### IN THE CO URT OF APPEALS OF TE NNE SS EE

AT NASHVILL E

May 12, 2 01 0 S es si on

RUFUS R. C LI FFORD, II I A N D W I F E 

### , CARRIE C. CLIFFORD v . LOYDA

TACOGUE , M. D., ST. THO MAS HOS PITAL

, A N D 

### ST. J UDE MEDICAL

, S.C., INC.

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

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

c a t h e t e r i z a t i o n p r o c e d u r e

. P l a i n t i f f s f i l e d s u i t a g a i n s t t h e t r e a t i n g p h y s i c i a n

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t h e m a n u f

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o r m e d i c a l b a t t e r y c o m m i t t e d b y i t s e m p l o y e e

. T h e t r i a l c o u r t g r a n t e d

s u m m a r y j u d g m e n t t o t h e d e f e n d a n t s o n a l l c l a i m s

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t h a t t h e u s e o f t h e m e d i c a l d e v i c e t o c l o s e t h e s i t e w h e r e t h e c a t h e t e r w a s i n s e r t e d w a s t h e

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j u r y

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e s s e n t i a l t o e a c h c a u s e o f a c t i o n

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R IC H A R D H

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W i l l i a m K e n n e r l y B u r g e r

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T h o m a s H o s p i t a l

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T i f f a n y M

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O n J u n e 6

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u s C l i f f o r d w a s s e e n b y D r

. L o y d a T a c o g u e

, a c a r d i o l o g i s t

, b e c a u s e h e w a s e x p e r i e n c i n g s o m e s h o r t n e s s o f b r e a t h a n d c h e s t p a i n s

. D r

. T a c o g u e

r e c o m m e n d e d h e u n d e r g o a c a r d i a c c a t h e t e r i z a t i o n

, a l s o k n o w n a s a n a n g i o g r a m

, w h i c h i s

a p r o c e d u r e t h a t r e q u i r e s i n s e r t i o n o f m e d i c a l i n s t r u m e n t s i n t o a p a t i e n t ’ s f e m o r a l a r t e r y t o

c o n d u c t a n e x a m i n a t i o n o f t h e h e a r t a n d a r t e r i e s ; t h e l a s t s t e p o f t h e p r o c e d u r e i s t o c l o s e t h e

i n s e r t i o n s i t e t o c o n t r o l b l e e d i n g

. M r

. C l i f f o r d a g r e e d t o t h e a n g i o g r a m a n d t h e p r o c e d u r e

w a s p e r f o r m e d o n J u n e 9 b y D r

. T a c o g u e a t S t

. T h o m a s H o s p i t a l ( “ S t

. T h o m a s ” )

. D r

.

T a c o g u e w a s n o t a n e m p l o y e e o f S t

. T h o m a s b u t w a s g r a n t e d p r i v i l e g e s t o p r a c t i c e m e d i c i n e

t h e r e

. T h e a n g i o g r a m w a s u n e v e n t f u l a n d D r

. T a c o g u e c l o s e d t h e i n s e r t i o n s i t e i n M r

.

C l i f f o r d ’ s f e m o r a l a r t e r y u s i n g a n i n s t r u m e n t c a l l e d a n “ A n g i o

- s e a l v a s u l a r c l o s u r e d e v i c e ”

( “ d e v i c e ” )

, w h i c h i s u s e d t o s h o r t e n a p a t i e n t ’ s r e c o v e r y t i m e

. D u r i n g t h e c o u r s e o f t h e

p r o c e d u r e

, D a v i d B e l l

, a s a l e s r e p r e s e n t a t i v e f o r t h e d e v i c e ’ s m a n u f

a c t u r e r

, S t

. J u d e M e d i c a l

,

I n c

. ( “ S t

. J u d e ” )

, e n t e r e d t h e o p e r a t i n g r o o m t o p r o v i d e D r

. T a c o g u e w i t h t h e d e v i c e

. A f t e r

t h e p r o c e d u r e

, M r

. C l i f f o r d e x p e r i e n c e d i n c r e a s i n g p a i n a t t h e i n s e r t i o n s i t e a n d p r e s e n t e d

t o t h e S t

. T h o m a s e m e r g e n c y r o o m a n u m b e r o f t i m e s w i t h s e v e r e g r o i n p a i n

, w h i c h h e

a l l e g e d t o b e c o n t i n u i n g i n n a t u r e

.

M r

. C l i f f o r d a n d h i s w i f

e

, C a r r i e

, s u b s e q u e n t l y f i l e d s u i t a g a i n s t D r

. T a c o g u e

, S t

.

T h o m a s

, a n d S t

. J u d e

, a s s e r t i n g a n u m b e r c l a i m s a g a i n s t e a c h

. M r

. C l i f f o r d c o n t e n d e d t h a t

,

p r i o r t o t h e a n g i o g r a m

, D r

. T a c o g u e t o l d h i m s h e w o u l d b e u s i n g t h e “ m a n u a l p r e s s u r e ”

m e t h o d t o c o n t r o l h i s f

e m o r a l b l e e d i n g a n d n e v e r m e n t i o n e d t h e d e v i c e ; t h a t t h e d e c i s i o n t o

u s e t h e d e v i c e

, i n l i e u o f t h e “ m a n u a l p r e s s u r e ” m e t h o d

, w a s n e v e r c o n v e y e d t o h i m n o r d i d

h e a u t h o r i z e i t s u s e ; t h a t D r

. T a c o g u e h a d d i f f i c u l t y w i t h t h e d e v i c e a n d M r

. B e l l i n s t r u c t e d

h e r o n h o w t o u s e i t ; t h a t M r

. C l i f f o r d d i d n o t d i s c o v e r t h a t M r

. B e l l w a s n o t a m e d i c a l

p r o f e s s i o n a l u n t i l a f

t e r t h e p r o c e d u r e ; a n d t h a t D r

. T a c o g u e ’ s u s e o f t h e d e v i c e d a m a g e d a

n e r v e a t t h e i n s e r t i o n s i t e

.

S t

. J u d e f

i l e d a m o t i o n f

o r s u m m a r y j u d g m e n t

, a s s e r t i n g t h a t t h e d e v i c e w a s n o t

d e f e c t i v e

, t h a t S t

. J u d e h a d n o d u t y t o o b t a i n M r

. C l i f f o r d ’ s c o n s e n t p r i o r t o u s e o f t h e

d e v i c e

, a n d t h a t M s

. C l i f f o r d ’ s c o n s o r t i u m c l a i m c o u l d n o t s u r v i v e t h e d i s m i s s a l o f h e r

h u s b a n d ’ s c l a i m s

. T h e C l i f f o r d s a n d S t

. J u d e e n t e r e d i n t o a n a g r e e d o r d e r t o g r a n t S t

. J u d e ’ s

m o t i o n f o r s u m m a r y j u d g m e n t w i t h o u t p r e j u d i c e

, a l l o w i n g t h e C l i f f o r d s t o f i l e a n a m e n d e d

c o m p l a i n t a g a i n s t S t

. J u d e

.

-2-T h e C l i f f o r d s t h e r e a f

t e r f i l e d a n A m e n d e d a n d S u p p l e m e n t a l C o m p l a i n t

, r e

- a l l e g i n g

t h e i r c l a i m s a g a i n s t a l l d e f e n d a n t s

. T h e C l i f

f o r d s a l l e g e d c l a i m s o f m e d i c a l m a l p r a c t i c e

, l a c k

o f i n f o r m e d c o n s e n t

, a n d m e d i c a l b a t t e r y a g a i n s t D r

. T a c o g u e ; m e d i c a l m a l p r a c t i c e a g a i n s t 1

S t

. T h o m a s b a s e d o n t h e a c t u a l o r a p p a r e n t a g e n c y o f D r

. T a c o g u e ; a n d m e d i c a l b a t t e r y 2

a g a i n s t S t

. J u d e b e c a u s e i t w a s l i a b l e f o r t h e t o r t i o u s a c t s o f M r

. B e l l u n d e r t h e d o c t r i n e o f

r e s p o n d e a t s u p e r i o r

. T h e c l a i m s w e r e b a s e d o n a n a l l e g a t i o n t h a t M r

. C l i f f o r d ’ s i n j u r y

r e s u l t e d f

r o m t h e n e g l i g e n t

, u n c o n s e n t e d t o

, a n d u n a u t h o r i z e d u s e o f t h e d e v i c e

. T h e

C l i f f o r d s s o u g h t $ 5

, 0 0 0

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d a m a g e s f

o r w i l l f u l b a t t e r y a n d / o r g r o s s n e g l i g e n c e

.

O n M a y 2 0

, 2 0 0 9

, t h e D e f e n d a n t s f i l e d s e p a r a t e m o t i o n s f

o r s u m m a r y j u d g m e n t

. I n

s u p p o r t o f

h e r m o t i o n

, D r

. T a c o g u e s u b m i t t e d a s t a t e m e n t o f m a t e r i a l f a c t ; t h e a f

f i d a v i t s o f

D r

. D a v i d U s k a v i t c h a n d h e r s e l f ; a n i n d e p e n d e n t m e d i c a l e x a m i n a t i o n r e p o r t o f M r

. C l i f f o r d ;

t h e d e p o s i t i o n t e s t i m o n y o f t h e C l i f f o r d s ’ e x p e r t w i t n e s s e s

, D r

. L o u i s e L e d b e t t e r

, D r

. S a m

G a m m e n t h a l e r

, a n d D r

. A a r o n F i l l e r ; a n d t h e e v i d e n t i a r y d e p o s i t i o n t e s t i m o n y o f D r

. F i l l e r

.

I n s u p p o r t o f i t s m o t i o n

, S t

. T h o m a s s u b m i t t e d a s t a t e m e n t o f u n d i s p u t e d f a c t s ; t h e a f

f i d a v i t s

o f D r

. U s k o v i t c h a n d D r

. T a c o g u e ; a n d t h e d e p o s i t i o n t e s t i m o n y o f D r

. L e d b e t t e r

, D r

.

G a m m e n t h a l e r

, a n d D r

. F i l l e r

. I n s u p p o r t o f i t s m o t i o n

, S t

. J u d e s u b m i t t e d a s t a t e m e n t o f

u n d i s p u t e d m a t e r i a l f

a c t s ; t h e d e p o s i t i o n t e s t i m o n y o f D r

. T a c o g u e

, D r

. L e d b e t t e r

, D r

.

G a m m e n t h a l e r

, a n d D r

. F i l l e r ; a n d t h e a f f i d a v i t o f D r

. F i l l e r

.

