d at 754-55, th e C o u rt re

jected the notion that an expert from any medical pr ofession ca

n testify “re g arding matters of common observa tion and ex perie nce” and concluded that “whe re a n expert is unfamiliar with the prac tice of a

nother fie ld and with its standard of c are ,” it would be incon s i s t en t wi th the terms and policy

of the Medic al Malpra ctice A ct to permit such g ener alized evidence

.
There fore , we f

ind that the trial court did not abuse its discretion in concluding that Dr. Marks did not meet the qualifications set forth in T ennesse e Code Annotated section 2 9-26-115. When Dr. Piper submitted his affidavit stating that he complied with t h e ap p licable standa rd of pr o f e s s io n a l p r a c ti c e , h e a f

f ir mati v e ly n e g a te d a

n e s s e n ti a l e le me n t o f Pl a in ti f f s ’ c la im

. As such, the burde n shifted to Plaintiffs to “produce evidenc e of spe cific f acts e stablishing that g enuine issues of mater ial fac t exi st.” Ma rti n , 271 S.W .3d at 83. We find that Plaintiffs did not meet their burden by submitt ing the opinion of Dr. Mar ks. There fore , the trial cour t properly

g rante d summary jud g me nt t o D r. Pip e r a

nd Pe dia tr ic Em e rg e nc y

Spe c ia lis ts, P.C.

C. Dr. Ru stom

Dr. Rustom testified at her de position t hat althoug h she beca me cer tified in inter

nal medicine in 1999, she had never prac ticed internal medicine and had pra cticed only emer g ency

medicine since 1 9 9 8

. After

Dr. Mar ks’ discover

y deposition was taken, D r. Rustom filed a motion for summary judgme nt a sserting that “the plaintiff[s’] only expert, Dr. Dona ld Marks, does not cr eate a g enuine iss ue of mate ri a l f

a c t be c a us e Dr . M ark s is un fa

mil iar w iththe sta

nd a rd of c a re of me dic ine wi thi n the def endant’ s specialty of emer g ency room medicine

. . . .” Dr. Rustom filed the deposition of Dr. Marks a nd argued that his deposition testimony clea rly demonstrated that he was unable to testi fy reg ardingthe standar d of car e for an emer g ency room phy sician. Dr. Rustom also pointed out that pursuant to the court’s scheduling order , the deadline for Pl aintiffs t o identify experts had passed, and Plaintiffs had not identified a ny other medic al expert.-16-

On appe al, Plaintiffs argue that because Dr. Rustom did not file her own a ffidavit stating that she complied with the a

pplicable standa

rd of pr ofessional pra ctice, the burden ne ver shifte d to them to pr oduce expert testimony in support of their cla im. W e disag ree . I t is true that defe ndants filing

a mot ion fo r sum mary jud g me nt in med ic a l malp ra c tic e a c tio ns g e ne ra lly su pp or t th e ir mot ion wi th their own a ffidavits stating that, in their opinion, their actions did not violate the applica ble standar d of prof essional pra ctice. See Hessm er , 1 38 S.W. 3d a t 24 4. “ Af

fi davit s of t

his so rt e ff e c tiv e ly ne g a te the allegations of neglig ence in the pl aintiff’s complaint and force the plaintiff to demonstrate the exis tence of a g enuine, mate rial fa ctual dispute that wa rra nts a trial.” Id. Ho we ve r, a pa rt y a g a ins t whom a cla im is asserted may move for summary judgme nt “with or without supporting af fidavits.” Tenn. R. Civ. P. 56.02. A par ty moving f or summary judgme nt may shift the burden of

production to the nonmoving pa

rty by either: “ (1) a ffirmatively neg ating an essential element of the nonmoving party ’s claim; or (2) showing t h at t h e nonmoving party cannot pr ove an e ssential element of the claim at trial.” Ma rti

n , 271 S.W .3d at 83. The movingparty cannot simpl y

asser t that the nonmoving party has no evidenc e or insufficient evidenc e. Id. a t 83- 84

