### IN THE COURT OF APP EALS OF TENNESS EE ATJAC KSON January 21, 201 0 S es sio n EFFIE RIVERS v. NORTHW EST T ENNESSE E HUMAN RESO URCE AGENCY

A p p ea l f ro m th e C ircu it C o u rt fo r C a rr o llC o u n ty N o. 08C V 25 D onal d E . P ari s h, Judge

N o. W 2009- 01454- C O A - R 3- C V - F i l ed A pri l 19, 2010

T h is i s a p erso n al i n

juryca se. T h e d ef

en d an t’ s em p loy ee n eg li g en tl y b ac k ed the d ef en d an t’ s vehi cl e i nt o t he vehi cl e i n w hi ch the pl ai nt i ff w as a p asse n g er. Pr i ort o t he ac ci dent , t he pl ai nt i ff ha d r epor t ed di s comforti n her s houl der s t o her phy s i ci an. A t s om e poi ntaft ert he ac cide n t, the p lai n tif

f re p o rt ed to h er p h y sici an that sh e h ad p ain in h er righ t sho u lder. U l t i m at el y , t he pl ai nt i ff r equi r ed s houl derr epl ace m ent su rgery . T he pl ai nt i ff s ued the defe ndantfornegl i gence . T he par t i es s t i pul at ed t o t he defe ndant ’ s l i abi l i t y , and a benc h t r i al w as hel d o n cau sat i on and dam ages. B ased i n p a rt o n d e p o si t i on t est i m on yof p hy si ci ans, t he tr i al cour tfound thatt he ac ci dentcaus ed the pl ai nt i ff’ s i nj ur yand the ens ui ng s ur geryand e n t e r e d j u d g me n tf

o rt h e p l a i n t i f

f

. Th e d e f

e n d a n ta p p e a l s . W e a f

f i r m. T enn. R . A pp. P . 3 A ppeal as of R i ght ; Judgm ent of

t he C i rcui t C ourt A f

f i rm ed H OLL Y M. K IR BY , J. , del i ver ed the opi ni on of the C our t , i n w hi ch A LAN E. H I G HERS , P .J ., W .S ., and J. S TEV EN S TAFFORD , J

. , j oi ned. R ober tO

. B i nkl ey , J r . and J ames V

. T hom ps on, J acks on, T ennes s ee, fort he D efe ndant/ A ppel l ant , N or t hw es tT ennes s ee H um an R es our ce A gency R ickyL

. B o ren , Jac k so n , T en n esse e, fo r th e P lai n ti ff /A p p ell ee , E ff

ie R ivers-2- OP I NI ON F AC T S AN D P ROCEDURAL H I ST ORY In A p ril 2 0 0 7 , P lain tiff /A p p e lle e E f

f ie R iv e rs ( “ M s. R iv e rs” ) w a s a se v e n ty -f iv e y e a r o ld w i dow , r et i r ed af

t erw or ki ng for m any y ear s i n a l ocal ar s enal , i n t he fi el ds , and cooki ng and cl ea n i n g f

o rl o c a l r e s i d e n t s . Sh e a n d h e rh u s b a n d r a i s e d t wel v e c h i l d r e n . M s . Ri v e r s had s om e art hr i t i s i n her sh o u lder s and el s ew her e, a l ongs t andi ng hi s t or yof che s tpai n and h e a d a c h e s, a n d h a d h a d k n e e re p lac e m e n t su rg e ry , b u t sh e to o k c a re o f h e rse lf , an d d id canni ng, baki ng, and s ew i ng. O n A pr i l 24, 2007, M s. R i ver s had bee n dr i ven t o an appoi nt m entatt he off i ce of her l ongt i me p r i ma r yc a r e p h y s i c i a n , J a me s W i l l i a ms o n , M

. D. ( “ Dr

. W i l l i a ms o n ” ) , t o r e c e i ve al l ergyshots

. S he w as i n the passenger seat of a F ord T aurus autom ob i l e. W hen M s. R i vers’ dr i verpul l ed i nt o D r . W i l l i amson’ s par ki ng l ot , t hey encount er ed t r aff i c conges t i on neart he e n tra n c e to th e b u ild in g . R a th e r th a n p a rk in g a n d w a lk in g to th e b u ild in g , the yp u lled in behi nd a van a nd w ai t ed fort he tr aff i c at the entr ance t o cl ear . T he van w as ow ned by D efe ndant/A ppel l antN orth w est T en n esse e H u m an R eso u rce A g en cy(“N o rth w est ”) and w as o p era ted b yD ef

en d an t M icha el R idg ely(“R idg ely ”). W h ile M s. R iv e rs’ v e h icle w a s w a iti n g a t a sta n d still, R id g e lyb a c k e d th e N o rth w e st v a n in to t he fr ontof the For d T aurus i n w hi ch M s . R i ver s s at