I n h e r m e m o r a n d u m i n s u p p o r t o f t h e m o t i o n

, D r

. T a c o g u e a s s e r t e d t h a t t h e C l i f f o r d s

“ f a i l e d t o e s t a b l i s h c a u s a t i o n a s a n e c e s s a r y e l e m e n t o f t h e i r d a m a g e s c l a i m s ” b e c a u s e t h e i r

“ e x p e r t w i t n e s s e s h a [ d ] c o n c e d e d t h e i r i n a b i l i t y t o e s t a b l i s h c a u s a t i o n c l a i m s w i t h t h e

r e q u i s i t e d e g r e e o f m e d i c a l c e r t a i n t y ” a n d b e c a u s e t h e i r e x p e r t s w e r e e i t h e r n o t q u a l i f i e d t o

o f f e r m e d i c a l c a u s a t i o n t e s t i m o n y o r l a c k e d t h e p r o p e r f o u n d a t i o n t o d o s o

. I n i t s

m e m o r a n d u m

, S t

. T h o m a s c o n t e n d e d t h a t i t “ t o o k a f f i r m a t i v e m e a s u r e s t o i n f o r m [ M r

. ]

C l i f f o r d t h a t c o n s u l t i n g p h y s i c i a n s

, i n c l u d i n g D r

. T a c o g u e

, w e r e n o t i t s a g e n t s o r

e m p l o y e e s

, ” t h a t M r

. C l i f f o r d a c k n o w l e d g e d t h i s f a c t i n a s i g n e d c o n s e n t f o r m

, t h a t t h e

“ h o s p i t a l a n d i t s s t a f

f d i d n o t d e v i a t e f

r o m t h e s t a n d a r d o f a c c e p t a b l e n u r s i n g p r a c t i c e

, ” a n d

t h a t M r

. C l i f

f o r d c a n n o t “ e s t a b l i s h a c a u s a l c o n n e c t i o n b e t w e e n a n y b r e a c h o f d u t y b y t h e

h o s p i t a l a n d i t s s t a f

f a n d t h e a l l e g e d i n

j u r y

. ” ( E m p h a s i s i n o r i g i n a l )

. I n i t s m e m o r a n d u m

,

S t

. J u d e a s s e r t e d t h a t M r

. C l i f f o r d ’ s “ b a t t e r y c l a i m s f

a i l a s a m a t t e r o f l a w a s t h e r e w a s n o

T he complai nt al so al le ged a cl ai m for negli gen ce per se, however

, thi s cau se of act ion was not 1

pur sue d by the Cli ff

ord s t her eaf

te r a nd i s no t a n i ssu e on app eal

.

An act ion for m edi cal bat te ry agains t St. T homas doe s not app ear to be m ent ion ed in the amended 2

complai nt, however

, the tr ia l cou rt grant ed summ ar y j udgm ent on the cl ai m and the dis pos it ion of tha t cl ai m

is an is sue on a ppe al

.

-3-t o u c h i n g b y t h e S t

. J u d e r e p r e s e n t a t i v e ” a n d t h a t “ [ t ] h e r e i s n o c o m p e t e n t

, a d m i s s i b l e

e v i d e n c e t h a t t h e [ d e v i c e ] w a s t h e p r o x i m a t e c a u s e o f [ M r

. C l i f f o r d ’ s ] a l l e g e d i n

j u r i e s

. ” O n

M a y 2 9

, 2 0 0 9

, t h e C l i f f o r d s f i l e d a M e m o r a n d u m o f L a w i n s u p p o r t o f t h e i r m o t i o n f o r

p a r t i a l s u m m a r y j u d g m e n t o n t h e s o l e i s s u e o f m e d i c a l b a t t e r y

. 3

A f t e r a h e a r i n g o n J u n e 2 6

, 2 0 0 9

, t h e t r i a l c o u r t e n t e r e d s e p a r a t e o r d e r s d i s p o s i n g o f

e a c h p a r t y ’ s m o t i o n f

o r s u m m a r y j u d g m e n t

. T h e c o u r t g r a n t e d D r

. T a c o g u e ’ s m o t i o n

, f i n d i n g t h a t t h e C l i f

f o r d s ’ e x p e r t s f

a i l e d t o e s t a b l i s h c a u s a t i o n o r w e r e n o t q u a l i f i e d t o o f f e r

c a u s a t i o n t e s t i m o n y

. T h e c o u r t g r a n t e d S t

. T h o m a s ’ m o t i o n

, f i n d i n g t h a t t h e r e w a s n o p r o o f

t h a t D r

. T a c o g u e w a s a n a c t u a l a g e n t o r e m p l o y e e o f

, o r w a s a c t i n g u n d e r a p p a r e n t a u t h o r i t y

o f

, S t

. T h o m a s ; t h a t t h e r e w a s n o p r o o f t h a t S t

. T h o m a s w a s n e g l i g e n t i n d e p e n d e n t o f D r

.

T a c o g u e ’ s a c t i o n s ; t h a t t h e d u t y o f o b t a i n i n g i n f o r m e d c o n s e n t w a s o n t h e p h y s i c i a n

, n o t t h e

h o s p i t a l

, a n d t h a t D r

. T a c o g u e o b t a i n e d i n f o r m e d c o n s e n t ; t h a t M r

. C l i f f o r d c o n s e n t e d t o t h e

p r o c e d u r e a n d

, t h e r e f

o r e

, n o m e d i c a l b a t t e r y o c c u r r e d ; a n d t h a t t h e C l i f f o r d s f a i l e d t o p r o v e

c a u s a t i o n w i t h r e g a r d t o t h e n e g l i g e n c e c l a i m s

. T h e c o u r t g r a n t e d S t

. J u d e ’ s m o t i o n

, f i n d i n g

t h a t T e n n e s s e e l a w d o e s n o t r e c o g n i z e a c a u s e o f a c t i o n f o r m e d i c a l b a t t e r y a g a i n s t a m e d i c a l

d e v i c e m a n u f

a c t u r e r ; t h a t t h e C l i f

f o r d s f a i l e d t o p r o v e a “

j o i n t v e n t u r e ” o r “ a p p a r e n t

a u t h o r i t y ” b e t w e e n “ S t

. J u d e ( o r i t s s a l e s r e p r e s e n t a t i v e ) a n d a n y o f t h e o t h e r D e f e n d a n t s t h a t

w o u l d g i v e r i s e t o S t

. J u d e [ ’ s ] v i c a r i o u s l i a b i l i t y f o r a n y a l l e g e d m e d i c a l b a t t e r y ” ; a n d t h a t

t h e r e w a s n o e v i d e n c e t h a t t h e d e v i c e c a u s e d o r c o n t r i b u t e d t o a n y o f M r

. C l i f f o r d ’ s i n j u r i e s

.

T h e c o u r t t h e n d e n i e d t h e C l i f f o r d s ’ m o t i o n

, f

i n d i n g t h a t t h e y f

a i l e d t o e s t a b l i s h u n d i s p u t e d

m a t e r i a l f

a c t s i n s u p p o r t o f t h e i r m o t i o n

, t h a t t h e y f a i l e d t o e s t a b l i s h c a u s a t i o n i n s u p p o r t o f

a n y o f t h e i r c l a i m s

, a n d t h a t t h e t h e o r i e s o f v i c a r i o u s l i a b i l i t y w e r e u n s u p p o r t e d b y t h e

u n d i s p u t e d f

a c t s a n d / o r w e r e n o t r e c o g n i z e d c a u s e s o f a c t i o n o r l e g a l t h e o r i e s u n d e r

e s t a b l i s h e d T e n n e s s e e l a w

. T h e C l i f f o r d s a p p e a l

.

I I

. S t a t e m e n t o f t h e I s s u e s

T h e C l i f f o r d s r a i s e t h e f

o l l o w i n g i s s u e s f

o r r e s o l u t i o n :

1

. D i d t h e t r i a l c o u r t e r r i n i t s f a i l u r e t o g r a n t p a r t i a l s u m m a r y j u d g m e n t t o t h e

C l i f f o r d s o n t h e i s s u e s o f b a t t e r y a g a i n s t D r

. T a c o g u e

, S t

. J u d e

, a n d S t

.

T h o m a s ?

2

. D o g e n u i n e i s s u e s o f m a t e r i a l f a c t e x i s t

, p r e c l u d i n g s u m m a r y j u d g m e n t

d i s m i s s a l

, o n t h e b a t t e r y

, m e d i c a l m a l p r a c t i c e a n d i n f o r m e d c o n s e n t i s s u e s

T he re cor d doe s not con ta in the C l if for ds’ m oti on for par ti al summ ar y j udgm ent

. I n sup por t of 3

the m oti on, the Cli ff

ord s sub m it te d, in par t per ti nen t, a st at ement of undi spu te d m at er ia l fa ct s; the af fi davit s

of Mr . Cli ff

ord , M s. Cl if

for d, Dr . Gamm ent hal er , an d Dr . Fi ll er ; a nd t he d epo si ti on o f Dr . T aco gue,

-4-a s s e r t e d a g a i n s t D r

. T a c o g u e

, a n d a s t o t h e b a t t e r y i s s u e s a s s e r t e d a g a i n s t S t

.

T h o m a s a n d S t

. J u d e ?

3

. D o t h e i s s u e s r e l a t e d t o c a u s a t i o n p r e c l u d e s u m m a r y j u d g m e n t ? A n d

, u p o n

t h e f a c t s p r e s e n t e d b e l o w

, d o e s t h e p r e s u m p t i o n c r e a t e d b y t h e d o c t r i n e o f r e s

i p s a l o q u i t u r p r e c l u d e s u m m a r y j u d g m e n t d i s m i s s a l t o t h e D e f e n d a n t s o n t h e

i s s u e o f c a u s a t i o n ?

4

. I s t h e m e d i c a l t e s t i m o n y o f t h e t r e a t i n g n e u r o s u r g e o n

, D r

. A a r o n F i l l e r o f

S a n t a M o n i c a

, C A

, c o m p e t e n t t e s t i m o n y p u r s u a n t t o t h e r e q u i r e m e n t s o f T e n n

.

C o d e A n n

. § 2 9

- 2 6

- 1 1 5 ( b ) ?

I I I

. A n a l y s i s

A s s t a t e d e a r l i e r

, t h e C l i f f o r d s a l l e g e d t h a t t h e d e v i c e w a s u s e d n e g l i g e n t l y

, t h e r e b y

c a u s i n g M r

. C l i f

f o r d ’ s n e r v e d a m a g e a n d g i v i n g r i s e t o t h e c l a i m s o f m e d i c a l m a l p r a c t i c e ;

t h a t i t s u s e w a s u n c o n s e n t e d t o

, t h e r e b y c o n s t i t u t i n g t h e c a u s e o f a c t i o n b a s e d o n l a c k o f

i n f o r m e d c o n s e n t ; a n d i t s u s e w a s u n a u t h o r i z e d

, t h e r e b y c o n s t i t u t i n g m e d i c a l b a t t e r y

. T h e

t r i a l c o u r t g r a n t e d s u m m a r y j u d g m e n t t o t h e D e f e n d a n t s o n a f

i n d i n g t h a t t h e C l i f

f o r d s f a i l e d

t o e s t a b l i s h c a u s a t i o n f

o r e a c h c a u s e o f a c t i o n a s s e r t e d ; i n a s m u c h a s c a u s a t i o n i s a n e l e m e n t

o f e a c h c a u s e o f a c t i o n

, w e b e g i n o u r a n a l y s i s b y c o n s i d e r i n g w h e t h e r t h e D e f e n d a n t s

s u c c e s s f u l l y n e g a t e d t h a t e l e m e n t

.

