# FILED July 2, 1997 Cecil Crowson, Jr. App ellate C ou rt Clerk I N THECOUR

TOFAPPEALSOFTENNES SEE EA STER N SEC TI O N

SANDR A J . SCOTT ) ANDER S ON C OUNTY ) 03A 01- 9608- C

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- 00270 Pl a i ntif f

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pp e lla nt )

) ) v. ) HON. J AM ESB. SCOTT, J R. , ) J UDGE ) DR. GER

ALD B. C

ALI A ) ) D e f e nd a nt - A

pp e l l ee ) VAC ATED AND R

EM ANDED

KENNETH K. KENNEDY OFKNOXVI LLEFOR APPELLANT M AR TI N L. ELLI Sa n dVONDA M . LAUGHLI N OFKNOXVI LLEFOR APPELLEE

O PI N I O N

G odda r d, P. J .

Thi s m e di cal m

a l pr act i ce s ui t ar i s e s o ut o f s ur g e r y pe r f or m

e d on S a ndr a Sc ot t ’ s f e e t by D r . G e r a l d Ca l i a on M

a y 17, 1989. M

s . Sc ot t c ont e nds t ha t D r . Ca l i a w

a s ne gl i ge nt i n hi s m e di cal car e o f he r . She i n s i s t s o napp eal t h a t t he Tr i a l C o ur t w a s i ner r or i ndi r ect i n ga v e r di c t ag a i n s t he r at t he cl o s e o f he r pr oof .2 M s . Sc ot t r a i s e s t he f ol l ow i ng t w o i s s ue s on a ppe a l :

I . D i dthe tr i a l c o ur t e r r ine x c l u di n gthe te s tim o ny of D r . M a r i on C. H

a 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 m e nt s of § 29- 26- 115, Te nn. C ode A nn. , 1996? I I . W a 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 R ul e s of C

i vi l Pr oc e dur e 50. 01?

I n A pr i l 1989 M

s . Sc ot t s ought t r e a t m e nt f r om

D r . Ca lia , a p o di a t r i s t, to c or r e c t a v a r i e t yo f a ilm e nt s a f f lic ting he r f eet . M

s . Sc o t t agr eedt oh a v e D r . Ca l i a p e r f or m

s ur g e r yo n he r f eet . D

r . Ca l i a p e r f or m

e df i v e s e p a r a t e s ur g i cal pr o cedur e s o ne a c ho f M

s . S c o tt’ s f e e t. M s . S c o tt c o ntinu e dtov i s it D r . Ca l i a f or pos t - ope r a t i ve e va l ua t i ons . D e s pi t e f ol l ow

i ng D r . 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 w ounds t ha t r e m a i ne d a f t e r t he s ur ge r y, t he s ur gi c a l w ound on he r r i ght gr e a t t oe f a i l e dtohe a l.

Ei ght m

ont hs a f t e r he r s ur ge r y, M s . Sc ot t s ought t he opi ni on of D

r . M a r i on C. H

a r pe r , a n or t hope di s t a s s oc i a t e d w i t h V a n de r b i l t H

o s p i t a l i nN

a s hv i l l e , Te nn e s s e e . D r . H a r p e r pe r f or m

e d a s e c ond s ur ge r y i n Fe br ua r y 1990 t o c om ba t a n i nf e c t i on t ha t ha d i nva de d t he bone of M s . Sc ot t ’ s gr e a t r i ght t oe . D

r . H a r pe r a l s o l a t e r pe r f or m e d a t hi r d s ur ge r y t o c l os e t he w ound on M

s . 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 M a y 1989 s ur ge r y pe r f or m e d by D

r . Ca l i a .3 The r e qui r e m

e nt s n ecess a r yf or a p l a i nt i f f t oes t a b l i s h a pr i m a f aci e case of m e di cal m

a l pr act i ce i s s e t o ut i nT. C. A . 29- 26- 115. W

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

l ai m ant ' s bur de ni nm al pr ac t i c e ac t i o n-- E

xpe r t te s t i m

o ny-- Pr e s um

pt i o nof ne gl i g e nc e -- Jur yi ns t r uc t i o ns . - - ( a ) I na m a l pr act i ce act i o n , t he c l a i m

a 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 eco g ni zeds t a nd a r do f accept a b l 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 p eci a l t yt he r e o f , i f any , t h a t t he de f e nd a nt pr act i ces i n t he c om

m uni t y i n w

hi c h he pr a c t i c e s or i n a s i m i l a r c om m uni t y a t t he t i m

e t he a l l e ge d i nj ur y or w r ongf ul act i o no ccur r e d ; ( 2) Tha t t he de f e nda nt a c t e d w i t h l e s s t ha n or f a i l e dt oact w

i t hor di n a r yandr eas o n a b l e car e i n a c c or da nc e w

i t h s uc h s t a nda r d; a nd ( 3) A s a pr oxi m

a t e r e s ul t of t he de f e nda nt ’ s n e g lig e nt a c t or o m i s s i o n , th e p l a i ntif f s u f f e r e d i nj ur i e s w

hi c h w oul d not ot he r w

i s e ha ve oc c ur r e d.