. Ra the r, “ [t]he mov ingpa rt y must either produc e evide nce or ref er to e vidence previously submitt ed by the nonmoving party that

ne g a te s a ne s s e n t i a l e l e m e n to f t h e n o n m o v i n g p art y ’ s c l a i m o r s h o w s t h a tt h e n o n m o v i n g p art y cannot pr ove an e ssential element of the claim at t ri al.” Id. at 84. “Summary judgme nt may

be

a pp ro pr iate fo r t

he mov ingpa

rt y wh o r e lie s u

po n e vid e nc e fr om t

he no nmo vi ng party , b ut o nly if that evidenc e af

firmatively

neg ates a n essential ele ment of the nonmoving party ’s claim or shows that the nonmoving pa

rty cannot pr ove an e ssential element of the claim at tria l.” Hann an v. Allt el Publ’g Co. , 270 S.W .3d 1, 10 (Tenn. 2008)

.
Her e , in s u p p o rt o f h e r mo ti o nf o r s u mm ar y ju d g me n t, D r

. Ru s to m f il e d th e discovery deposition of Dr. Marks and point ed to his testimony that he had not worke d in an eme rg ency room since 1983 a

nd did not consider himself an expert in emerg ency medicine. B eca

use Plaintiffs had alre ady identified Dr. Ma

rks as their only

medical e x pert, this e vidence demonstrated that Plaintiffs

co u l d n o t p ro ve an e ssential element of their cla im at trial, i.e., “[t] he re cog nized standard of

acc eptable pr ofessional pra ctice in the profe ssion a nd the specia lty there of, if any , that the def endant prac tices . . . .” Tenn. Cod e Ann. § 29-26-115(a) (1) ( Sup p. 2008). I n oth e r wo rd s, Pla int if fs ’ o nly expert was not “su ff

i ci en t l y familiar with the standa

rd of c are of the [defe ndant’s] profession or

s p ec i al ty .” See Cardwe ll , 7 2 4 S. W. 2 d a t 7 5 4

. T h e b u r d e nth e ns h if te d to Pl a in ti f

f s to produce evidenc e of spe cific f

acts e stablishing that g enuine issues of mater ial fac t exi sted. See Ma rti n , 271 S

. W

. 3 d a t8 3

. P l a i n t i f

f s c o u l d s a t i s f y t h e i r b u r d e n o f p r o d u c t i o nb y: (1) pointing to e vidence establishing materia l f actua l disputes that wer e over -looked or ig nored by

the moving pa

rty ; (2) re habi l i tating the evidenc e attac ked by the

m o v ing pa

rty ; (3) produc ing a dditional evidence establishing the exis tence of a genuine issue for trial; or (4) submitt ing a n aff idavit expl aining the nec essity for further discovery

pursuant to Tenn. R. Civ. P., Rul e 56.06.

Id. at 84.I n H annan v. Al l t el Publ ’ g Co. , 27 0 S. W

. 3d 1, 19

- 20 ( T enn. 200 8), J ust i ce K och, i n hi s di s s ent , w ar ned t hat 6

t h e su m m ary j u d g m en t an aly si s set fo rth b y t h e m ajo rit y w o u l d h av e sig n i fican t effe cts o n m ed i ca l m alp rac t i ce ca ses:

W hat pra ct i cal eff ect w i l l t hi s d eci s i on h ave o n l i t i gat i on i n T enness ee’ s co urt s ? T he ans w er i s t hat i t s effect s w i l l b e si g n i fi can t an d far- reach i n g

. It w i l l p rov i d e an o t h er s afe ha rbo r f o r t h o se w h o are
u n p repa red. In cases i n w h i ch ex p ert ev i d e n c e is n e c e ssa ry t o pro v e an ess en t i al el em en t of a pl ai nt i f f ' s c l ai m , s uch as m ed i cal m al pr ac t i ce c as es , de f enda nt s w i l l no l onger be e nt i t l ed t o a
s um m ar y j ud gm ent w hen t he y d em o n s t r at e t hat t he pl ai nt i f f ’ s expert i s not qual i f i ed t o re nd er an opi ni on. Suc ce s s ful l y cha l l engi ng a pa r t i cul ar e xper t ’ s qua l i f i ca t i ons doe s not de m ons t r at e t hat t he pl ai nt i f f c annot pr ove an es s ent i al e l em ent of i t s c as e. I t s i m pl y de m ons t r at es t hat t he pl ai nt i f f c annot

es t abl i s h an es s ent i al el em ent of i t s ca s e w i t h t h a t ex p ert