. M s . R i ver s s aw t he i m pendi ng col l i s i on and bra ced f

ort he i m pactbypl aci ng herr i ghthand on the das hboar d. W hen the van s t ruck th e c a r, M s. R iv e rs m o v e d f o rw a rd a g a in st he r se a tb e lt a n d th e n ro c k e d b a c k in to h e r se a t. T h e c o ll isi o n cra ck ed a h ea d li g h t l en s o n the F o rd T au rus an d d en ted th e va n ’s rea r bu m p er. W i t hi n a fe w m i nut es aft ert he ac ci dent , M s . R i ver s w ent i nt o D r . W i l l i amson’ s offi ce a nd w as ex am i ned by him

. F res h from t he co l l i si on , she com plai ned of p ai n in her upp er chest an d b ac k an d so m ew h at all o v er. D r. W il li am so n ex am ined M s. R ivers a n d n o ted h er rep o rt o f p a in . A t th a t ti m e , h e a p p a re n tlyd id n o t trea t h e r p a in o r re f e r h e r to a sp e c ialist. D u ri n g M ay2 0 0 7 , the m o n th af ter th e a cc iden t, M s . R ivers sa w D r. W il li am so n tw ice. I n t he fi r s tappoi nt m ent , M s . R i ver s agai n r epor t ed pai n i n herupperches t , l egs , hi p, and bac k. A ft eran exa m i nat i on, D r . W i l l i amson not ed t endernes s i n herupperches ton t he r i ghts i de, a b o v e a n d a ro u n d th e rig h t b re a st. T h e se c o n d a p p o in tm e n t w ith D r. W ill iam so n a p p a re n tly conce r ned unr el at ed m edi cal i s s ues per t ai ni ng t o a s t om ach i l l nes s , as w el l as pai n i n her back, hi p, and l eg. O n Ju n e 2 0 , 2 0 0 7 , M s. R iv e rs h a d a n o th e r a p p o in tm e n t w ith D r. W ill iam so n . A t th a t v isit, M s . R iv e rs co m p lai n ed to D r. W il li am so n that sh e h ad p ain in h er righ t sho u lder. D r.In h is dep osition testimony , D r. S tein d escribed the proced

ure a s follow s: 1 [Y]ou no rm ally

think of the shoulde r as a ba ll fittinginto a cu p an d theno rm al total shou lder b asically

recreate s the bal l and recreate s the cup. The rev erse sh oulder replacement stands ev erythingon its h ead and puts the b a l l w here the cu p is and the cu

p whe re the ball is. After the consent orde r dismissingthe claim ag ainst Ridg ely

w as entered, Northwest filed an 2 am ended ans wer contain ingthe sam e admission of liabilityand denial of causatio n. T he p arties do no t raise th e fi li ng o f ei th er th e orde r or

th e amen de d an sw er

a s an is su e on a pp ea l. -3- W i l l i amson arr anged f oran M R I of M s . R i ver s ’ r i ghts houl d er. A ft erD r . W i l l i amson r e v i e we d t h e M RI , M s . Ri v e r s wa s r e f e r r e d t o o r t h o p a e d i c s u r g e o n Ro b e r tE

. S t e i n , M

. D. (“D r. S tei n ”) f

o r trea tm en t. D r. S tei n h ad p erf o rm ed M s. R ivers’ k n ee rep lace m en t surg ery i n Sept ember 2005. W hen M s . R i ver s s aw D r . St ei n i n A ugus t2007, D r . St ei n r evi ew ed the M R I D r . W i l l i amson h ad o rde red

. T h e M R I sh o w ed a c o m p let e a b sen ce o f th e ro tat o r cu ff o n the righ t sho u lder. D r. S tein th e n o r d e r e d a n x -ra y , w h ich re v e a led se v e re a rth ritis in th e rig h t sh o u ld e r w ith bone- on- bone cont act

. A ft erphy s i cal t her apy pr oved uns ucce s s ful , D r . St ei n r ecomm ended s ur geryon M s . R i ver s ’ r i ghts houl der

