FILED

July 2, 1997

Cecil Crowson, Jr.

Appellate Court Clerk

I N THE COURT OF APPEALS OF TENNESSEE

EASTERN SECTI ON

SANDRA J . SCOTT ) ANDERSON COUNTY

) 03A01- 9608- CV- 00270

Pl a i ntif f - Appe lla nt )

)

)

v. ) HON. J AMES B. SCOTT, J R. ,

 ) J UDGE

) 

DR. GERALD B. CALI A )

)

De f e nda nt - Appe l l ee ) VACATED AND REMANDED

KENNETH K. KENNEDY OF KNOXVI LLE FOR APPELLANT

MARTI N L. ELLI S a nd VONDA M. LAUGHLI N OF KNOXVI LLE FOR APPELLEE

 O P I N I O N

 Godda r d, P. J .

Thi s me di cal ma l pr act i ce s ui t ar i s e s out of s ur ge r y

pe r f or me d on Sa ndr a Sc ot t ’ s f e e t by Dr . Ge r a l d Ca l i a on Ma y 17,

1989. Ms . Sc ot t c ont e nds t ha t Dr . Ca l i a wa s ne gl i ge nt i n hi s

me di cal car e of he r . She i ns i s t s on appeal t ha t t he Tr i a l Cour t

wa s i n er r or i n di r ect i ng a ve r di c t aga i ns t he r at t he cl os e of

he r pr oof . 
2

Ms . Sc ot t r a i s e s t he f ol l owi ng t wo i s s ue s on a ppe a l :

I . Di d the tr i a l c our t e r r in e xc l udi ng the te s timony

of Dr . Ma r i on C. Ha r pe r on t he i s s ue s of c a us a t i on

unde r t he r e qui r e me nt s of § 29- 26- 115, Te nn. Code Ann. ,

1996?

I I . Wa s t he t r i a l c our t ’ s s ua s pont e gr a nt of di r e c t e d

ve r di c t pr ope r unde r Te nne s s e e Rul e s of Ci vi l Pr oc e dur e

50. 01?

I n Apr i l 1989 Ms . Sc ot t s ought t r e a t me nt f r om Dr .

Ca lia , a podi a t r i s t, to c or r e c t a va r i e t y of a ilme nt s a f f lic ting

he r f eet . Ms . Sc ot t agr eed t o ha ve Dr . Ca l i a pe r f or m s ur ge r y on

he r f eet . Dr . Ca l i a pe r f or me d f i ve s e pa r a t e s ur gi cal pr ocedur e s

on e a c h of Ms . Sc ott’ s f e e t. Ms . Sc ott c ontinue d to vi s it Dr .

Ca l i a f or pos t - ope r a t i ve e va l ua t i ons . De s pi t e f ol l owi ng Dr .

Ca l i a ’ s i ns t r uc t i ons f or t he c a r e of he r s ur gi c a l wounds t ha t

r e ma i ne d a f t e r t he s ur ge r y, t he s ur gi c a l wound on he r r i ght gr e a t

t oe f a i l e d to he a l. 

Ei ght mont hs a f t e r he r s ur ge r y, Ms . Sc ot t s ought t he

opi ni on of Dr . Ma r i on C. Ha r pe r , a n or t hope di s t a s s oc i a t e d wi t h

Va nde r bi l t Hos pi t a l i n Na s hvi l l e , Te nne s s e e . Dr . Ha r pe r

pe r f or me d a s e c ond s ur ge r y i n Fe br ua r y 1990 t o c omba t a n

i nf e c t i on t ha t ha d i nva de d t he bone of Ms . Sc ot t ’ s gr e a t r i ght

t oe . Dr . Ha r pe r a l s o l a t e r pe r f or me d a t hi r d s ur ge r y t o c l os e

t he wound on Ms . Sc ot t ’ s gr e a t r i ght t oe t ha t ha d be e n ope n s i nc e

t he Ma y 1989 s ur ge r y pe r f or me d by Dr . Ca l i a .
3

The r e qui r e me nt s necess a r y f or a pl a i nt i f f t o es t a bl i s h

a pr i ma f aci e case of me di cal ma l pr act i ce i s s e t out i n T. C. A.