. T h u s, r a th e r th a n th e litig a tio n e n d in g w ith t he di s qu al i f i cat i o n of t he expert , i t w i l l cont i nu e w hi l e t he pl ai nt i f f at t em pt s t o fi nd yet anot her expert

. D et er m i ni ng how m any c hances a pl ai nt i f f m ust be gi ven t o f i nd a qu al i f i ed expert befor e a
ca s e ca n be di s m i s s ed r em ai ns a n ope n que s t i on.
( f oo t no t es om i t t ed). I n t hi s ca s e, how ever , w hen D r

. R ust om dem on s t r at ed t hat Pl ai nt i f f s coul d no t es t abl i s h an es s ent i al el em ent of t hei r ca s e w i t h t he t es t i m on y of D r

. M ar ks, s he al s o dem on s t r at ed t hat Pl ai nt i f f s coul d no t prove an es s ent i al

e le m e n t o f t h e ir c la im a t tria l b e c a u se D r. M a rk s w a s th e o n ly m e d ic a l ex p e rt id e n tified b y P la in tiffs in a c c o rd a n c e w ith t h e d ea d l i n es im p o sed b y t h e tri al co u rt’s sch ed u l i n g o rd ers.
-17- I n r e sp on se to D r. Rus tom ’s mot ion for su mmar y jud g me nt, Pla int if

fs fi le d a re sp on se pointing to Dr. Marks’ affidavit in which he stated that he w as familiar with the standard of car e for

emer g ency

room phy sicians, and they also pointed to Dr. Mark s ’ d eposition testimony wher e he stated that he w as familiar with the standard of car e for any phy sician in any

specia lty treating a

n adolesc ent patient with a f ever , backa che, and headache

. For the reasons discussed in the pre vious section, Dr. Ma

rks’ re citation of statutory “buzzwords” and hi s conclusory statement that he w as familiar with the a

ppli ca ble standar d of ca

re did not, alone , satisfy

the re quirements of Te nnessee Code Annotated se ction 29-26-115. Courts look to the substance of an expert’s opinion to determine whether it is based on trustworthy

fac ts or data sufficie nt to provide a basis for the opinion. Ke ny on, 12 2 S. W.3 d at 75 9; Chu rch , 39 S.W .3d at 166.
Plaintiffs also argued in the ir response to the motion for summary judgme nt that D r. Mar ks was qua lified to testify

as t o the standar d of ca

re a pplicable to Dr . Rustom because both phy sicians held board cer

tifications in inter

nal medicine. Howeve r, as in Bravo , 148 S.W .3d at 365, we be lieve that in thi s ca se it is “ ne c e ssa

ry to l oo k b e y on d th e no me nc latur e of [the ] fi e ld o f s pe c ia lty” be c a us e Dr . Ru sto m w a s n ot a c tua lly pr a c tic ingin h e r f

ie ld o f s pe c ia lty . D r. Rus tom te sti fi e d th a t sh e did not pr actice internal medicine and that she had prac ticed emer g ency medicine excl u s i v el y since 1998. Dr. Marks testified t hat hi s part-time medical practice betwee n 2002 and 2004 was limited to a g ener al clinical se tting, one da y per w eek.

I n sum, we conc lude that the trial c ourt did not abuse its discretion in finding that Dr. Mar ks was not compe tent to testify , and without expert proof a s to the applicable standard of profe ssional pr a c tic e , w e fi nd

that Pla int if

fs fa ile d to e sta

bli sha g e nu ine iss ue o f m a te ri a l f a c t in or de r t o
ov e rc ome Dr . Ru sto m’ s mo tio n f or summa ry jud g me nt. 6 V. C ONCL US I ON-18-

F or the a fo re me nti on ed reas on s, we a ff ir m th e de c isi on

of the c ir c uit

c ourt . Co sts of

thi s
a p p e a l ar e t a x e d

t o t h e a p p e l l an t s , T o m m y M c D an i e l an d W i l l i e M a e M c D an i e l , an d t h e i r s u r e t y, f o r 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 ANE. HI GH ERS , P. J. , W .S.