Tos a tis f ythe s t a t ut or yr e qui r e m e nt s , M

s . S c o tt h a d D r . I va n C

oope 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 ya t tr i a l. D r . Co op e r te s tif i e dth a t D r . 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 , D r . C oope 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 m i ng t oo m a 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, D r . C oope 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 m i ne i f a n i nf e c t i on w a s pr e s e nt i n t he ope n w ound. Fi na l l y, D r . C oope 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 m i ng a s e c ond s ur ge r y t o c ove r a n e xpos e d w

ound. H

ow e ve r , D

r . C oope r t e s t i f i e d t ha t he ha d onl y s e e n M s . Sc ot t on t w

o oc c a s i ons a nd w a s not i n a pos i t i on t o4

t e s t i f y a bout a ny da m a ge s t ha t m

a y ha ve r e s ul t e d f r om D r . 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 D r . C oope r ’ s t e s t i m

ony 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 m e 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 m ony di d not s a t i s f y t he c a us a t i on r e qui r e m e nt s e t out i n T. C. A . 29- 26- 115( 3) . M s . Sc ot t a tte m p t e dtos a tis f ythi s s t a t ut or yr e qui r e m e nt w iththe t e s t i m o nyo f D

r . M a r i o nH

a r p e r w

h o , as s t a t e dear l i e r , b ecam e M s . Sc o tt’ s tr e a tingp hy s i c i a n . D r . Ca lia m

a de a m

o tio ninlim

i ne to e x c l u de anyr e f e r e nce t ocau s a t i o nas i t r e l a t e s t oanyal l e g e d de vi a t i o no nt he p a r t o f D r . Ca l i a b ecau s e D r . H a r p e r r eadi l y a dm i t t e d t ha t he l a c ke d a ny know l e dge c onc e r ni ng t he r e c ogni z e d s t a nd a r do f accept a b l e , pr o f e s s i o n a l pr act i ce i nt he pr o f e s s i o n a nd s pe c i a l t y of podi a t r y. The Tr i a l C our t gr a nt e d D

r . Ca l i a ’ s m ot i on i n l i m

i ne a s t o s om

e of D r . H a r pe r ' s t e s t i m

ony be c a us e he w a s unf a m

ilia r w

iththe s t a n d a r do f c a r e . M s . S c o tt in s i s t s th a 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 m e nt t hr ough t he de pos i t i on t e s t i m ony of D

r . H a r pe r . C ont r a r y t o t he hol di ng of t he Tr i a l C our t , a pl a i nt i f f i na m e di cal m

a l pr act i ce s ui t m a ys a t i s f yt he cau s a t i o n r e qui r e m

e nt f ound i n T. C. A . 29- 26- 115( 3) w

i t h t e s t i m

ony f r om

a doc t or unf a m

i l i a r w

i t h t he s t a nda r d of c a r e . For e xa m pl e , a doc t or , w

ho i s unf a m

i l i a r w

i t h t he s t a nda r d of c a r e , m a y n e v e r t he l e s s t e s t i f yt h a t a s p eci f i c act o f t he de f e nd a nt , s u c h a s pr e s c r i bi ng a c e r t a i n dr ug t o w hi 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 w hi c h w oul 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 , w e m us t r e vi e w t he de pos i t i on t e s t i m ony of D

r . H a r pe r t o de t e r m

i ne w he t he r t he Tr i a l C our 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 D r . Ca l i a .U

pon c ons i de r a t i on of a m ot i on f or di r e c t e d ve r di c t , t he tr i a l c o ur t m u s t lo oktoa ll the e v i de n c e , ta ke the m o s t l e gi t i m

a t e vi e w

of i t i n f a vor of t he oppone nt of t he m ot 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 w he n t he r e i s no c ont r ove r s y a s t o a ny m a t e r i a l f a c t t ha t w oul d b e de t e r m

i n a t i v e o f t he case. See C r o s s linv . A

l s up , 594 S . W

. 2d 379 ( Te nn. 1980) . W he r e t he pr of f e r e d e vi de nc e l e a ve s t o s p e c u l a tio na de t e r m i n a tiv e f a c t ina la w s uit, th e p a r t yh a v i n g t he bur de n of pr ovi ng t he f a c t m us t s uf f e r t he l os s . Le ona r d v. G ilr e a t h , 625 S . W