T o s u c c e e d i n a c l a i m f o r m e d i c a l m a l p r a c t i c e

, a p l a i n t i f f m u s t m e e t t h e b u r d e n o f

p r o o f s e t f

o r t h a t T e n n

. C o d e A n n

. § 2 9

- 2 6

- 1 1 5 ( a )

, w h i c h p r o v i d e s :

( a ) I n a m a l p r a c t i c e a c t i o n

, t h e c l a i m a n t s h a l l h a v e t h e b u r d e n o f p r o v i n g b y

e v i d e n c e a s p r o v i d e d b y s u b s e c t i o n ( b ) :

( 1 ) T h e r e c o g n i z e d s t a n d a r d o f a c c e p t a b l e p r o f e s s i o n a l p r a c t i c e i n t h e

p r o f e s s i o n a n d t h e s p e c i a l i t y t h e r e o f

, i f a n y

, t h a t t h e d e f

e n d a n t p r a c t i c e s i n t h e

c o m m u n i t y i n w h i c h t h e d e f e n d a n t p r a c t i c e s o r i n a s i m i l a r c o m m u n i t y a t t h e

t i m e t h e a l l e g e d i n

j u r y o r w r o n g f

u l a c t i o n o c c u r r e d ;

( 2 ) T h a t t h e d e f

e n d a n t a c t e d w i t h l e s s t h a n o r f a i l e d t o a c t w i t h o r d i n a r y a n d

r e a s o n a b l e c a r e i n a c c o r d a n c e w i t h s u c h s t a n d a r d ; a n d

( 3 ) A s a p r o x i m a t e r e s u l t o f t h e d e f e n d a n t ’ s n e g l i g e n t a c t o r o m i s s i o n

, t h e

p l a i n t i f f s u f f e r e d i n j u r i e s w h i c h w o u l d n o t o t h e r w i s e h a v e o c c u r r e d

.

I d

. T h e n e c e s s a r y e l e m e n t o f c a u s a t i o n i s s u b s e c t i o n ( a ) ( 3 )

.

-5-W i t h r e s p e c t t o t h e c a u s e s o f a c t i o n f o r m e d i c a l b a t t e r y a n d l a c k o f i n f o r m e d c o n s e n t

,

t h e T e n n e s s e e S u p r e m e C o u r t h a s r e c o g n i z e d a d i s t i n c t i o n b e t w e e n m e d i c a l b a t t e r y

, “ i n

w h i c h a d o c t o r p e r f

o r m s a n u n a u t h o r i z e d p r o c e d u r e

, ” a n d l a c k o f i n f o r m e d c o n s e n t

, “ i n

w h i c h t h e p r o c e d u r e i s a u t h o r i z e d b u t t h e p a t i e n t c l a i m s t h a t t h e d o c t o r f a i l e d t o i n f

o r m t h e

p a t i e n t o f a n y o r a l l [ o f ] t h e r i s k s i n h e r e n t i n t h e p r o c e d u r e

. ” B l a n c h a r d v

. K e l l u m

, 9 7 5

S

. W

. 2 d 5 2 2

, 5 2 4 ( T e n n

. 1 9 9 8 )

. T h e i n q u i r y c r e a t e d t o c l a s s i f y t h e s e c a u s e s o f a c t i o n i s : “ ( 1 )

w a s t h e p a t i e n t a w a r e t h a t t h e d o c t o r w a s g o i n g t o p e r f o r m t h e p r o c e d u r e ” a n d “ i f s o ( 2 ) d i d

t h e p a t i e n t a u t h o r i z e p e r f o r m a n c e o f t h e p r o c e d u r e ? ” I d

. “ A p l a i n t i f

f ’ s c a u s e o f a c t i o n m a y

b e c l a s s i f

i e d a s a m e d i c a l b a t t e r y o n l y w h e n [ t h e ] a n s w e r s t o e i t h e r o f t h e a b o v e q u e s t i o n s

a r e i n t h e n e g a t i v e

. ” I

d

. “ I f

. . . [ t h e ] a n s w e r s t o t h e a b o v e q u e s t i o n s a r e a f f i r m a t i v e a n d i f t h e

p l a i n t i f f i s a l l e g i n g t h a t t h e d o c t o r f a i l e d t o i n f

o r m o f a n y o r a l l r i s k s o r a s p e c t s a s s o c i a t e d

w i t h a p r o c e d u r e

, a p a t i e n t ’ s c a u s e o f a c t i o n r e s t s o n a n i n f o r m e d c o n s e n t t h e o r y

. ” I d

. I n

o r d e r t o r e c o v e r u n d e r e i t h e r t h e o r y

, a p l a i n t i f f m u s t s h o w s o m e s o r t o f c o m p e n s a b l e i n j u r y

a n d t h a t t h e i n

j u r y r e s u l t e d f

r o m t h e p r o c e d u r e a t i s s u e

. R a n g e v

. S o w e l l

, N o

. M 2 0 0 6

- 0 2 0 0 9

-

C O A

- R 3

- C V

, 2 0 0 9 W L 3 5 1 8 1 7 6

, a t * 8 ( T e n n

. C t

. A p p

. O c t

. 2 9

, 2 0 0 9 ) ( p e r m

. a p p

. d e n i e d

J u l y 6

, 2 0 1 0 ) ( “ W h e n t h e c l a i m i s f o r m e d i c a l b a t t e r y

, l i a b i l i t y a t t a c h e s f o r a n y i n j u r i e s

r e s u l t i n g f

r o m t h e t r e a t m e n t o r p r o c e d u r e n o t c o n s e n t e d t o

. . . . ” ) ; S h a d r i c k v

. C o k e r

, 9 6 3

S

. W

. 2 d 7 2 6

, 7 3 2 ( T e n n

. 1 9 9 8 ) ( “ W h e n t h e h e a l t h c a r e p r o v i d e r p e r f o r m s t h e t r e a t m e n t o r

p r o c e d u r e w i t h o u t t h e r e q u i s i t e i n f o r m e d c o n s e n t o f t h e p a t i e n t

, l i a b i l i t y a t t a c h e s f o r t h e

r e s u l t i n g i n

j u r i e s

. . . . ” )

. T h e r e f

o r e

, t h e C l i f

f o r d s w e r e r e q u i r e d t o s h o w t h a t M r

. C l i f f o r d

s u f f e r e d a n e r v e i n

j u r y t h a t r e s u l t e d f

r o m m e d i c a l m a l p r a c t i c e

, o r t h e a l l e g e d u n a u t h o r i z e d

a n d u n c o n s e n t e d t o u s e o f t h e d e v i c e

.

I n t h e i r m o t i o n s f

o r s u m m a r y j u d g m e n t

, t h e D e f e n d a n t s a s s e r t e d t h a t t h e u s e o f t h e

d e v i c e w a s n o t t h e c a u s e i n f a c t o f M r

. C l i f

f o r d ’ s n e r v e d a m a g e

. I n s u p p o r t o f t h i s

c o n t e n t i o n

, t h e D e f

e n d a n t s r e l i e d u p o n t h e a f f i d a v i t o f D r

. T a c o g u e

, t h e a f f i d a v i t o f D r

. 4

I n her af fi davit

, Dr. T aco gue st at ed, in p a r t

, t h a t “t o a re aso nab le degree of m edi cal cer ta int y, 4

n o t h i n g [ s h e ] did or fa il ed to do cau sed or con tr ibu te d to cau se any inj ury to Mr

. Cli ff ord tha t oth er wis e

woul d no t h ave occ urr ed.”

-6-D a v i d U s k a v i t c h

, a n e u r o l o g i s t e m p l o y e d b y V a n d e r b i l t U n i v e r s i t y M e d i c a l C e n t e r

, a n d a 5

r e p o r t f r o m a n i n d e p e n d e n t m e d i c a l e x a m i n a t i o n

. 6

I n a d d i t i o n t o h e r a s s e r t i o n r e g a r d i n g t h e p r o x i m a t e c a u s e o f M r

. C l i f f o r d ’ s i n j u r y

, D r

.

T a c o g u e a t t a c k e d t h e C l i f f o r d s ’ e x p e r t w i t n e s s e s b y c o n t e n d i n g t h a t t h e y w e r e n o t q u a l i f i e d

I n his aff ida vit, Dr. Usk avitc h, an exper t witn ess for the Def end ant s, opi ned

, in par t per ti nen t, as 5

fol lows :

16. Base d up on my edu cat ion , tr ai nin g and ex per ie nce , I am fam il ia r wi th the re cognized

st and ar d of acc ept abl e pr o f e s si ona l pra ct ic e for neu rol ogy in the Nash vill e comm uni ty in

the car e and tr eat m ent of pat ie nts suc h as [M r. Cli ff ord ] in 2005 and now. I t is m y opi nio n,

to a reas ona ble degree of m edi cal cer ta int y, tha t the re ar e no obj ect ive, cl ini cal fi ndi ngs to

sup por t Mr

. Cli ff

ord ’s cl ai m s of a fe m ora l ner ve i n j u r y due to car dia c cat het er izat ion or

oth er wis e. I n fact , m

y re view of the re cor ds reveal s no obj ect ive, cli nic al eviden ce of any

ner ve inj ury in Mr . Cli ff

ord ....I nso fa r as Mr. Cli ff ord con te nds tha t the re is suc h an in j ury

as a con seq uen ce of a hematoma suf fe re d dur ing the car dia c cat het er izat ion pro ced ure

per for m ed by Dr. T aco que [s ic ], suc h hematoma and swel li ng m ay occ ur in the abs enc e of

negli gence and

, in fa ct

, is comm on fol lowi ng c ar dia c c a t h e t e r i zati on pro ced ure s. I nso fa r

as Mr

. Cli ff

ord con te nds tha t he suf

fe re d a hematoma and /or swel li ng as a r e s u l t of Dr.

T a c o q u e ’ s [ si c] use of [t he device ], it is impossi ble to asc er ta in whet her the use of the

[de vice] to cl ose the ar te ri al punc tur e si te

, whic h is nec ess ar il y re qui re d by the angiogra m

,

cau sed a hemato ma i n add it ion to or dif fe re nt fr om the hematoma and swel li ng tha t is a

known ri sk of c ar dia c c at het er izat ion pr oce dur es.

17. Base d upon m

y edu cat ion

, tr ai nin g and exp er ie n c e and m y re view of Mr

. Cli ff

ord ’s

m edi cal re cor ds, it is m

y opi nio n, to a re aso nab le degree of m edi cal cer ta int y, tha t not hin g

tha t St. T homas Hosp it al nur si ng and oth er st af f did or did not do cau sed or con tr ibu te d to

cau se any inj ury to Mr

. Cli ff ord tha t woul d not have oth er wis e occ urr ed. Fur the rmore, the

pre sen ce of the [de vice] re pre sen ta ti ve in the pro ced ure roo m for the cl ose of Mr

. Cli ff ord ’s

cat het er izat ion pro ced ure did not cau se or con tr ibu te to cau se any inj ury to Mr

. Cli ff ord tha t

oth er wis e wou ld not have oc cur re d.

On Febr uar y 5, 2009

, Dr. Mi cha el K aminski con duc te d an ind epe nde nt m edi cal exa m ina ti on of 6

Mr . Cli ff ord and con cl ude d t he f

oll owin g, in pa rt per ti nen t:

Mr

. Cli ff ord has had a lon g his tor y of chr oni c une xpl ai ned pai n.