. Subse quent l y , i n O ct ober 2007, D r . St ei n per for m ed a re v ers e t ot al s houl derr epl ace m ent on M s . R i ver s . A ft ert hat , s he underw entext ens i ve 1 p h y sical th era p yto aid h er rec o v ery . D esp it e the su rge ry an d p h y sical th era p y , M s. R ivers w as l eftw i t h l i m i t ed r ange of m ot i on i n herr i ghts houl der , as w el l as s om e r es i dual pai n. O n A p r i l 2 2 , 2 0 0 8 , M s . R iv e rs f ile d th e in s ta n t la w s u it a g a in s t N o rt h w e s t a n d R id g e ly, see k ing $ 3 0 0 , 0 0 0 in d am ag es. In the co m p lai n t, M s. R ivers a ll eg ed that sh e su stai n ed sev ere per s onal in

juri es as a r es ul tof the aut om obi l e ac ci dentcaus ed byR i dgel y ’ s negl i gence . N or t h wes ta n d Ri d g e l ya n s wer e d t h e c o mpl a i n ta n d a d mi t t e d t h a t , whi l e i n t h e c o u r s e a nd s cope of hi s empl oym ent , R i dgel yhad backe d t he N or t hw es t van i nt o t he vehi cl e occ upi ed b yM s. R iv e rs. H o w e v e r, th e yd e n ied th a t M s. R iv e rs h a d su sta in e d se v e re in ju rie s d u e to th e a c c id e n t. D isco v eryen su ed , an d ev en tuallyM s. R ivers’ c lai m s ag ains t R idg elyw ere d ism issed

. In 2 ant i ci pat i on of tr i al , N or t hw es tr et ai ned J ames C. V arner , M

. D

. (“D r. V arner ”) , an o rth o p ae d ic su rge o n , as a n ex p e rt w itn ess. T h e p arti es d ep o sed , am o n g o thers, D r. W il li am so n , D r. S tei n , an d D r. V arn er. P ri o r to tri al, the p arti es stipu lat ed to N o rth w est’s l i abi l i t y , l eavi ng onl yi s s ues of ca us at i on and damages t o be dec i ded.-4-

O n A pr i l 22, 2009, t he t r i al cour t conduct ed a bench t r i al

. Fi ve w i t nes s es t es t i fi ed, i ncl udi ng M s . R i ver s . Si x exhi bi t s w er e ent er ed i nt o evi dence , i ncl udi ng t r ans cr i pt s of the depos i t i ons o f D rs. W il li am so n , S tei n , an d V arn er. M s . R i ver s t es t i fi ed as t o herbackgr ound. She i ni t i al l y deni ed t hat s he had ha d pai n i n her sh o u ld e r p r io r to th e a c c id e n t, an d th e n su b se q u e n tlya llo w e d th a t sh e h a d h a d “ a little ar t hr i t i s pai n. ” W hen t he ac ci dentoccurr ed, M s . R i ver s s ai d, s he br ace d herr i ghthand on th e d a sh b o a rd in f

ro n t o f h e r, a n d th e im p a c t c a u se d h e r t o g o f o rw a rd a n d th e n ro c k b a c k in hers eat

. A ft erD r . W i l l i amson r efe r r ed her t o a s peci al i s tforphy s i cal t her apy , s he s ai d, her s ho u l d e r p a i n wor s e n e d

. M s . Ri v e r s s a i d t h a t s h e “ h u r t e d , c r i e d wi t h p a i n s . ” A ft er t he s ur geryand addi t i onal phy s i cal t her apy , s he s ai d, s he w as l eftunabl e t o cook, s ew , oreven rea ch u p fa r en o u g h to b rush h er o w n h air. In h is d e p o sitio n , D r. W ill iam so n tes tifie d th a t M s. R iv e rs h a d b e e n h is p a tien t f o r o v e r th irty y ear s , and thathe had t r eat ed her for a var i ety of ai l m ent s . H e not ed t hat M s . R i ver s s uffe r ed fr om ar t hr i t i s i n m anypar t s of herbody , butm os t l yi n her hi ps and knees

. A ft era r evi ew of M s . R i ver s ’ m edi cal r ecor ds , he r ecal le d t hats he had c om pl ai ned of pa i n i n herr i ght sh o u lder a s fa r ba ck as O ctob er 2 0 0 4 ; h e h ad attri b u ted the p ain to h er g en era l arth ri ti s. D r. W ill iam so n ’s r e c o rd s n o ted th a t M s. R iv e r s r e p o rte d p ro b lem s w ith h e r rig h t sh o u ld e r in A p ril 2 0 0 6 , Ju ly2 0 0 6 , S e p tem b e r 2 0 0 6 , an d M a rc h 2 0 0 7 , o n e m o n th p rio r to th e a c c id e n t. O n t he dayt hatD r . W il li amson s aw M s . R i ver s i m m edi at el yaft ert he ac ci dent , s he m ent i oned onl yupperback and ches t pai n, he sai d. H e ac know l edged thatM s . R i ver s m ade no compl ai ntof pai n i n herr i ghts houl derunt i l J une 20, 2007, so m e tw o m ont hs aft ert he a c c id e n t. W h e n a sk e d w h e th e r th e re w a s a c a u sa l re latio n sh ip b e tw e e n th e a u to m o b ile ac cide n t and the c o m p li ca ti o n s M s . R ivers h ad ex p erien ce d w ith h er righ t sho u lder, D r. W i l l i amson ans w er ed af fi r m at i vel yand s t ated : “Y eah. I fee l i t[M s . R i ver s ’ s houl der c o m p lica tio n s] w a s d u e to th e a c c id e n t b e c a u se , li k e I sa id , sh e h a d n ’t h a d a n yre a lly sig n if ica n t p ro b lem s w ith [ th e sh o u ld e r] p rio r to th a t.” D r. W ill iam so n c o n c e d e d th a t, w ith in the tw o -m o n th p eriod af ter the ac cide n t, M s. R ivers did no t co m p lai n o f p ain o r disco m fo rt sp e c if ica llyin h e r sh o u ld e r. H o w e v e r, h e f e lt th a t th e ten d e rn e ss in h e r c h e st a re a n o ted in heroffi ce vi s i ti n M ay2007 w as “conne ct ed ” to the subs equent l ydi agnos ed s houl der pr obl ems and her s houl ders ur gery . D r . W i l l i amson ac know l edged thathe had no s peci al i zed t ra in i ng i n o rtho paed i cs and n o ex peri ence w i t h sho ulderproblem s such as M s. R i vers’ condi t i on. I n hi s depos i t i on, D r . St ei n t es t i fi ed that M s . R i ver s came t o s ee hi m on A ugus t20, 2007, for pai n i n herr i ght s houl der