29- 26- 115. We quot e t he pe r t i ne nt pr ovi s i ons a s f ol l ows :

29- 26- 115. Cl ai mant ' s bur de n i n mal pr ac t i c e

ac t i on -- Expe r t te s t i mony -- Pr e s umpt i on of ne gl i ge nc e

-- Jur y i ns t r uc t i ons . - - ( a ) I n a ma l pr act i ce act i on,

t he c l a i ma nt s ha l l ha ve t he bur de n of pr ovi ng by

e vi de nc e a s pr ovi de d by s ubs e c t i on ( b) :

( 1) The r ecogni zed s t a nda r d of accept a bl e

pr of e s s i ona l pr a c t i c e i n t he pr of e s s i on a nd t he

s peci a l t y t he r e of , i f any, t ha t t he de f e nda nt pr act i ces

i n t he c ommuni t y i n whi c h he pr a c t i c e s or i n a s i mi l a r

c ommuni t y a t t he t i me t he a l l e ge d i nj ur y or wr ongf ul

act i on occur r e d;

( 2) Tha t t he de f e nda nt a c t e d wi t h l e s s t ha n or

f a i l e d t o act wi t h or di na r y and r eas ona bl e car e i n

a c c or da nc e wi t h s uc h s t a nda r d; a nd 

( 3) As a pr oxi ma t e r e s ul t of t he de f e nda nt ’ s

ne glige nt a c t or omi s s i on, the pl a i ntif f s uf f e r e d

i nj ur i e s whi c h woul d not ot he r wi s e ha ve oc c ur r e d.

To s a tis f y the s t a t ut or y r e qui r e me nt s , Ms . Sc ott ha d

Dr . I va n Coope r , a podi a t r i s t s ur ge on f r om Ea s t Te nne s s e e ,

t e s tif y a t tr i a l. Dr . Coope r te s tif i e d tha t Dr . Ca lia br e a c he d

t he s t a nda r d of c a r e f or podi a t r i s t s . Fi r s t , Dr . Coope r

t e s t i f i e d t ha t he br e a c he d t he s t a nda r d of c a r e by pe r f or mi ng t oo

ma ny s ur gi c a l pr oc e dur e s dur i ng one ope r a t i on. Se c ond, Dr .

Coope r t e s t i f i e d t ha t he br e a c he d t he s t a nda r d of c a r e by not

t a ki ng a c ul t ur e t o de t e r mi ne i f a n i nf e c t i on wa s pr e s e nt i n t he

ope n wound. Fi na l l y, Dr . Coope r t e s t i f i e d t ha t he br e a c he d t he

s t a nda r d of c a r e by not pe r f or mi ng a s e c ond s ur ge r y t o c ove r a n

e xpos e d wound. Howe ve r , Dr . Coope r t e s t i f i e d t ha t he ha d onl y

s e e n Ms . Sc ot t on t wo oc c a s i ons a nd wa s not i n a pos i t i on t o
4

t e s t i f y a bout a ny da ma ge s t ha t ma y ha ve r e s ul t e d f r om Dr . Ca l i a ' s

ne gl i ge nc e .

The pa r t i e s do not di s put e t ha t Dr . Coope r ’ s t e s t i mony

s a t i s f i e d t he s t a nda r d of c a r e r e qui r e me nt s s e t out i n T. C. A. 29-

26- 115( 1) a nd ( 2) , but t ha t hi s t e s t i mony di d not s a t i s f y t he

c a us a t i on r e qui r e me nt s e t out i n T. C. A. 29- 26- 115( 3) . Ms . Sc ot t

a ttempt e d to s a tis f y thi s s t a t ut or y r e qui r e me nt with the

t e s t i mony of Dr . Ma r i on Ha r pe r who, as s t a t e d ear l i e r , became Ms .

Sc ott’ s tr e a ting phys i c i a n. Dr . Ca lia ma de a motion in limi ne to

e xc l ude any r e f e r e nce t o caus a t i on as i t r e l a t e s t o any al l e ge d

de vi a t i on on t he pa r t of Dr . Ca l i a becaus e Dr . Ha r pe r r eadi l y

a dmi t t e d t ha t he l a c ke d a ny knowl e dge c onc e r ni ng t he r e c ogni z e d

s t a nda r d of accept a bl e , pr of e s s i ona l pr act i ce i n t he pr of e s s i on

a nd s pe c i a l t y of podi a t r y. The Tr i a l Cour t gr a nt e d Dr . Ca l i a ’ s

mot i on i n l i mi ne a s t o s ome of Dr . Ha r pe r ' s t e s t i mony be c a us e he

wa s unf a milia r with the s t a nda r d of c a r e . Ms . Sc ott ins i s t s tha t

s he c oul d ha ve s a t i s f i e d t he c a us a t i on r e qui r e me nt t hr ough t he

de pos i t i on t e s t i mony of Dr . Ha r pe r .