. .His m ore re cen t dra m at ic

pai n syndro m e al so can not be at tr ibu te d to a def ina ble m ech ani sm re aso nab ly re la te d to his

pro ced ure of 6/9 /05

. T hes e fa ct ors woul d sugg est tha t his unde rl ying dia gnosis is a

somatof orm pai n dis ord er ....T he la tt e r c o n n o t es a pai n dis ord er in whic h psychol ogical

fa ct ors ar e j udged to pla y a si gnifi can t rol e in the ons et

, s e ve r i t y, exa cer bat ion and

m ai nte nan ce of the pai n. I n add it ion it is al so very li kely tha t sec onda ry ga i n i s s u e s a re

pla ying a pro m ine nt rol e in his impair m ent whic h see m s ext re m e giv en his be nign

exa m ina ti on. I bas e t his opi nio n on a r eas ona ble degre e of m edi cal ce rt ai nty.

-7-t o o f

f e r c a u s a t i o n t e s t i m o n y

. I n h i s r e s p o n s e t o D r

. T a c o g u e ’ s S t a t e m e n t o f M a t e r i a l F a c t s

, 7

M r

. C l i f f o r d a d m i t t e d t h a t h e w a s r e l y i n g u p o n t h r e e e x p e r t w i t n e s s e s t o s u p p o r t h i s c l a i m s :

D r

. L o u i s e L e d b e t t e r

, h i s t r e a t i n g n e u r o l o g i s t ; D r

. A a r o n F i l l e r

, h i s t r e a t i n g n e u r o s u r g e o n

w h o i s l o c a t e d i n S a n t a M o n i c a

, C a l i f o r n i a ; a n d D r

. S a m G a m m e n t h a l e r

, a c a r d i o l o g i s t

l i c e n s e d t o p r a c t i c e m e d i c i n e i n T e n n e s s e e

.

D r

. L e d b e t t e r t e s t i f

i e d

, a n d M r

. C l i f

f o r d c o n c e d e d

, t h a t s h e w a s n o t o f f e r i n g c a u s a t i o n

t e s t i m o n y

. W i t h r e g a r d t o D r

. F i l l e r

, t h e D e f e n d a n t s a r g u e d t h a t h e w a s s t a t u t o r i l y 8

p r o h i b i t e d f

r o m o f f e r i n g c a u s a t i o n t e s t i m o n y p u r s u a n t t o T e n n

. C o d e A n n

. § 2 9

- 2 6

- 1 1 5 ( b )

,

w h i c h p r o v i d e s t h a t :

N o p e r s o n i n a h e a l t h c a r e p r o f e s s i o n r e q u i r i n g l i c e n s u r e u n d e r t h e l a w s o f t h i s

s t a t e s h a l l b e c o m p e t e n t t o t e s t i f y i n a n y c o u r t o f l a w t o e s t a b l i s h t h e f a c t s

r e q u i r e d t o b e e s t a b l i s h e d b y s u b s e c t i o n ( a )

, u n l e s s t h e p e r s o n w a s l i c e n s e d t o

p r a c t i c e i n t h e s t a t e o r a c o n t i g u o u s b o r d e r i n g s t a t e a p r o f e s s i o n o r s p e c i a l t y

w h i c h w o u l d m a k e t h e p e r s o n ’ s e x p e r t t e s t i m o n y r e l e v a n t t o t h e i s s u e s i n t h e

c a s e a n d h a d p r a c t i c e d t h i s p r o f e s s i o n o r s p e c i a l t y i n o n e ( 1 ) o f t h e s e s t a t e s

d u r i n g t h e y e a r p r e c e d i n g t h e d a t e t h a t t h e a l l e g e d i n j u r y o r w r o n g f

u l a c t

o c c u r r e d

.

I d

. A t h i s d e p o s i t i o n

, D r

. F i l l e r t e s t i f i e d t h a t h e i s l i c e n s e d t o p r a c t i c e m e d i c i n e i n C a l i f o r n i a

, b u t h a s n e v e r b e e n l i c e n s e d t o p r a c t i c e m e d i c i n e i n T e n n e s s e e o r i t s c o n t i g u o u s s t a t e s

.

T h e D e f e n d a n t s c o n t e n d e d t h a t

, b e c a u s e n e i t h e r D r

. F i l l e r n o r D r

. G a m m e n t h a l e r w a s

p r o v i d e d w i t h M r

. C l i f

f o r d ’ s c o m p l e t e m e d i c a l r e c o r d s a n d b e c a u s e n e i t h e r h a d s u f f i c i e n t

k n o w l e d g e o f t h e d e v i c e

, t h e y l a c k e d a p r o p e r f o u n d a t i o n t o o f

f e r e x p e r t c a u s a t i o n t e s t i m o n y.

T h e D e f e n d a n t s r e l y u p o n t h i s C o u r t ’ s o p i n i o n i n C h u r c h v

. P e r a l e s

, 3 9 S

. W

. 3 d 1 4 9 ( T e n n

.

C t

. A p p

. 2 0 0 0 )

, w h i c h s t a t e s t h a t a n e x p e r t ’ s o p i n i o n m u s t b e b a s e d o n “ t r u s t w o r t h y f a c t s o r

d a t a s u f f i c i e n t t o p r o v i d e s o m e b a s i s f o r t h e o p i n i o n

. ” I

d

. a t 1 6 6

. “ E x p e r t o p i n i o n s h a v i n g

n o b a s i s c a n p r o p e r l y b e d i s r e g a r d e d b e c a u s e t h e y c a n n o t m a t e r i a l l y a s s i s t t h e t r i e r o f f a c t

, ”

“ [ n ] o r c a n t h e y c r e a t e g e n u i n e d i s p u t e s o f m a t e r i a l f a c t a t s u m m a r y j u d g m e n t s t a g e

. ” I d

. I n

h i s d e p o s i t i o n

, D r

. F i l l e r s t a t e d t h a t h e w a s t e s t i f y i n g a s M r

. C l i f

f o r d ’ s “ c l i n i c a l p r o v i d e r ”

a n d t h a t

, t h e r e f

o r e

, h e d i d n o t r e v i e w a n y d o c u m e n t s b e y o n d h i s o w n c h a r t

. D r

. F i l l e r a l s o

Alt hough nei the r St. T homas nor St. J ude ra is ed thi s a r gu me nt in sup por t of the ir m oti ons for 7

summ ar y j udgm ent

, the y eac h fi le d not ic es ado pti ng the ar gum ent s con ta ine d in the m emor a n d um of la w

fi le d on beh al f o f Dr . T aco gue.

In h i s r e s pons e to Dr. T aco gue’s Sta te m ent of Ma te ri al Fac ts

, Mr

. Cli ff ord admitt ed tha t “Dr

. 8

Loui se Y. (“ Lucy”) Ledb et te r has tes ti fi ed tha t she is off er ing no cau sat ion te st imony re gardi ng Pla int if fs ’

pur por te d i nj uri es. ”

-8-s t a t e d t h a t h e h a d n o e x p e r t i s e i n c a r d i a c c a t h e t e r i z a t i o n p r o c e d u r e s

, h a d n e v e r u s e d o r h e l d

t h e d e v i c e

, a n d h a d n o f

a m i l i a r i t y w i t h h o w t h e d e v i c e i s u s e d o r i t s r i s k s

. D r

. G a m m e n t h a l e r

t e s t i f i e d t h a t h e h a d n o t r e v i e w e d a n y r e c o r d s o f M r

. C l i f f o r d ’ s m e d i c a l c o n d i t i o n p r i o r t o t h e

a n g i o g r a m p r o c e d u r e

, t h a t h e r e v i e w e d a f e w r e c o r d s a f

t e r t h e p r o c e d u r e

, t h a t h e h a d n o t

r e v i e w e d a n y m e d i c a l i m a g e s

, a n d t h a t h e h a d n e v e r m e t w i t h o r e x a m i n e d M r

. C l i f f o r d

. D r

.

G a m m e n t h a l e r a l s o s t a t e d t h a t h e h a d n e v e r u s e d o r p e r s o n a l l y s e e n t h e d e v i c e a n d h a d n o t

w i t n e s s e d u s e o f t h e d e v i c e f i r s t h a n d

.

L a s t l y

, t h e D e f

e n d a n t s a r g u e d t h a t

, i f D r

. F i l l e r a n d D r

. G a m m e n t h a l e r w e r e q u a l i f i e d

t o p r o v i d e e x p e r t t e s t i m o n y

, t h e y e i t h e r r e f u s e d t o t e s t i f

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

t h a t t h e d e v i c e c a u s e d M r

. C l i f f o r d ’ s i n j u r i e s w i t h a r e a s o n a b l e d e g r e e o f m e d i c a l c e r t a i n t y

.

I n s u p p o r t o f t h i s c o n t e n t i o n

, t h e D e f e n d a n t s r e l i e d u p o n D r

. T a c o g u e ’ s S t a t e m e n t o f

-9-M a t e r i a l F a c t s ; t h e t e s t i m o n y o f D r

. F i l l e r f r o m h i s d i s c o v e r y d e p o s i t i o n

, a n d f r o m h i s 9 1 0

I n her Sta te m ent of Ma te ri al Fac ts

, Dr. T aco gue m ade the f o l l o w i n g a s s e r ti on, to whic h Mr

. 9

Cli ff ord re spo nde d, i n pa rt per ti nen t:

23. [Dr .] Fil le r bel ie ves tha t inj ury cou ld h a ve o ccu rr ed at any of vario us pha ses of the

cat h e te ri zati on pro ces s, inc lud ing the inj ect ion of a loc al ane st het ic at the beginn ing,

pot ent ia l ble edi ng at the ope ra ti ve si te , local tr auma, the inj ect ion of dyes, a con ta m ina te d

cat het er , or a l oca l i nfe ct ion

. ... RESPONSE: Adm it te d, wit h the caveat tha t Dr. Fil le r des cr ibe s, in his af fi davit (¶ 8), “many

pos si ble ” cau ses for the type of inj uri es sus ta ine d by Mr

. Cli ff ord

, bu[ t] tha t the “pr oba ble ”

cau se (ba sed upon the fa ct ual his tor y re la te d by Mr

. Cli ff ord ) was the tr auma des cr ibe d by

Mr . Cli ff ord

.

T he ful l tr ans cr ipt of thi s dep osi ti on is not a par t of the re cor d on app eal and we ar e abl e to re view 1 0

onl y the exc er pts of te st imony sub m it te d by the par ti es in sup por t of the ir m oti ons

. T he fol lowi ng te st imony

pro vided b y Dr. Fil le r i s t aken f rom the se exc er pts :

Q. And i s - - s o is your unde rs ta ndi ng of your rol e her e tod ay is

, it ’s not as an exp er t

wit nes s. It’s as

- - as th e c li nic al pr ovider ?

A. T hat ’s cor re ct

.

***

A. ...I re al ly am

tr ying to be a p er ci pie nt wit nes s he re

.... Q. ...I want to m ake sur e I und er st and what ...“p er ci pie nt wit nes s” m ean s.

A. At le ast m

y unde rs ta ndi ng of it

, m

y doc tor ’s unde rs ta ndi ng, at le ast in Cal if orn ia

, is tha t

we have ei the r you’re an exp er t wit nes s...wh er e you have an opi n i o n a n d yo u re ly on al l

kinds of sou rc es, and the n you have a per ci pie nt wit nes s whic h j ust says tha t I ’m ta king car e

of the pat ie nt and I saw thi s, I exa m ine d him, he tol d m e thi s, thi s i s w h at I fou nd, thi s is

what I did

. And the n when you come bac k to m e for te st imony

, I ’m re al ly onl y going to be

te st if ying abo ut what I saw and what I did ...[ I ]n thi s cas e, I ’m re al ly j ust awar e of what the

pat ie nt has des cr ibe d.