. H e t ook a hi s t or y fr om her , i n w hi ch s he t ol d hi m t hatherr i ght s houl der“had gi ven her t r oubl e for about four m ont hs

. ” M s . R i ver s connec t ed the ons etof-5-

h e r sh o u ld e r d if

f icu ltyw ith th e a u to m o b ile a c c id e n t, t e lli n g D r. S tein th a t “th e se a tb e lt a p p a re n tly je rk e d h e r s h o u ld e r a n d s h e h a d p a in th e re a f te r.” A ft er exam i ning M s. R i vers and takin g an x-r ayof h er s ho ulder , D r. S t ei n d i agn osed M s. R iv e rs w ith se v e re a rth ritis in th e sh o u ld e r, n o tin g th e c o m p lete a b se n c e o f a ro tato r c u f f in t he joi nt. U l t i m at el y , he p erform ed the r everse t otal shou l der r eplacem ent s urgeryon M s. R iv e rs ’ r ig h t s h o u ld e r. I n hi s t es t i m ony , D r . St ei n s t at ed t hat M s . R i ver s had a l ongs t andi ng ar t hr i t i c condi t i on t hat p re -d a ted th e A p ril 2 0 0 7 a u to m o b il e a c c id e n t. H e n e v e rth e les s f e lt th a t th e m o to r v e h icle acc i dentnece s s i t at ed the s ur gery : “I tw oul d appea rt hatM r s . R i ver s bas i cal l yhad an under l y i ng s ever e art hr i t i c condi t i on t hat w as atl eas ts t abl e, and byhi s t or y , as a r es ul tof the acc i dent , w hatw as s t abl e w as s uddenl ys ym pt om at i c. ” D r . St ei n acknow l edged that , i f the a c c id e n t w e re th e c a u se o f M s. R iv e rs’ sh o u ld e r p ro b lem s, “ th e n I w o u ld sa y th a t y o u w o u ld e x p e c tt h a t[ s h o u l d e rp a i n ] t o b e g i n s h o r t l ya f t e rt h e a c c i d e n t , wi t h i n a f e w d a y s . ” He te s tif ie d th a t h is o p in io n o n c a u s a tio n , i

. e. , t hatt he ac ci dentw as t he ca us e of t he condi t i on that necessi t at ed M s. R i vers’ surger y , w as based on the hi st ory t hat sh e g a v e h im ; s peci fi cal l y , hers t at ement t hatt he s eatbel t j erked hers houl deri n t he ac ci dentand s he had had pai n evers i nce. N o rth w e st p ro f

f e re d th e tes tim o n y o f D r. V a rn e r on w h e th e r th e re w a s a c a u sa l re latio n sh ip betw een the aut om obi l e ac ci dentand M s . R i ver s ’ s houl ders ur gery . D r . V arner ’ s t es t i m ony w as bas ed on a r evi ew of M s . R i ver s ’ m edi cal r ecor ds and the depos i t i ons of D r . W i l l i amson an d D r. S tei n . D r. V arn er d id n o t spe ak w ith M s. R ivers o r ex am ine h er. D r . V arnerconcurred w ith D r. S tei n ’s op inion that M s. R ivers’ u n d erly ing sh o u lder c o n di t i on pr e- dat ed the aut om obi l e ac ci dent

. L i ke D r . St ei n, D r . V arneral s o s ai d t hati f the ac ci dent w er e th e ca u se of M s . R i ver s ’ s houl dercompl i cat i ons , t hen the s houl derpai n s houl d have m ani fes t ed w i t hi n one or t w o day s aft er t he acci dent