Cont r a r y t o t he hol di ng of t he Tr i a l Cour t , a pl a i nt i f f

i n a me di cal ma l pr act i ce s ui t ma y s a t i s f y t he caus a t i on

r e qui r e me nt f ound i n T. C. A. 29- 26- 115( 3) wi t h t e s t i mony f r om a

doc t or unf a mi l i a r wi t h t he s t a nda r d of c a r e . For e xa mpl e , a

doc t or , who i s unf a mi l i a r wi t h t he s t a nda r d of c a r e , ma y

ne ve r t he l e s s t e s t i f y t ha t a s peci f i c act of t he de f e nda nt , s uc h

a s pr e s c r i bi ng a c e r t a i n dr ug t o whi c h t he pl a i nt i f f i s a l l e r gi c ,
5

c a us e d t he pl a i nt i f f t o s uf f e r i nj ur i e s whi c h woul d not ha ve

oc c ur r e d i f t he pl a i nt i f f ha d not t a ke n t he dr ug. Thus , we mus t

r e vi e w t he de pos i t i on t e s t i mony of Dr . Ha r pe r t o de t e r mi ne

whe t he r t he Tr i a l Cour t pr ope r l y gr a nt e d a di r e c t e d ve r di c t f or

Dr . Ca l i a . 

Upon c ons i de r a t i on of a mot i on f or di r e c t e d ve r di c t ,

t he tr i a l c our t mus t look to a ll the e vi de nc e , ta ke the mos t

l e gi t i ma t e vi e w of i t i n f a vor of t he oppone nt of t he mot i on, a nd

a l l ow a l l r e a s ona bl e i nf e r e nc e s f r om i t i n hi s f a vor a nd di s c a r d

a l l c ount e r va i l i ng e vi de nc e . A di r e c t e d ve r di c t i s onl y pr ope r

whe n t he r e i s no c ont r ove r s y a s t o a ny ma t e r i a l f a c t t ha t woul d

be de t e r mi na t i ve of t he case. See Cr os s lin v. Al s up, 594 S. W. 2d

379 ( Te nn. 1980) . Whe r e t he pr of f e r e d e vi de nc e l e a ve s t o

s pe c ul a tion a de t e r mi na tive f a c t in a la ws uit, the pa r t y ha vi ng

t he bur de n of pr ovi ng t he f a c t mus t s uf f e r t he l os s . Le ona r d v.

Gilr e a t h, 625 S. W. 2d 722 ( Te nn. App. 1981) , c i t i ng Re s e r ve Li f e

I ns ur a nc e Co. v. Whi t t e mor e , 59 Te nn. App. 495, 442 S. W. 2d 266

( 1969) . A c a s e doe s not ha ve t o be s ubmi t t e d t o a j ur y whe r e t he

pl a i nt i f f ’ s ve r di c t woul d be ba s e d on s pe c ul a t i on, c onj e c t ur e , or

a me r e gl i mme r of evi de nce. Sa de k v. Na s hvi l l e Re c yc l i ng Co. ,

751 S. W. 2d 428 ( Te nn. App. 1988) .

Dur i ng di r e c t e xa mi na t i on of Dr . Ha r pe r i n hi s

de pos ition the f ollowi ng te s timony wa s e lic ite d:

Q Doc t or , ha ve you f or me d a n opi ni on ba s e d upon a

r eas ona bl e de gr ee of me di cal cer t a i nt y as t o whe t he r or
6

not t ha t di a gnos i s of c hr oni c os t e omye l i t i s [ i nf e c t i on

of t he bone ] wa s c a us a l l y r e l a t e d t o t he s ur ge r y

pe r f or me d by Dr . Ca l i a on 5- 17- 89?

. . . .

A Ye s , I be l i e ve i t wa s r e l a t e d.

. . . .

Q Oka y. Wha t a bout t he gr e a t r i ght t oe , Doc t or ?

Wha t di d i t l ook l i ke pr i or t o s ur ge r y - - c or r e c t i ve

s ur ge r y by you?

A I t a s s ume d a pos ition of e xt e ns i on, i. e . , it wa s

t e ndi ng t o c oc k up a nd a l s o de vi a t e t owa r d t he mi d

l i ne , t owa r d t he mi d por t i on of t he body.

Q I s t ha t nor ma l ?

A No.

Q Wha t wa s the c a us e of tha t, pl e a s e , Doc t or , withi n

a r eas ona bl e de gr ee of me di cal cer t a i nt y?

A The pr i or s ur ge r y.

. . . .

Q Oka y. On 2- 5- 90, Doc t or , t he f i r s t t i me you

pe r f or me d a de br i de me nt or de br i de me nt on he r , we r e

t he r e a ny ki nd of pa t hol ogy r e por t s a t t ha t t i me ?