. 2d 722 ( Te nn. A

pp. 1981) , c i t i ng R e s e r v e Li f e I ns ur a nc e C

o. v. W

hi t t e m or e , 59 Te nn. A

pp. 495, 442 S . W

. 2d 266 ( 1969) . A

c a s e doe s not ha ve t o be s ubm i t t e d t o a j ur y w he r e t he pl a i nt i f f ’ s ve r di c t w oul d be ba s e d on s pe c ul a t i on, c onj e c t ur e , or a m e r e g l i m

m e r o f evi de nce. S a de k v. N a s hvi l l e R

e c yc l i ng C

o . , 751 S . W

. 2d 428 ( Te nn. A

pp. 1988) . D ur i ng di r e c t e xa m i na t i on of D

r . H a r pe r i n hi s de p o s itionthe f o llo w i n gte s tim

o nyw a s e lic ite d : Q D oc t or , ha ve you f or m e d a n opi ni on ba s e d upon a r eas o n a b l e de gr ee o f m e di cal cer t a i nt yas t ow he t he r or6

not t ha t di a gnos i s of c hr oni c os t e om ye l i t i s [ i nf e c t i on of t he bone ] w

a 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 m

e d by D

r . Ca l i a on 5- 17- 89?

. . . . A Y e s , I b e l i e v e i t w a s r e l a t e d .

. . . . Q O ka y. W

ha t a bout t he gr e a t r i ght t oe , D oc t or ? W ha 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 um

e da p o s itiono f e xt e n s i o n , i. e . , it w a s t e ndi ng t o c oc k up a nd a l s o de vi a t e t ow a r d t he m

i d l i ne , t ow

a r d t he m

i d por t i on of t he body. Q I s t ha t nor m a l ? A No . Q W h a t w a s the c a u s e o f th a t, p l e a s e , D o c t or , w

ithi n a r eas o n a b l e de gr ee o f m e di cal cer t a i nt y ? A The pr i or s ur ge r y.

. . . . Q O ka y. O

n 2- 5- 90, D

oc t or , t he f i r s t t i m e you pe r f or m

e d a de br i de m

e nt or de br i de m

e nt on he r , w

e 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 m e ? A Ye s . Q W h a t di dt he yr e v eal , p l 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 m e 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 m e nt of r i ght gr e a t to e , c o l o n , foc a l a c ut e inf l a m m a tio nc o m

p a tib l e w itho s t e o m

y e litis , g r a m

- p o s itiv e c o c c i pr e s e nt . Q O ka y. D

oc t or , a ga i n, ba s e d upon a r e a s ona bl e de gr e e of m

e di c a l c e r t a i nt y, ha ve you f or m e 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 O ka y . A

n dw h a t is th a t, p l e a s e , D o c t or ?1 A p o r t i o n o f D

r . H a r p e r ' s answe r was excl u d e d . H i 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 m p 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 g e r y . 1

I n l i ght of t he f or e goi ng w e c onc l ude t he r e w a 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 C

o ur t di r e c tinga v e r di c t .

M or e ove r , a l t hough c ouns e l f or M s . Sc ot t s e e m

e d t o c onc e de D

r . C oope r ' s t e s t i m

ony di d not m

e e t t he c a us a t i on r e qui r e m

e nt, w e b e lie v e it di d : Q A l l r i ght . Le t ' s go on, D oc t or . Y

ou 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 h a t inf e c tio nw

a s n e g lig e n c e , th a t y o u ' r e f a m ilia r w i 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 K nox C ount y, a nd t ha t t he de vi a t i on c a us e d s om e da m a ge . I don' t s e e a nyw

he r e i n t he r e D

oc t or , t ha t you c r i t i c i z e dD

r . Ca l i a a b o ut t he typ e , or the num b e r , o f pr oc e dur e s he pe r f or m e d on M

s . Sc ot t ; ha ve I r e a d i t c or r ect l y ? A I g u e s s , it -- the b o tto m line is he di dto o m uc h i n one a r e a . Q A nd I don' t s e e t ha t a nyw he r e i n t hi s a f f i d a v it. A Y e a h. But t ha t ' s w ha t ha ppe ne d. I m e a n, I know you' r e t a l ki ng f r om t he w or ds a nd t hi ngs now - - j us t - - t ha t ' s w

ha t w e nt w r ong. I f he ha dn' t done s o m uc h i n t ha t one a r e a , t he n t he i nf e c t i on w oul 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 w oul dn' t ha ve be e n ha m

pe r e d s o m

uc h by a l l t he l i t t l e bl ood ve s s e l s a n da ll the thi n g s th a t w e r e v i o l a t e d .