. D r . V arnerbel i eved thatt he ac ci dent d i d n o t n e c e s s i t a t e M s . Ri v e r s ’ s u r g e r y , s t a t i n g : “ [ I ] t i s my o p i n i o n t h a t t h e p a t h o l ogy t hat n e c e ss itate d th is s u rg ica l p ro c e d u re p re d a ted th e a c c id e n t as d e sc rib e d , an d th e re f o re I d id n o t se e a cau sat io n a l re latio n sh ip b e tw e e n th e d e sc rib e d a c c id e n t o f 4 -2 1 -0 7 a n d th e n e c e ss ity fors ur gi cal i nt er vent i on. ” D r . V arner s ai d t hat , at s om e poi nti n t he pas t , M s . R i ver s had had a tea r o f th e ro tato r cu ff that resu lt ed in a c h ron ic arthrit ic co n d it ion

. In re v iew ing D r. W i l l i amson’ s r ecor ds aft er t he acci dent , he saw no compl ai nt s of pai n l ocal i zed t o t he r i ght s houl derand the rot at or cuff ar ea unt i l J ul y 20, 2007. I tw as D r . V arner ’ s opi ni on t hatt he fac t t hat M s . R i ver s di d not des cr i be s peci fi c s houl der s ym pt om s unt i l m ont hs aft er the a c c id e n t “w o u ld a rg u e a g a in st s p e c if ica lly th e a c c id e n t as a c a u sa tiv e a g e n t” w ith re g a rd to t he s ur gery . B as ed on M s . R i ver s ’ pr e- exi s t i ng chr oni c condi t i on and abs ence of a r ot at or c u f f in h e r rig h t sh o u ld e r, co u p led w ith th e lac k o f a n yc o m p lain t b yM s. R iv e rs s p e c if ica lly-6-

r el at ed t o t he righ t sh o ul derunt i l m ont hs aft ert he ac ci dent , D r . V arnerconcl uded thatt he su rg e ryw a s n o t n e c e ss itate d b yth e a c c id e n t. A ft e rc o n s i d e r i n g t h e e v i d e n c e p r e s e n t e d , i n c l u d i n g t h e d e p o s i t i o n t e s t i mon yo f t h e t hr ee p h y sici an s, the t ri al co u rt fo u n d that the m o tor v eh icl e acc iden t resu lt ed in a “ sev ere aggr avat i on” of M s . R i ver s ’ pr eexi s t i ng condi t i on and aw ar ded damages of $202, 593. 88 by or al rul i ng. O n M ay 4, 2009, t he t r i al cour t ent er ed a w r i t t en orde rcons i s t entw i t h t he pr i or o ra l ru lin g . N o rt h w e s t n o w a p p e a ls

.

I SS UE ON A PPE AL AN D S T AN DA RD OF R EVIE W O n appea l , N or t hw es tar gues t hatt he tr ial courterr ed i n fi ndi ng t hatt he A pr i l 24, 2007 acc i dentcaus ed M s . R i ver s ’ s houl der condi t i on, s ur geryand damages

. T hus , t he s ol e i s s ue on appea l i s t hatof ca us at i on. S ince this case w as tr ied b y the tr ial co u rtsitti n g w ith o u t a j u ry , w e re v iew the tri al co u rt ’s f in d in g s o f

f a c t de novo aff

ordi ng a pr es um pt i on of corr ectnes s unl es s t he evi dence p re p o n d e ra te s to th e c o n tr a ry. T ENN

. R. A PP

. P. 1 3 (d ); N as hvil le For d T

r actor , I nc. v. G r eat A m . I ns. Co. , 19 4 S

. W

. 3d 41 5, 42 4 ( T enn . C t

. A pp . 20 05 ). “[C ]ausat i on i n a n egli gen ce case i s a ques t i on of fa ct

. ” H aines v. Henr

y C ount y B d. of E duc. , N o. W

. 2008- 02532- C O A

- R 3- C V , a t * 7 (T e n n . C t. A p p . F e b . 1 1 , 2 0 1 0 ), no per m . app. ( quot i ng Jones v. Shel by Ct y. Ci v. of Corr. , N o. W 2007- 00198- C O A

- R 3- C V , 2008 W L 366151, at *5 ( T enn. C t

. A pp. Feb. 12, 2 0 0 8 ), no per m . app. ). W e not e the l evel of def er ence acc or ded t o t he tr i al cour t ’ s det erm i nat i ons r egar di ng t he credi bil i t yof the w i t nesses: W hen the r es ol ut i on of the i s s ues i n a ca s e dep en d s u p o n t he trut hful nes s of w itn e ss e s, th e f

a c t-f in d e r, w h o h a s the o p p o rtu n ityto o b se rv e th e w itn e ss e s in th e ir m a n n e r a n d d e m e a n o r w h ile te stif y in g , is in a f

a r b e tter p o sitio n th a n th is C o u rt to d e c id e th o s e is s u e s . Mach . S ales Co. , Inc. v. D iam on dcu t Forestry Pr o d s . , LLC , 102 S. W