***

Q. I s it fa ir to say, Dr. Fil le r, tha t if you ar e asked to re nde r cau sat ion opi nio ns, tha t you re ly

fi rs t u pon the pat ie nt’ s de scr ipt ion of hi s medic al hi st ory?

A. We ll

, I w o u l d n ’ t

- - I w o u l dn’ t re nde r a cau sat ion opi nio n. I can j ust te ll you what I

thi nk you have at the m om ent

, what you’re te ll ing m e your sy m pto m s are, and I can re pea t

bac k what the pat ie nt tol d m e abo ut the his tor y. But I woul dn’ t have any bas is to do any

cau sat ion opi nio n, ot her th an t o co m m ent th at if a pati ent says, well , th is hap pen ed t o me,

the n I ’m hap py to per ci pie ntl y [s ic ]

- - as a per ci pie nt wit nes s, say, oh wel l, if tha t hap pen ed

to you, it cou ld have ca use d t his

.

***

Q. So i n t his cas e, you can see a cau sal con nec ti on bet ween Mr . Cli ff ord ’s con dit ion and

m edi cal tr eat m ent he re c e i ve d

, b ut unl ess you know the ful l pan opl y of re cor ds and

pro vider s a nd h is tor y, y ou c an’ t mak e i t t he c aus e?

A. Yeah

, ‘c aus e when you come bac k and sa y “with re aso nab le m edi cal ce rt ai nty,” n o...I

can ’t sa y that

.

-10-e v i d e n t i a r y d e p o s i t i o n ; a n d t h e t e s t i m o n y o f D r

. G a m m e n t h a l e r f r o m h i s d e p o s i t i o n

. 1 1 1 2

I n t h e i r r e s p o n s e t o t h e D e f e n d a n t s ’ m o t i o n s a n d s u p p o r t i n g m a t e r i a l s o n t h e i s s u e o f

c a u s a t i o n

, t h e C l i f

f o r d s a s s e r t e d t h a t “ D r

. T a c o g u e c o m m i t t e d m e d i c a l m a l p r a c t i c e

. . . b y

c a u s i n g n e r v e d a m a g e [ ] a s c o n f i r m e d b y D r

. G a m m e n t h a l e r

, D r

. F i l l e r

, a n d b y [ D r

. ]

T a c o g u e ’ s o w n a d m i s s i o n t o M r

. a n d M r s

. C l i f f o r d

, t h a t s h e h a d c a u s e d d a m a g e t o t h e n e r v e s

i n t h e a r e a o f t h e f

e m o r a l a r t e r y ” ; t h i s c o n t e n t i o n w a s n o t s u p p o r t e d b y c i t a t i o n t o a n y

T he ful l tr ans cr ipt of the eviden ti ar y dep osi ti on ta ken of Dr. Fil le r is a par t of the re cor d on app eal 1 1

and Dr. Fil le r t est if

ie d as fo ll ows, in par t p er ti nen t:

Q. And you pre viousl y te st if ie d that any one or m ore of tho se pos si ble cau ses tha t we j ust

li st ed cou ld have occ urr ed at any one of sever al st ages of the cat het er izat ion pro ced ure

. Do

you rec al l t hat as your t est imony ?

A. Yes

. Q. And you ar e not abl e to dete rmine which of tho se poss ibl e caus es res ult ed in the ner ve

adh esi ons th at you obs er ved in Mr . Cli ff ord ; i s t hat tr ue?

A. T hat ’s cor re ct

. Q. And you ar e al so not abl e to det er m ine at what st age of the cat het er izat ion pro ced ure the

ner ve adhe si ons m ay have occ urr ed; is th at tr ue?

A. Or at le ast

, yeah, the con dit ion s tha t le d to the m

. I t’ s har d to know a t w h a t p o i n t t h at

hap pen ed; ri ght.

Q. Okay

. And you ar e not say i n g tha t the [de vice] cau sed the ner ve adh esi ons tha t you

obs er ved in Mr . Cli ff

ord ; i s t hat tr ue?

A. No, I am

not sa ying that . I t c oul d ha ve. I am not s ure exa ct ly how.

Q. And m aybe I wil l ask it t h i s way: You can ’t say to a re aso nab le degree of m edi cal

cer ta int y t h a t i t was the [de vice] or Dr. T aco que ’s [s ic ] dep loym ent of the [de vice] tha t

cau sed Mr . Cli ff

ord ’s al le ged inj uri es; is th at cor re ct ?

A. T hat ’s cor re ct

.

T he ful l tr ans cr ipt of Dr. Gam m ent hal er ’s te st imony is not avail abl e in the re cor d on app eal and 1 2

we ar e abl e to re view onl y the exc er pts sub m it te d by the par ti es in sup por t of the ir m oti ons

. T he fol lowi ng

te st imony pr ovided by Dr. Gamm ent hal er is ta ken fr om th ese exc er pts :

Q. You re fe re nce d the develo pm ent of hematoma, but ...w e ’ve dis cus sed al re ady tha t a

h ematoma...can and doe s ar is e af te r car dia c cat het er izat ion pro ced ure s whet her o r n o t

the re ’s [a devic e] , ri ght?

A. Cor re ct

. Q. Okay

. S o the pre sen ce of a hematoma, in and of it sel f, doe s not implic at e tha t the

[de vice] ca use d t he h ematoma?

A. Cor re ct

.

***

Q. Okay

. Can y ou dete rmine at thi s poin t wheth er Mr . Clif for d’s inj uri es wer e cau sed by

the use of th e [ device ] o r b y the c ar dia c c at het er izat ion it sel f?

A. No.

-11-e v i d e n c e

. U p o n a r e v i e w o f t h e r e c o r d

, w e b e l i e v e t h a t t h e y w e r e m o s t l i k e l y r e l y i n g u p o n

t h e a f f i d a v i t s o f M s

. C l i f

f o r d

, M r

. C l i f

f o r d

, D r

. F i l l e r

, a n d D r

. G a m m e n t h a l e r

, 1 3 1 4 1 5 1 6

I n her af fi davit

, Ms

. Cli ff

ord st at ed, in par t per ti nen t, tha t “I sol emnly swea r, unde r the oat h tha t 1 3

I have giv en, tha t Dr. T aco que [s ic ] st at ed to m y hu sba nd, and to m e, (more t han onc e) th at she knew tha t

she had somehow ‘ damag ed t he n er ve’ (s ta ti ng it was the fe m ora l n er ve).”

I n hi s a ff ida vit, M r. Cl if

for d pr ovided th e f

oll owin g stat ements, in par t p er ti nen t: 1 4

...W it hin m om ent s, Dr. T aco que [s ic ] app ear ed to begin ins er ti ng the device at the ins er ti on

si te in m y fe m ora l ar te ry. At tha t poi nt, I bec ame ext re m el y al ar m ed bec aus e of Dr.

T aco que ’s [s ic ] demeanor

. Alt hough she did not verbal ly exp re ss the p rob le m whic h she

had enc ount er ed, she app ear ed (by her genera l demeanor ) fr ust ra te d and con cer ned

. I do not

re cal l h er exa ct wor ds, but I re cal l h er m aking a co m m ent to the m an ( who I as sumed was

a doc tor ), at whic h ti m e he le ane d over the ta ble

, dir ect ly abo ve m y m id-sect ion

, and st at ed

to her “no , no, not th at way - pus h ha rde r, p ush har der .” ..

.

***

10. Dr. T aco que [s ic ] came to m y r oom [ in the hos pit al ] on J une 17, 2005 a n d at te m pte d

to re ass ure m e and m

y wif e tha t the pro ble m was not ser iou s. However, she spe ci fi cal ly

admitt ed to m

y wif e and m e that she had “da m aged t he ner ve,” but that suc h probl ems ar e

not tha t unus ual , and that m y pro ble m woul d be re sol ved in a m ont h to si x weeks.

. .I st at e

unde r oat h, and unde r the pen al t y of per j ury, tha t Dr. T aco que [s ic ] une qui vocall y and

spe ci fi cal ly admitt ed tha t she had “da m aged the ner ve” at some poi nt in the pro ced ure

, but

tha t i t wa s no t a pro ble m whic h j ust if ie d any lon g- te rm c onc er n, al tho ugh she unde rs too d

why I was in pai n an d up set

.

I n hi s a ff ida vit, Dr . Fi ll er m ade th e f oll owin g stat ements, in par t p er ti nen t: 1 5

8. I t m ust be not ed and conc ede d that the re ar e m any pos si ble fa ct ors whic h can cau se the

“multi ple

- ner ve ent ra pm ent pro ble m ”...Ho wever, bas ed upon : (a ) Mr

. Cli ff ord ’s emphasi s

tha t he had exp er ie nce d no si m il ar ri ght fe m ora l pai n pri or to the sur gery; (b) Mr

. Cli ff ord ’s

det ai le d his tor y re gardi ng [Dr

. T aco gue’s] dif fi cul ty in ins er ti ng the [de vice] in his fe m ora l

ar te ry at the con cl usi on of the angiogra m (whi ch he was ful ly con sci ous and awake) ; (c ) the

abs en c e a n yw h e re in the m edi cal re cor ds exh ibi te d for m y re view thu s fa r of any oth er

pro bab le or li kely c aus e of the ner ve e ntr apment pro ble m

, it is m y op ini o n t h a t i t i s m ore

pro bab le tha n not tha t events ass oci at ed wit h the use of the [de vice] ar e the li kely cau se of

the ner ve pro ble m s.... Again, it m ust be not ed tha t the r e a r e oth er pos si ble cau ses whic h

woul d re sul t in the con dit ion ....Howe ver, wher e a pat ie nt des cr ibe s, in his his tor y, ins er ti on

of [t he device ] int o the fe m ora l ar te ry, wit h the at te ndi ng car dio logis t des cr ibi n g ( i n the

pre sen ce of the pat ie nt) dif fi cul ty in pla ci ng the [de vice]

, tha t his tor y (i n the abs enc e of any

oth er fa ct ors app ear ing in the m edi cal re cor ds) m ay be rea son abl y ass um ed to be the m ore

pro bab le ca use of

th e pa ti ent ’s complai nts

....