. . . . Q Y ou t ol d m

e i n one of your de pos i t i ons t ha t i t w oul 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 , D r . Ca l i a , you s houl d br e a k t he m up i nt o t w

o or t hr e e or f our2 D r . A k e r m a n i s al so a p o d i a t r i s t .

8 di ffe r e nt pr o c e dur e s -- di ffe r e nt op e r a t i o n s , di ffe r e nt tim e s . D oy o ur e c a ll th a t te s tim o ny ? A Y e s , si r . Q A nd ha ve you be e n t ol d t ha t D r . A ke r m a n 2is of t he opi ni on t ha t t ha t w oul d not be a good i de a be c a us e you w

oul d e xpos e t he pa t i e nt t o m ul 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 m ul t i pl e s ur ge r i e s w oul d be t o c r e a t e a bi gge r f e e ? H a ve you be e n a dvi s e d of t ha t , D r . C oope r ? A W e l l , l e t m

e addr e s s t h a t a s econ d . Q D oc t or , c a n you a ns w e r " ye s " or " no" ? The n f eel f r ee t oexp l a i n . A Y e s , I am

aw a r e t h a t s he h a s s a i dt h a t , b ut s he i s w

r 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 w ha t I m

e 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 m a gni t ude be c a us e , i f i t w e r e a nyt hi ng ot he r t ha n unus ua l , t he n w

ho w a nt s t o s t a r t w

i t h s om

e t hi ng t ha t w oul d e nd w

i t h t hi s m

uc 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 w ha t w a s done , i n t he a r e a t ha t i t w

a s done , j us t w

a s t oo m

uc h f or t hi s f oot t o he a l f r om

. A nd i t put t oo m

uc 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 um a t o t hi s ar ea - - ev e ni f i t w e r e do n e m

e t i c ul o u s l y . I m e a n, j us t - - t he r e w e r e t oo m

a ny bl ood ve s s e l s vi ol a t e d. The r e w a s j us t t oo m

uc h done i n a s m

a l l a r e a . So I ' m

not r e a l l y oppos e d t o m ul t i pl e pr oc e dur e s . I t ' s w he r e t he y' r e done a nd t he m u ltip lic ityina na r e a . Q O ka y. D

oc t or , ha ve you f or m e d a n opi ni on ba s e d up o na r eas o n a b l e de gr ee o f m e di cal cer t a i nt yas t o w he t he r or n o t thi s p e r m a n e nt p a r tia l di s a b ilityr a ting w hi c hy o uh a v e as s e s s e dhe r i s cas u a l l yr e l a t e dor c onne c t e d t o t he s ur ge r y t ha t D r . Ca l i a pe r f or m

e d on he r on 5- 17- 89? A Ye s .9 M s . S c o tt a l s oc o m p l a i n s th a t the C o ur t s u a s pont e di r ect e da v e r di c t ag a i n s t he r i nt hi s cas e . The l a w s eem s 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 u a s pont e . Bur n v. Te nn- V a l R e a l t y , I n c . , a n unr e por t e d opi ni on of t hi s C our t , f i l e d i n K noxvi 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 C

our 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 dv e r di c t , coun s e l f or D r . Ca l i a b e l a t e dl y , andapp a 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 m ove 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 w e be l i e ve t he Tr i a l J udge di d i nf act di r ect a v e r di c t s u a s pont e but , unde r Bur n , w e 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 w a s i m pr ope r . H a vi ng c onc l ude d t ha t t he Tr i a l C our t w a s i n e r r or i n di r ect i n ga v e r di c t , w e v acat e t he j u dg m e nt ent e r e dt he r e o n . The c a us e i s r e m

a nde d f or f ur t he r pr oc e e di ngs not i nc ons i s t e nt w i t h t hi s opi ni on. C

os t s of a ppe a l a r e a dj udge d a ga i ns t D r . Ca l i a .

_______________________________ H ous t on M

. G odda r d, P. J .10

CONC UR:

________________________________ D on T. M

c M ur r a y, J .

________________________________ C h a r l e s D

. Su s a n o , J r ., J .