. 3d 638, 643 ( T enn. C t

. A pp. 2002)

. H ow ever , “[w ] hen t he i s s ues i nvol ve expe r tm edi cal t es t i m onyt hati s cont ai ned i n t he r ecor d by deposit ion , det er m i nat i on of the w ei ghtand cr edi bi l i t yof the evi dence nece s s ar i l ym us tbe dr aw n fr om t he cont ent s of the depos i t i on s, and the re v ie w in g c o u r t m a y d ra w its o w n c o n c lu s io n s w ith re g a rd to th o s e is s u e s .” For em an v. A utom ati c Sys . , I nc. , 272 S. W

. 3d 560, 571 ( T enn. 2008) ( ci t i ng O r r i ck v. B es tw ay Trucking, I nc. , 1 8 4 S

. W

. 3 d 2 1 1 , 2 1 6 (T en n . 2 0 0 6 )).-7-

H aines , 2 0 1 0 W L 4 5 7 5 0 2 , at *7

. T h u s, w e a c c o rd g re at de fe ren ce to the tr ial co u rt ’s as s es s m entof the t es t i m onyof w i t nes s es w ho t es t i fi ed i n open court

. A s t o t he depos i t i on t es t i m ony of t he exper t s i n t hi s cas e, t he appe l l at e courtm aydr aw i t s ow n concl us i ons on t he w i t n e s s e s ’ c r e d i b i l i t y. A N A LY S IS N or t h wes ta r g u e s t h a tt h e t r i a l c o u r te r r e d i n f i n d i n g a c a u s a l r e l a t i o n s h i p b e t wee n t he au tom o b il e a cc iden t and the p rob lem s M s. R ivers e x p erien ce d w ith h er righ t sho u lder. U r gi ng t hi s C our t to m ak e it s ow n det erm i nat i on aboutt he cr edi bi l i t yand w ei ghtof the depos i t i on t es t i m onyof the thr ee phy s i cian s, N or t hw es tcont ends t hatt he evi dence p re p o n d e ra tes a g a in st a f in d in g o f c a u sa tio n . N o rth w e st a rg u e s th a t D r. V a rn e r’s o p in io n is t he mostacc ur at e and r el i abl e beca us e D r . V arner had t he mostcompl et e fa ctual foundat i on up on w hich t o re n d e r his op i nion, i n thatD r. V arnerw as aw are of bo t h M s. R i vers’ preexi st i ng arth ritic co nd i t i on and t he m echan i cs of t he au t om ob i l e acci den t

. N orthw est points o u t thatD r . W i l l i amson l acks t r ai ni ng i n or t hopaedi cs and i s pot ent i al l ybi as ed becau se he ha s a l on gst and i ng rel at i on shi p w i t h M s. R i vers. M oreove r, N orthw est e m p h a siz e s th a t D r. S tein ’s o p in io n is b a se d o n th e m e d ica l h isto ry M s. R iv e rs r e c ited to h im a n d a ss e rts tha t M s. R iv e rs p re se n ted a n in a c c u ra te m e d ica l h isto ryto D r. S tein i n t hats he d id n o t tell h im th a t sh e h a d c o m p lain e d o f sh o u ld e r p a in p rio r to th e a c c id e n t. I n r es pons e, M s . R i ver s not es t hat t he t r i al cour t cr edi t ed herl i ve t es t i m ony , and as s er t s t hat the i ssu e of ca u sati o n d ep en d s o n this cre d ibil ity d eterm ination as w ell as th e ex p ert t es t i m onyof D r s . W i l l i amson and S t ei n, w ho bot h exami ned M s . R i ver s . M s . R i ver s ar gues t hatD r . W i l l i amson i n par t i cul arw as i n t he bes tpos i t i on t o r enderan opi ni on as t o caus at i on, b e c a u se h e w a s f

a m ili a r w ith M s. R iv e rs’ c o n d iti o n b o th b e f o re a n d a f

ter th e a c c id e n t. C a u sa tio n is a d istin c t ele m e n t o f n e g lig e n c e , an d “ [ n ]o c laim f o r n e g lig e n c e c a n su c c e e d in th e a b s e n c e o f