I n hi s a ff ida vit, Dr . Gamm ent hal er m ade th e f oll owin g stat ements, in par t p er ti nen t: 1 6

21. I t is fur the r m

y opi nio n, bas ed upon re aso nab le m edi cal cer ta int y, and upon a st and ar d

( c o n t i n u e d

. . . )

-12-a n d t h e d e p o s i t i o n s o f D r

. F i l l e r a n d D r

. G a m m e n t h a l e r

. A t t h e t r i a l c o u r t l e v e l

, t h e 1 7

(

. . . c o n t i n u e d ) 1 6

of “pr oba bil it y” an d “more li kely tha n not ” (“ great er tha n 50% li kelih ood” ) tha t the

dep loym ent of the [de vice] by Dr. T aco que [s ic ], and the re si st enc e whic h she enc ount er ed,

con st it ute d exc ess ive tr auma thr ough the use of the device whic h impact ed on the ner ves

si tua te d in t he vic ini ty of the fe m ora l art er y in a permanent and dis abl ing m ann er ....W hil e

I am enti re ly comfort abl e in expr ess ing a cau sat ion opi nio n on the re la ti on o f t he [ device ]

ins ta ll at ion to the ner ve tr auma app ar ent ly exp er ie nce d by Mr

. Cli ff ord

, I woul d def

er to the

tr eat ing neu ros ur geon (Dr

. [Fi ll er ]) re gardi ng the is sue s of per m ane ncy, and the exa ct

ana tomi c a l develo pm ent of the ner ve ent ra pm ent dis ord er whic h pur por ts to re la te to the

tr auma cau sed by Dr. T aco que [s ic ]. No obj ect ive m edi cal re cor d has bee n exh ibi te d to m e

whic h des cr ibe s (on the dat e of the sur gery, or in the ens uin g re

- hos pit al izat ion ) con fi rming

doc um ent at ion tha t the ner ve i nj ury re sul te d fr om the [ d e vi c e ] i n st al la ti on, as oppo sed to

oth er pos si ble events in a cat het er izat ion ....I n the pre sen t m at te r, it is re aso nab le and

app rop ri at e to acc ept the pat ie nt’ s des cr ipt ion (a s a hypothe ti cal pre m is e) and con cl ude tha t

a caus al re la ti ons hip exi st s betwe en the app ar ent per m ane nt ner ve inj ury sus ta ine d by Mr

. Cli ff ord

, and the at te m

pts by Dr. T aco que [s ic ] to “pu sh har der ” when she enc ount er ed

“r esi st enc e”

...

As st at ed ear li er

, Mr

. Cli ff ord did not ci te to te st imony fr om Dr. Fil le r’ s and Dr. Gam m ent hal er ’s 1 7

dep osi ti ons to sup por t his pos it ion ; he did

, however

, re spo nd to cer ta i n st at ements con ta ine d in Dr.

T aco gue’s Sta te m ent of Ma te ri al Fac ts wit h ci ta ti on to the dep osi ti ons and af fi davit s. Dr. T aco gue’s

st at ements, and Mr . Cli ff ord ’s re spo nse s, i n pa rt per ti nen t, a re as fo ll ows:

11. Dr. Ga m

m ent hal er is una ble to det er m ine whet her Pla int if f’ s inj uri es wer e cau sed by

the use of th e [ device ] o r b y the c ar dia c c at het er izat ion it sel f. .

.. RESPONSE: Deni ed. Gamm ent hal er Depo si ti on...

“I thi nk tha t the

- the i n f o r ma t ion tha t I have re cei ved thu s fa r and the

fol low up inf

ormati on, whic h st ron gly sup por t a

- an al le gatio n o f o u r, at

le ast , suppor ti ng st at ement from m e that sai d ther e was a dep loym ent tha t

was m ore li kely than not exc ess ively tr aumati c of th at devic e.”

Als o, Gam m ent hal er Depos it ion

. . .“wei ght of the eviden ce. ..su gge s t s t h at the re was

exc ess ive for ce, exc ess ive t ra um a as the app rox imate [s ic ] cau se in the pla cement of the

[de vice]

- the a p p r o x i ma t e [s ic ] cau se of his pro ble m ”.

. .I t is admitt ed tha t Dr.

Gam m ent hal er st at es.

. .th at he cou ld not con cl usi vely rul e out tha t the cat het er izat ion it sel f

had cau sed the ner ve damag e, but tha t, on the h i s t o ry cl ar if ie d in the for egoing exc er pts

,

tr auma fr om

th e “ pus hin g” of t he [ device ] c aus ed t he d amag e.

***

20. I n this act ion , Dr. Fil le r sta te s that he “woul dn’ t ren der a caus at ion opi nio n”, and th at

he “woul dn’ t have any bas is to do any cau sat ion opi nio n.” Dr. Fil le r st at es tha t “t o giv e an

opi nio n abo ut cau sat ion

, you have to know the whol e st ory.” Dr. Fil l e r s t a te s tha t he

“ca nnot off

er cau sat ion opi nio ns” and tha t the “ca usa ti on opi nio n in a le gal cas e tr ie s to loo k

at al l t hin gs happ eni ng. . .” ..

. ( c o n t i n u e d

. . . )

-13-C l i f

f o r d s d i d n o t a d d r e s s t h e D e f e n d a n t s ’ c o n t e n t i o n s t h a t D r

. F i l l e r a n d D r

. G a m m e n t h a l e r

w e r e n o t q u a l i f

i e d t o p r o v i d e c a u s a t i o n t e s t i m o n y o r t h a t t h e y l a c k e d a p r o p e r f o u n d a t i o n t o

d o s o

.

“ T h e m o v i n g p a r t y i s e n t i t l e d t o s u m m a r y j u d g m e n t o n l y i f t h e ‘ p l e a d i n g s

, d e p o s i t i o n s

, a n s w e r s t o i n t e r r o g a t o r i e s

, a n d a d m i s s i o n s o n f i l e

, t o g e t h e r w i t h t h e

a f f i d a v i t s

. . . s h o w t h a t t h e r e i s n o g e n u i n e i s s u e a s t o a n y m a t e r i a l f a c t a n d t h a t t h e m o v i n g

p a r t y i s e n t i t l e d t o j u d g m e n t a s a m a t t e r o f l a w

. ’ ” M

a r t i n v

. N

o r f o l k S

. R y

. C o

. , 2 7 1 S

. W

. 3 d

7 6

, 8 3 ( T e n n

. 2 0 0 8 ) ( q u o t i n g T e n n

. R

. C i v

. P

. 5 6

. 0 4 )

. “ T h e m o v i n g p a r t y m a y m a k e t h e

r e q u i r e d s h o w i n g a n d t h e r e f o r e s h i f t t h e b u r d e n o f p r o d u c t i o n t o t h e n o n m o v i n g p a r t y b y

e i t h e r : ( 1 ) a f

f i r m a t i v e l y n e g a t i n g a n e s s e n t i a l e l e m e n t o f t h e n o n m o v i n g p a r t y ’ s c l a i m ; o r ( 2 )

s h o w i n g t h a t t h e n o n m o v i n g p a r t y c a n n o t p r o v e a n e s s e n t i a l e l e m e n t o f t h e c l a i m a t t r i a l

. ”

I d

. ( c i t i n g H

a n n a n v

. A l l t e l P u b l ’

g C o

. , 2 7 0 S

. W

. 3 d 1

, 5 ( T e n n

. 2 0 0 8 ) )

. “ I f t h e m o v i n g p a r t y

f a i l s t o m a k e t h i s s h o w i n g

, t h e n ‘ t h e n o n

- m o v a n t ’ s b u r d e n t o p r o d u c e e i t h e r s u p p o r t i n g

a f f i d a v i t s o r d i s c o v e r y m a t e r i a l s i s n o t t r i g g e r e d a n d t h e m o t i o n f o r s u m m a r y j u d g m e n t

f a i l s

. ’ ” I d

. ( q u o t i n g M c C a r l e

y v

. W

. Q u a l i t y F o o d S e r v

. , 9 6 0 S

. W

. 2 d 5 8 5

, 5 8 8 ( T e n n

. 1 9 9 8 ) )

.

I f t h e m o v i n g p a r t y m e e t s i t s b u r d e n

, t h e n t h e “ n o n m o v i n g p a r t y i s r e q u i r e d t o p r o d u c e

e v i d e n c e o f s p e c i f

i c f a c t s e s t a b l i s h i n g t h a t g e n u i n e i s s u e s o f m a t e r i a l f a c t e x i s t

. ” M

a r t i n

, 2 7 1

S

. W

. 3 d a t 8 4 ( c i t i n g M c C a r l e y

, 9 6 0 S

. W

. 2 d a t 5 8 8 )

. T h e n o n m o v i n g p a r t y ’ s b u r d e n m a y b e

s a t i s f i e d b y :

( 1 ) p o i n t i n g t o e v i d e n c e e s t a b l i s h i n g m a t e r i a l f a c t u a l d i s p u t e s t h a t w e r e o v e r

l o o k e d o r i g n o r e d b y t h e m o v i n g p a r t y ; ( 2 ) r e h a b i l i t a t i n g t h e e v i d e n c e a t t a c k e d

b y t h e m o v i n g p a r t y ; ( 3 ) p r o d u c i n g a d d i t i o n a l e v i d e n c e e s t a b l i s h i n g t h e

e x i s t e n c e o f a g e n u i n e i s s u e f o r t r i a l ; o r ( 4 ) s u b m i t t i n g a n a f f i d a v i t e x p l a i n i n g

t h e n e c e s s i t y f

o r f u r t h e r d i s c o v e r y p u r s u a n t t o T e n n

. R

. C i v

. P

. , R u l e 5 6

. 0 [ 7 ]

.

(

. . . c o n t i n u e d ) 1 7

RESPONSE: D e nie d, Dr. Fil le r’ s Aff ida vit ¶ 8. Fur the r, the exc er pts ci te d, in con te xt,

con fi rm that Dr. Fil le r was resp ondi ng to a qu est ion con dit ion ed u pon Dr. F il le r’ s ne ed t o

re view pre

- exi st ing m edi cal re cor ds whic h woul d have not bee n sho wn, by any wit nes s, to

be r el evant to Mr . Cli ff

ord ’s J une 9, 2 005 inj ury.

21. Dr. Fil le r con te nds tha t he can not off er c aus at ion te st imony in thi s cas e “wi th

re aso nab le m edi cal ce rt ai nty.” ..

. RESPONSE: Deni ed..

., for the re aso n re fe re nce d abo ve, whic h implie d, and sugg est ed, the

exi st enc e of m edi cal re cor ds whic h document a si m il ar pai n sy ndr om e befo re the [de vice]

inc ide nt. No suc h doc um ent exi st

, and the que st ion t o D r

. F i l l e r [] dir ect ly dis put ing his

af fi davit st at ement, was cond it ion ed upon ci rc um st anc es whic h have not bee n sho wn to be

tr ue o r a ccu ra te

.

-14-I

d

. ( c i t i n g M c C a r l e

y

, 9 6 0 S

. W

. 2 d a t 5 8 8 )

. T h i s C o u r t m u s t “ r e v i e w t h e e v i d e n c e i n t h e l i g h t

m o s t f a v o r a b l e t o t h e n o n m o v i n g p a r t y a n d t o d r a w a l l r e a s o n a b l e i n f e r e n c e s f a v o r i n g t h e

n o n m o v i n g p a r t y

. ” I

d

. ( c i t i n g S t a

p l e s v

. C

B L & A s s o c s

. , I

n c

. , 1 5 S

. W

. 3 d 8 3

, 8 9 ( T e n n

.

2 0 0 0 ) )

.