A Ye s .

Q Wha t di d t he y r e veal , pl eas e ?

A The s ur gi c a l pa t hol ogy not e da t e d 2- 5- 90, or

r e f e r r i ng t o t he s pe c i me n obt a i ne d on 2- 5- 90, i s r e a d

out a s f i na l di a gnos i s be i ng bone de br i de me nt of r i ght

gr e a t toe , c ol on, foc a l a c ut e inf l amma tion c ompa tibl e

with os t e omye litis , g r a m- pos itive c oc c i pr e s e nt .

Q Oka y. Doc t or , a ga i n, ba s e d upon a r e a s ona bl e

de gr e e of me di c a l c e r t a i nt y, ha ve you f or me d a n opi ni on

a s t o t he e t i ol ogy or c a us e of t ha t pa t hol ogy r e por t ?

. . . .

A Ye s .

Q Oka y. And wha t is tha t, pl e a s e , Doc t or ?
1 A p o r t i o n o f Dr . Ha r p e r ' s answe r was excl u d e d . Hi s f u l l an s we r

wa s " Th a t t h a t i n f e c t i on wa s a c o mp l i c a t i on of her pr i o r s u r g e r y . "

7

A Pr i or s ur ge r y.

1

I n l i ght of t he f or e goi ng we c onc l ude t he r e wa s

s uf f i c i e nt e vi de nc e pr e s e nt e d a s t o c a us a t i on t o pr e c l ude t he

Tr i a l Cour t di r e c ting a ve r di c t .

Mor e ove r , a l t hough c ouns e l f or Ms . Sc ot t s e e me d t o

c onc e de Dr . Coope r ' s t e s t i mony di d not me e t t he c a us a t i on

r e qui r e me nt, we be lie ve it di d:

Q Al l r i ght . Le t ' s go on, Doc t or . You ke e p

t a l ki ng a bout i nf e c t i on, a nd t he f a i l ur e t o r e c ogni z e

t ha t inf e c tion wa s ne glige nc e , tha t you' r e f a milia r

wi t h t he s t a nda r d of c a r e pr a c t i c e d i n podi a t r i c s i n

Knox Count y, a nd t ha t t he de vi a t i on c a us e d s ome da ma ge .

I don' t s e e a nywhe r e i n t he r e Doc t or , t ha t you

c r i t i c i z e d Dr . Ca l i a a bout t he type , or the numbe r , of

pr oc e dur e s he pe r f or me d on Ms . Sc ot t ; ha ve I r e a d i t

c or r ect l y?

A I gue s s , it -- the bottom line is he di d too

muc h i n one a r e a .

Q And I don' t s e e t ha t a nywhe r e i n t hi s

a f f i da vit.

A Ye a h. But t ha t ' s wha t ha ppe ne d. I me a n, I

know you' r e t a l ki ng f r om t he wor ds a nd t hi ngs now - -

j us t - - t ha t ' s wha t we nt wr ong. I f he ha dn' t done s o

muc h i n t ha t one a r e a , t he n t he i nf e c t i on woul dn' t ha ve

ha d a c ha nc e t o s t a r t be c a us e t he he a l i ng woul dn' t ha ve

be e n ha mpe r e d s o muc h by a l l t he l i t t l e bl ood ve s s e l s

a nd a ll the thi ngs tha t we r e vi ol a t e d.

. . . .

Q You t ol d me i n one of your de pos i t i ons t ha t

i t woul d ha ve be e n be t t e r t o br e a k t he s e s ur ge r i e s up 

- - i f you' r e goi ng t o do t he s e pr oc e dur e s , Dr . Ca l i a ,

you s houl d br e a k t he m up i nt o t wo or t hr e e or f our
2 Dr . Ak e r ma n i s al so a p o d i a t r i s t .

8

di ffe r e nt pr oc e dur e s -- di ffe r e nt ope r a t i ons , di ffe r e nt

time s . Do you r e c a ll tha t te s timony?

A Ye s , si r .

Q And ha ve you be e n t ol d t ha t Dr . Ake r ma n

2

 is

of t he opi ni on t ha t t ha t woul d not be a good i de a

be c a us e you woul d e xpos e t he pa t i e nt t o mul t i pl e

oppor t uni t i e s f or i nf e c t i on - - t ha t t he onl y r e a s on t o

do mul t i pl e s ur ge r i e s woul d be t o c r e a t e a bi gge r f e e ?

Ha ve you be e n a dvi s e d of t ha t , Dr . Coope r ?