” it. Ki l pa tr i c k v. Bry ant , 868 S. W

. 2d 594, 598 ( T enn. 1993 ) (cit i ng B ra dsh a w v. D ani el , 8 5 4 S .W .2 d 8 6 5 , 8 6 9 (T e n n . 1 9 9 3 )). “ C a u sa tio n , o r c a u se in f a c t, m eans t hat t he i nj ur y or harm w oul d not have occurr ed ‘ but for ’ t he defe n d an t' s negl i gent c o n d u c t

. ” I

d. (cit i ng Caldw el

l v. For d MotorCo. , 6 1 9 S .W .2 d 5 3 4 , 5 4 3 (T e n n . C t. A p p .1 9 8 1 ); W

yatt v. W innebago Indus. , I

nc. , 5 6 6 S

. W

. 2 d 2 7 6 , 2 8 0 (T en n . C t. A p p . 1 9 7 7 )). G ener al l y , expertm edi cal t es t i m onyi s nece s s aryt o es t abl i s h caus at ion o f a medi cal c o n d itio n . Mil

le rv . Cho o Cho o Pa r tne rs, L. P. , 73 S. W

. 3d 897, 901 ( T enn. C t

. A pp. 2001) ( ci t i ng T hom as v. A et

na L i f e & Cas . Co. , 8 1 2 S

. W

. 2 d 2 7 8 , 2 8 3 (T en n . 1 9 9 1 )). In h e r te stim o n y , M s. R iv e rs d e sc rib e s e lo q u e n tlyth e d e b ili tatin g p a in in h e r sh o u ld e r, b o th befor e and a ft ert he s ur gery , and her bel i ef thatt he ac ci dentw as t he ca us e of thi s condi t i on. S h e in d ica ted th a t an yd isc o m f o rt in h e r sh o u ld e r p rio r to th e a c c id e n t w a s m in im a l.-8-

N ow her e i n hert es t i m ony , how ever , does s he s t at e w hen t he p ai nfu l shou l der sym ptom s fi rs t a ro se , an d sp e c if

ica lly , h o w so o n a f

ter th e A p ril 2 4 , 2 0 0 7 c o lli sio n . B o th o rth o p a e d ic s peci al i s t s , D r . St ei n and D r . V arner , t es t i fi ed thati f the ac ci dentcaus ed the condi t i on t hat r equi r ed s ur gery , t heyw oul d expec tM s . R i ver s t o exper i ence pai n s peci fi cal l yi n herr i ght s houl derw i t hi n a fe w day s aft ert he ac ci dent

. T her efor e, w hi l e w e accor d gr eatdefe r ence t o t he tr i al cour t ’ s det erm i nat i on t hatM s . R i ver s ’ t es t i m onyw as cr edi bl e, s he s i m pl y di d not t e s t i f ya s t o a f

a c tc ru c i a l t o d e t e r mi n i n g c a u s a t i o n , na mel y , h o w s o o n h e rs ymp t o ms o c c u rr e d

. D r. W ill iam so n ’s re c o rd s p re se n t a c o n tem p o ra n e o u s a c c o u n t o f M s. R iv e rs’ sh o u ld e r p a in a n d in d ica te c lea rlyth a t M s. R iv e rs h a d a p a in f u l s h o u ld e r c o n d iti o n lo n g b e f o re th e A p ril 2 4 , 2 0 0 7 ac cide n t. N o ta b ly a b s en t from h is r ec o rds a re a n yn o tat ion that M s. R ivers compl ai ned of pa i n i n herr i ghts houl deratanyp o intdur i ng hers ever al vi s i t s t o hi s offi ce du ri ng t he tw o-m on t h p eri od foll ow i ng t he acc i den t

. R at her, t he records i nd i cat e t hat M s. R iv e rs c o m p la in e d o n ly o f c h e s t p a in a n d te n d e rn e s s d u ri n g th is p e ri o d

. I n o p i n i n g t h a tt h e a c c i d e n tc a u s e d M s . Ri v e r s ’ s h o u l d e rc o mpl i c a t i o n s , Dr

. W i l l i a m s on s eems t o l i nk M s . R i ver s ’ compl ai ntof che s tpai n and t endern ess af ter the ac ci dentt o her su bsequ ent s ho uldersurger y . H ow ever, he o ffers no ex planat i on as t o h ow t he ch estpain w o u ld b e re late d to M s. R iv e rs’ ro tato r cu f f , a n d a c k n o w led g e s h is l a c k o f e x p e rt is e in s houl der i s s ues s uch as t he pr obl ems M s . R i ver s had. M or eover , D r . W i l l i amson’ s as s er t i on t hatt he che s tpai n w as connec t ed t o t he s houl deri nj ur yi s notbor ne out by t he t es t i m onyof eit h er D r. S tei n o r D r. V arn er. I n for m ul at i ng hi s opi ni on, D r . V arner r el i es heavi l yon t he natur e of M s . R i ver s ’ undi s put ed p ree x ist ing co n d it ion an d the l ac k o f an y n o tat ion o f sho u lder pa in in D r. W il li am so n ’s m edi cal r ecor ds for t he t w o- m ont h per i od fol l ow i ng t he ac ci dent