W h i l e t h e D e f

e n d a n t s d i s p u t e d t h e f

a c t t h a t M r

. C l i f

f o r d s u f f e r e d a n y i n

j u r y i n t h e i r

M e m o r a n d a o f L a w

, n o n e o f t h e m b a s e d t h e i r s u m m a r y j u d g m e n t m o t i o n o n t h e n e g a t i o n o f

t h i s e l e m e n t ; r a t h e r t h e D e f e n d a n t s r e l i e d s o l e l y o n n e g a t i n g t h e e l e m e n t o f c a u s a t i o n

. W e

f i n d t h e r e i s a g e n u i n e i s s u e o f f a c t a s t o w h e t h e r M r

. C l i f f o r d s u f f e r e d a n i n

j u r y ; h o w e v e r

, 1 8

s i n c e t h i s C o u r t r e v i e w s e v i d e n c e “ i n t h e l i g h t m o s t f a v o r a b l e t o t h e n o n m o v i n g p a r t y ” f o r

p u r p o s e s o f s u m m a r y j u d g m e n t

, w e r e s o l v e t h i s i s s u e i n f a v o r o f M r

. C l i f

f o r d ’ s a s s e r t i o n t h a t

h e s u f f e r e d a n i n

j u r y a s w e c o n s i d e r t h e p r o p r i e t y o f s u m m a r y j u d g m e n t g r a n t e d t o t h e

D e f e n d a n t s

. Ma r t i n

, 2 7 1 S

. W

. 3 d a t 8 4

. W i t h r e s p e c t t o o u r c o n s i d e r a t i o n o f t h e C l i f f o r d ’ s

m o t i o n f o r p a r t i a l s u m m a r y j u d g m e n t o n t h e m e d i c a l b a t t e r y c l a i m

, w e f i n d t h a t t h e r e i s a

g e n u i n e i s s u e o f m a t e r i a l f a c t a s t o w h e t h e r M r

. C l i f f o r d s u f f e r e d a n i n

j u r y a s a r e s u l t o f t h e

c a r d i a c c a t h e t e r i z a t i o n p r o c e d u r e

.

T h e m a t e r i a l s s u b m i t t e d b y t h e D e f e n d a n t s i n s u p p o r t o f t h e i r m o t i o n s f o r s u m m a r y

j u d g m e n t w e r e s u f

f i c i e n t t o n e g a t e a n e s s e n t i a l e l e m e n t o f t h e C l i f f o r d s ’ c l a i m s

, v iz

. , t h a t M r

.

C l i f f o r d ’ s i n j u r y w a s c a u s e d b y t h e u s e o f t h e d e v i c e

. T h e a f f i d a v i t s o f D r

. T a c o g u e a n d D r

.

U s k a v i t c h a n d t h e r e p o r t f r o m t h e i n d e p e n d e n t m e d i c a l e x a m i n a t i o n s t a t e d t h a t t h e r e w a s n o

c a u s a l c o n n e c t i o n b e t w e e n t h e u s e o f t h e d e v i c e a n d M r

. C l i f f o r d ’ s n e r v e d a m a g e

. I n

a d d i t i o n

, t h e e x c e r p t s o f t h e d e p o s i t i o n s o f t h e C l i f f o r d s ’ e x p e r t w i t n e s s e s f i l e d b y

D e f e n d a n t s s u p p o r t e d t h e i r c o n t e n t i o n t h a t t h e C l i f f o r d s c o u l d n o t s h o w c a u s a t i o n b e c a u s e

t h e e x p e r t s e i t h e r r e f

u s e d

, w e r e n o t q u a l i f

i e d

, o r w e r e u n a b l e t o p r o v i d e c a u s a t i o n t e s t i m o n y

.

D r

. L e d b e t t e r a d m i t t e d t h a t s h e w o u l d n o t b e o p i n i n g o n c a u s a t i o n i n t h i s m a t t e r

. D r

. F i l l e r

w a s n o t q u a l i f

i e d t o o f f e r a c a u s a t i o n o p i n i o n p u r s u a n t t o T e n n

. C o d e A n n

. § 2 9

- 2 6

- 1 1 5 ( b )

b e c a u s e h e w a s n o t a p h y s i c i a n p r a c t i c i n g i n T e n n e s s e e o r a c o n t i g u o u s s t a t e

. N e v e r t h e l e s s

,

D r

. F i l l e r t e s t i f

i e d t h a t h e w a s s e r v i n g a s a “ p e r c i p i e n t w i t n e s s ” i n t h i s m a t t e r

, t h a t h e w a s

t e s t i f y i n g a s M r

. C l i f

f o r d ’ s “ c l i n i c a l p r o v i d e r

, ” a n d n o t a s a n e x p e r t w i t n e s s

. L a s t l y

, D r

.

G a m m e n t h a l e r t e s t i f

i e d t h a t h e d i d n o t h a v e t h e b e n e f i t o f r e v i e w i n g M r

. C l i f

f o r d ’ s c o m p l e t e

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

, w h i c h e x c l u d e d s o m e m e d i c a l r e c o r d s a n d a l l m e d i c a l i m a g i n g

, a n d a d m i t t e d

i n h i s a f f i d a v i t t h a t t h e m e d i c a l r e c o r d s h e w a s p r o v i d e d c o u l d n o t c o n f i r m t h e u s e o f t h e

T he Def end ant s’ re li ed on Dr. Uskavitch ’s af fi davit

, whic h con cl ude d tha t his re cor ds “r eveal [e d] 1 8

no obj ect ive, cl ini cal eviden ce of any ner ve inj ury,” and Dr. K aminski’s ind epe nde nt m edi cal exa m ina ti on

re por t, whic h fou nd tha t Mr

. Cli ff ord ’s “un der lying dia gnosis is a soma t o f o r m p ai n dis ord er ” in whic h

“ps ycholo gical fa ct ors ...pl ay a si gnifi can t rol e in the ons et

, sever it y, exa cer bat ion and m ai nte nan ce of pai n.”

T he Cli ff ord s’ re li ed upon Dr. Fil le r’ s af fi davit

, whic h con cl ude d tha t Mr

. Cli ff ord suf fe re d fr om a “multi ple

ner ve ent ra pm ent pro ble m ,” and Dr. Gam m ent hal er ’s af f i d a vi t

, w hic h st at ed tha t Mr

. Cli ff ord suf fe re d

“ex ces si ve tr auma” as a r esu lt of th e de vice’ s i m

pac t o n t he n er ves in th e “ vicin it y of t he f emoral ar te ry.”

-15-d e v i c e a s t h e c a u s e o f t h e i n j u r i e s

. H e a l s o t e s t i f

i e d t h a t h e c o u l d n o t “ d e t e r m i n e

. . . w h e t h e r

M r

. C l i f f o r d ’ s i n j u r i e s w e r e c a u s e d b y t h e u s e o f t h e [ d e v i c e ] o r b y t h e c a r d i a c

c a t h e t e r i z a t i o n i t s e l f

. ”

H a v i n g h a d a n e s s e n t i a l e l e m e n t o f t h e i r c l a i m s n e g a t e d

, t h e b u r d e n t h e n s h i f t e d t o t h e

C l i f f o r d s t o e i t h e r c o m e f

o r w a r d w i t h e v i d e n c e e s t a b l i s h i n g m a t e r i a l f a c t u a l d i s p u t e s t h a t

w e r e o v e r

- l o o k e d o r i g n o r e d b y t h e D e f e n d a n t s

, p r o d u c e a d d i t i o n a l e v i d e n c e e s t a b l i s h i n g t h e

e x i s t e n c e o f a g e n u i n e i s s u e o f f a c t f o r t r i a l

, r e h a b i l i t a t e t h e e v i d e n c e a t t a c k e d b y t h e

D e f e n d a n t s

, o r e x p l a i n t h e n e e d f o r f u r t h e r d i s c o v e r y

. S e e M c C a r l e y

, 9 6 0 S

. W

. 2 d a t 5 8 8 ;

B y r d

, 8 4 7 S

. W

. 2 d a t 2 1 5 ; H a n n a n

, 2 7 0 S

. W

. 3 d a t 8

- 9

. W e f i n d t h a t t h e C l i f

f o r d s f a i l e d t o

m e e t t h e i r b u r d e n o f p r e s e n t i n g s u c h e v i d e n c e

. T h e C l i f f o r d s o f f e r e d n o e v i d e n c e t o r e

e s t a b l i s h D r

. L e d b e t t e r ’ s o r D r

. F i l l e r ’ s q u a l i f i c a t i o n t o p r o v i d e c a u s a t i o n t e s t i m o n y

. D r

.

G a m m e n t h a l e r

, a s s t a t e d e a r l i e r

, c o u l d n e i t h e r d e t e r m i n e a n o b j e c t i v e c a u s e f

o r M r

.

C l i f f o r d ’ s i n j u r y f r o m h i s m e d i c a l r e c o r d s n o r c o u l d h e d e t e r m i n e a t w h i c h p o i n t i n t h e

a n g i o g r a m p r o c e d u r e t h e i n j u r y o c c u r r e d

. W h i l e D r

. G a m m e n t h a l e r d o e s c o n c l u d e i n h i s

a f f i d a v i t t h a t t h e u s e o f t h e d e v i c e “ m o r e l i k e l y t h a n n o t ” c a u s e d M r

. C l i f f o r d ’ s i n j u r y

, h e

s t a t e d t h a t t h i s c o n c l u s i o n w a s l a r g e l y b a s e d o n M r

. C l i f f o r d ’ s r e c i t a t i o n o f t h e p r o c e d u r e

,

w h i c h D r

. G a m m e n t h a l e r d e s c r i b e s a s a “ h y p o t h e t i c a l p r e m i s e

. ” L a s t l y

, w h i l e M r

. a n d M s

. 1 9

C l i f f o r d a s s e r t i n t h e i r a f

f i d a v i t s t h a t D r

. T a c o g u e a d m i t t e d t h a t s h e c a u s e d M r

. C l i f f o r d ’ s

i n j u r y

, t h e a f

f i d a v i t s p r e s e n t n o e v i d e n c e t o s u g g e s t t h a t t h e i n j u r y r e s u l t e d f

r o m h e r u s e o f

t h e d e v i c e ; r a t h e r

, t h e C l i f f o r d s s t a t e d t h a t D r

. T a c o g u e “ s o m e h o w ‘ d a m a g e d t h e n e r v e ’ ” a n d

t h a t s h e “ ‘ d a m a g e d t h e n e r v e ’ a t s o m e p o i n t i n t h e p r o c e d u r e

. ” ( E m p h a s i s a d d e d )

.

“T he cau sat ion of a m edi cal con dit ion m ust be est abl is hed by te st imony fr om a m edi cal exp er t.” 1 9

Jac kso n v. All en

, No. M2 000-01673- COA- R3- CV

, 2002 WL 6619 30, at *2 (T enn

. Ct. App. Apri l 23, 2002 ).

“[ A] m edi cal exp er t m

ust det er m ine tha t a cau sal con nec ti on exi st s bet ween [t he event in que st ion ] and the

inj ury to ‘a re aso nab le degree of m edi cal cer ta int y.’” Id

. “T hos e ‘mag ic word s,’ however

, nee d not be use d

for the exp er t opi nio n to suf fi ce as pro of of cau sat ion ,” but ra the r, “t he te st imony m ust sho w, as a whol e, tha t

it is m ore pro bab le t h a n n o t t h a t the [e vent] cau sed the inj ury.” Id

. “T he m er e pos si bil it y of a cau sal

re la ti ons hip

, wit hout m ore

, is ins uff ic ie nt to qua li fy as an admissi ble exp er t opi nio n.” Lin dse y v. Mi ami Dev.