A We l l , l e t me addr e s s t ha t a s econd.

Q Doc t or , c a n you a ns we r " ye s " or " no" ? The n

f eel f r ee t o expl a i n.

A Ye s , I am awa r e t ha t s he ha s s a i d t ha t , but

s he i s wr ong. The pr oof ' s i n t he puddi ng. For you t o

r e a l l y unde r s t a nd wha t I me a n by t ha t i s t ha t - - t o

ha ve a n i nf e c t i on i n a young i ndi vi dua l a f t e r f oot

s ur ge r y i s r a r e . I t i s unus ua l , e s pe c i a l l y of gr e a t

ma gni t ude be c a us e , i f i t we r e a nyt hi ng ot he r t ha n

unus ua l , t he n who wa nt s t o s t a r t wi t h s ome t hi ng t ha t

woul d e nd wi t h t hi s muc h of a ha s s l e ? I t ' s t he r i s k - -

I t hi nk ye s t e r da y I t a l ke d a bout t he s t a nda r d of c a r e .

The r i s k of doi ng a l l of wha t wa s done , i n t he a r e a

t ha t i t wa s done , j us t wa s t oo muc h f or t hi s f oot t o

he a l f r om. And i t put t oo muc h bur de n on i t , a nd i t ' s

not be yond a ny ki nd of r e a s ona bl e t hi nki ng t o

unde r s t a nd how a l l t hi s i nj ur y - - s ur gi c a l t r a uma t o

t hi s ar ea - - eve n i f i t we r e done me t i c ul ous l y. I

me a n, j us t - - t he r e we r e t oo ma ny bl ood ve s s e l s

vi ol a t e d. The r e wa s j us t t oo muc h done i n a s ma l l

a r e a . So I ' m not r e a l l y oppos e d t o mul t i pl e

pr oc e dur e s . I t ' s whe r e t he y' r e done a nd t he

multiplic ity in a n a r e a .

Q Oka y. Doc t or , ha ve you f or me d a n opi ni on ba s e d

upon a r eas ona bl e de gr ee of me di cal cer t a i nt y as t o

whe t he r or not thi s pe r ma ne nt pa r tia l di s a bility r a ting

whi c h you ha ve as s e s s e d he r i s cas ua l l y r e l a t e d or

c onne c t e d t o t he s ur ge r y t ha t Dr . Ca l i a pe r f or me d on

he r on 5- 17- 89?

A Ye s .
9

Ms . Sc ott a l s o c ompl a i ns tha t the Cour t s ua s pont e

di r ect e d a ve r di c t aga i ns t he r i n t hi s cas e . The l a w s eems cl ear

t ha t a t r i a l j udge ha s t he r i ght , a l t hough he s houl d us e i t

s pa r i ngl y, t o di r e c t a ve r di c t s ua s pont e . Bur n v. Te nn- Va l

Re a l t y, I nc . , a n unr e por t e d opi ni on of t hi s Cour t , f i l e d i n

Knoxvi l l e on J a nua r y 28, 1986. I n t he c a s e a t ba r , a f t e r t he

Tr i a l Cour t ha s i ndi c a t e d t o c ouns e l hi s i nt e nt t o gr a nt a

di r ect e d ve r di c t , couns e l f or Dr . Ca l i a be l a t e dl y, and appa r e nt l y

a s a n a f t e r t hought , s t a t e d " a nd I gue s s f or t he r e c or d, I do

move f or di r e c t e d ve r di c t , j us t s o i t ' s i n t he r e c or d. "

I n vi e w of t he f or e goi ng we be l i e ve t he Tr i a l J udge di d

i n f act di r ect a ve r di c t s ua s pont e but , unde r Bur n, we ar e

obl i ga t e d t o s us t a i n hi s a c t i on unl e s s di r e c t i ng of a ve r di c t

unde r t he pr oof a dduc e d wa s i mpr ope r .

Ha vi ng c onc l ude d t ha t t he Tr i a l Cour t wa s i n e r r or i n

di r ect i ng a ve r di c t , we vacat e t he j udgme nt ent e r e d t he r e on. The

c a us e i s r e ma nde d f or f ur t he r pr oc e e di ngs not i nc ons i s t e nt wi t h

t hi s opi ni on. Cos t s of a ppe a l a r e a dj udge d a ga i ns t Dr . Ca l i a .

_______________________________

Hous t on M. Godda r d, P. J .
10

CONCUR:

________________________________

Don T. Mc Mur r a y, J .

________________________________

Cha r l e s D. Sus a no, J r ., J .