Corp

. , 689 S.W .2d 856

, 8 6 1 ( T e n n

. 1985 ). Even tho ugh Dr. Gam m ent hal er use d the word s “r eas ona ble

m edi cal cer ta int y,” “pr oba bil it y,” and “more li kely tha n not ” to est abl is h t h e s ta nda rd upon whic h his

con cl usi on regard ing causa ti on was base d, his opi nio n was stil l req uir ed to sho w, “as a whole ,” that it was

m ore pro bab le tha n not tha t the use of the device cau sed Mr

. Cli ff ord ’s inj ury and tha t the use of the device

was not j ust one pos si ble cau se of his inj ury; thi s he was una ble to do. Dr. Gam m ent hal er admitt ed tha t his

opi nio n was bas ed sol el y on Mr

. Cli ff ord ’s des cr ipt ion of the pro ced ure and tha t he fou nd no m edi cal re cor ds

to sup por t thi s “hypot het ic al pre m is e.” He a l s o s ta te d tha t he was una ble to det er m ine

, fr om the m edi cal

re cor ds, whet her “t he ner ve inj ury re sul te d fr om the [ d e vi c e ]

, as oppo sed to oth er pos si ble events in a

cat het er izat ion .” Sin ce Dr. Gam m ent hal er cou ld not obj ect ively dis ti nguish the use of the device as the cau se

of Mr . Clif

for d’s inj ury fr om the re st of the angiogra m pro ced ure and si nce he base d hi s c onc lus ion sol el y

on Mr

. Cli ff

ord ’s des cr ipt ion of the pro ced ure

, whic h cou ld not be con fi rmed by the m edi cal re cor ds, we fi nd

tha t his opi nio n onl y off

er ed a pos si bil it

y as to the cau se of his inj ury and

, the re for e, was ins uff ic ie nt to

cr eat e a n i ssu e of

fa ct re gardi ng caus at ion in fa ct

. See Lin dse y, s upr a.

-16-I n t h e i r b r i e f o n a p p e a l

, t h e C l i f f o r d s a s s e r t

, f

o r t h e f i r s t t i m e

, t h e t h e o r y o f r e s i p s a

l o q u i t u r t o e s t a b l i s h c a u s a t i o n

. T h e y c o n t e n d t h a t

, w h i l e t h e i r e x p e r t s “ a c k n o w l e d g e [ d ] t h a t

t h e r e [ w e r ] e m u l t i p l e ‘ p o t e n t i a l

, p o s s i b l e ’ c a u s e s f o r t h e n e r v e d a m a g e ” a n d “ c o n c e d e d t h a t

t h e m e d i c a l r e c o r d s p r o v i d e [ d ] n o o b j e c t i v e b a s i s f o r d i s c e r n i n g o r p i n p o i n t i n g t h e e x a c t

m e c h a n i s m i n v o l v e d

, ” “ b o t h e x p e r t s c o n s i s t e n t l y s t a t e [ d ] t h a t c a u s a t i o n i s s u p p o r t e d b y t h e

f a c t s r e l a t e d b y M r

. C l i f f o r d ” t h a t h e “ e n t e r e d t h e r o u t i n e a n g i o g r a m p r o c e d u r e w i t h n o

f e m o r a l n e r v e d a m a g e

, a n d e m e r g e d f r o m t h a t p r o c e d u r e

. . . w i t h a s e a r i n g f e m o r a l p a i n

. ”

( E m p h a s i s i n o r i g i n a l )

. T h e C l i f f o r d s a l s o a d d r e s s f

o r t h e f i r s t t i m e t h e D e f

e n d a n t s ’

c o n t e n t i o n t h a t D r

. F i l l e r a n d D r

. G a m m e n t h a l e r w e r e u n a b l e t o p r o v i d e c a u s a t i o n t e s t i m o n y

b e c a u s e t h e y w e r e n o t q u a l i f i e d o r l a c k e d a f

o u n d a t i o n

. T h e C l i f

f o r d s a s s e r t t h a t D r

. F i l l e r

a n d D r

. G a m m e n t h a l e r w e r e p r o v i d e d w i t h s u f f i c i e n t f o u n d a t i o n u p o n w h i c h t o p r o v i d e

c a u s a t i o n t e s t i m o n y a n d t h a t t h e w a i v e r p r o v i s i o n o f T e n n

. C o d e A n n

. § 2 9

- 2 6

- 1 1 5 s h o u l d

a p p l y t o a l l o w D r

. F i l l e r t o t e s t i f y ; a s n o t e d a b o v e

, n e i t h e r o f t h e s e c o n t e n t i o n s w e r e 2 0

p r e s e n t e d i n t h e c o u r t b e l o w

.

“ [ I ] s s u e s n o t r a i s e d i n t h e t r i a l c o u r t c a n n o t b e r a i s e d f o r t h e f i r s t t i m e o n a p p e a l

. ”

S i m p s o n v

. F r o n t i e r C m t

y

. C r e d i t U

n i o n

, 8 1 0 S

. W

. 2 d 1 4 7

, 1 5 3 ( T e n n

. 1 9 9 1 )

. “ T h i s C o u r t

c a n o n l y c o n s i d e r s u c h m a t t e r s a s w e r e b r o u g h t t o t h e a t t e n t i o n o f t h e t r i a l c o u r t a n d a c t e d

u p o n o r p e r m i t t e d b y t h e t r i a l c o u r t

. ” I r v i n v

. B i n k l e

y

, 5 7 7 S

. W

. 2 d 6 7 7

, 6 7 9 ( T e n n

. C t

. A p p

.

1 9 7 8 ) ( c i t i n g C l e m e n t v

. N i c h o l s

, 2 0 9 S

. W

. 2 d 2 3 ( T e n n

. 1 9 4 8 ) )

. B e c a u s e t h e C l i f f o r d s d i d

n o t r a i s e t h e i s s u e o f r e s i p s a l o q u i t u r w i t h t h e t r i a l c o u r t

, w e a r e u n a b l e t o c o n s i d e r t h e i r

r e l i a n c e o n t h e t h e o r y t o e s t a b l i s h c a u s a t i o n

. F o r t h e s a m e r e a s o n

, t h e i r a s s e r t i o n t h a t t h e i r 2 1

e x p e r t s h a d a p r o p e r f

o u n d a t i o n t o p r o v i d e c a u s a t i o n t e s t i m o n y a n d t h e i r a p p l i c a t i o n o f t h e

w a i v e r p r o v i s i o n o f T e n n

. C o d e A n n

. § 2 9

- 2 6

- 1 1 5 t o q u a l i f y D r

. F i l l e r t o p r o v i d e c a u s a t i o n

t e s t i m o n y c a n n o t b e c o n s i d e r e d

. 2 2

T enn

. Code An n

. § 29- 26- 115( b) st at es tha t the cou rt “may wai ve thi s sub sec ti on (b) when it 2 0

det er m ine s t hat th e a ppr opr ia te wit nes ses ot her wis e wou ld not be avail abl e.”

“[ R]e s ips a loq uit ur is a for m of ci rc um st ant ia l eviden ce tha t per m it s, but doe s not compel, a j ury 2 1

to inf er negli gence fro m the ci rc um st anc es of an inj ury.” Sea ver s v. Me tho dis t Me d. Ctr

. , 9 S.W.3d 86, 91

(T enn

. 1999 ). A pla int if f ass er ti ng the the ory o f r e s i p s a loq uit ur “must demonst ra te tha t he or she was

inj ure d by an ins tr um ent al it y tha t was wit hin the def end ant ’s exc lus ive con tr ol and tha t the inj ury woul d not

ord ina ri ly have occ urr ed in the abs enc e of negli gence.” Id

. See als o T enn

. Code Ann. §§ 29- 26- 115 (c ) and

(d)

. Our re view, of

cou rs e, i s c onf

ine d t o t he r eco rd of ple adi ngs and pr oce edi ngs in th e c our t bel ow and

,

even if we w e r e t o a d d r e s s thi s is sue

, we cou ld not ass um e tha t the par ti es woul d have bee n af for ded the

oppo rt uni ty to develo p t he r eco rd suf fi ci ent fo r o ur dis pos it ion of th e i ssu e.

Assu m ing, arg uen do

, tha t thi s Cour t was abl e to con si der the wai ver pro visio n of thi s st at ute

, we 2 2

nevert hel ess fi nd tha t the Cli ff ord s fa il ed to m eet the ir bur den for invoking it

. T he Cli ff ord s ass er t tha t, “[ a] s

a tr eat ing physic ia n who per for m ed two sur gerie s..., Dr. Fil le r, as a spe ci al is t wit h uni que knowled ge of Mr

. ( c o n t i n u e d

. . . )

-17-C o n s e q u e n t l y

, w e f i n d t h a t t h e D e f

e n d a n t s s u c c e s s f

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

o f e a c h c a u s e o f a c t i o n a n d t h a t t h e C l i f f o r d s d i d n o t e s t a b l i s h a g e n u i n e i s s u e o f m a t e r i a l f a c t

t o p r e c l u d e s u m m a r y j u d g m e n t t o t h e D e f e n d a n t s

. W e f

u r t h e r f i n d t h a t t h e e v i d e n c e

p r e s e n t e d b y t h e C l i f

f o r d s f a i l e d e s t a b l i s h t h e i r e n t i t l e m e n t t o j u d g m e n t a s a m a t t e r o f l a w

o n t h e i r c l a i m o f m e d i c a l b a t t e r y

. A s n o t e d h e r e i n

, t h e o t h e r i s s u e s r a i s e d b y t h e C l i f f o r d s

a r e w i t h o u t m e r i t

.

V

. C o n c l u s i o n

F o r t h e r e a s o n s s e t f

o r t h a b o v e

, t h e t r i a l c o u r t ’ s j u d g m e n t i s A F F I R M E D

. C o s t s o f

t h i s a p p e a l a r e a s s e s s e d a g a i n s t t h e C l i f f o r d s f o r w h i c h e x e c u t i o n m a y i s s u e i f n e c e s s a r y

.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ R I C H A R D H

. D I N K I N S

, J U D G E

(

. . . c o n t i n u e d ) 2 2

Cli ff ord ’s pro ble m s, can not be sup pla nte d by a T enn ess ee (or a con ti guous st at e) spe ci al is t [t hat ] pos ses s[ es]

the sa m e i nsi ght as Dr. Fil le r.” “Uniqu e k nowl edge” of an ex per t, h owever, is not suf fi ci ent to in vok e t he

w a i ve r p rovis ion and

, ins te ad, the re m ust be pro of tha t an app rop ri at e wit nes s was una vaila ble ; thi s t h e

Cli ff ord s did not do. Cons equ ent ly, the y fa il ed to suc ces sf ull y invoke the wai ver provisi on of Te nn. Code

Ann. § 29- 26- 115( b). Ste el e v. Ber kman

, No. M2 005-02935- COA- R9- CV

, 2006 WL 6271 85, at *2 (T enn

. Ct. App. M ar

. 14, 2006 ) (de cl ini ng t o wai ve t he con ti guous st at e re qui re m ent bec aus e the pla int if f “made

no ef for t to fi nd,” and pre sen te d “no pro of re gardi ng the avail abi li ty of [

, ] a n a p p r o pri at e exp er t fr om

T enn ess ee or a c ont iguous st at e.” ).

-18-