. D r . V arnernei t hert r eat ed nor s poke w i t h M s . Ri v e r s i n f o r mi n g h i s o p i n i o n . App l y i n g h i s e x p e r t i s e i n s h o u l d er pr obl ems s uch as M s . R i ver s ’ condi t i on t o t he medi cal r ecor ds befor e hi m , D r . V arner t es t i fi ed unequi vocal l yt hatt he ac ci dentw as notcaus al l yr el at ed t o her s ubs equents houl der su rg e ry . T h u s, D r. V a rn e r f o u n d th e a b se n c e o f

a re p o rt o f

sh o u ld e r p a in in th e tw o -m o n th per i od aft ert he ac ci dentt o be det erm i nat i ve. I n for m ul at i ng hi s opi ni on, D r . St ei n r el i ed upon t he hi s t or yhe t ook fr om M s . R i ver s on her fi rs tvis i tt o h i m aft er the acc i den t

. In t est i fy i ng abo ut herhis t ory , he st at es that on A ug ust 20, 2007, M s . R i ver s t ol d hi m t hather s houl der pai n began about “fourm ont hs ” ea r l i er , t hat t he s e a tb e l t s h e was wea r i n g a t t h e t i me o f t h e a c c i d e n t j e r k e d h e r r i g h t s h o u l d e r upon i m pact , and thathers houl der s ym pt om s began s hor t l y aft er t hat

. T hus , D r . St ei n’ s opi ni on, t hatt he ac ci dentnece s s i t at ed the s houl ders ur geryhe per for m ed on M s . R i ver s , w as bas ed s q u a r e l yo n t h e a c c u r a c yo f t h e h i s t o r yt h a ts h e g a v e t o h i m.-9-

A s not ed above , had M s . R i ver s t es t i fi ed i n her l i ve t es t i m ony t hat hers houl derpai n began s hor t l yaft ert he ac ci d ent , i tw oul d be cl eart hatw e w oul d be r equi r ed t o acc or d “gr eat d ef ere n ce ” to the tr ial co u rt ’s ac cre d it ati o n o f h er testi m o n yin this reg ard

. H ere , h o w ev er, t he as s er t i on t hatM s . R i ver s ’ s houl der pai n began s hor t l yaft ert he ac ci dentappea r s i n t he re c o rd e ss e n tiallytw o ste p s re m o v e d f ro m M s. R iv e rs’ liv e tes tim o n y , tha t is, ita p p e a rs in t h e f o r m o f Dr

. S t e i n ’ s d e p o s i t i o n t e s t i mo n yr e c o u nt i ng M s . Ri v e r s ’ s t a t e me n t s t o h i m. M or eover , t he ac cur acyof M s . R i ver s ’ s t at ement s t o D r . St ei n m us tbe eva l uat ed i n l i ghtof t h e a b s e n c e o f

a n yn o t a t i o n o f

s h o u l d e rp a i n i n Dr

. Wi l l i a ms o n ’ s r e c o r d s u n t i l s o me t wo m o n th s a f

ter th e a c c id e n t. I n su p p o rt of M s . R i ver s ’ as s er t i on t hatt he tr i al cour t ’ s fi ndi ng on caus at i on s houl d be affirm ed, she ci t es T

aylorv. D

yer , 8 8 S .W .3 d 9 2 4 ( T e n n . C t. A p p . 2 0 0 2 ). T aylorw as a per s onal i nj ur ycas e i n w hi ch the pl ai nt i ff s ought damages for i nj ur y t o t he r ot at orcuff i n her ri g h t sh o u ld e r a f

te r b e in g re a r- e n d e d b y th e d e f e n d a n t’ s v e h ic le

. I

d. at925. U l t i m at el y , t he pl ai nt i ff ha d s houl ders ur gery . T he pl ai nt i ff ha d been i nvol ved i n t w o acc i dent s i n w hi ch her s houl derw as i nj ur ed, and an i s s ue att r i al w as w hethert he ac ci denti nvol vi ng t he def endant n e c e ss itate d th e p lain tiff ’s su rg e ry . A f ter a b e n c h trial, th e trial c o u rt e n ter e d a ju d g m e n t in f a v o r o f th e p la in tif

f , a n d th e d e f

e n d a n t a p p e a le d

. I

d. T he pr i m aryi s s ue on appe al w as pr oof o f c a u s a tio n . I

d. at926. O n appea l , t he def

endanti n T

aylorar gued that c au s at i on w as notpr oven bec aus e the pl ai nt i ff’ s s ur geon t es t i fi ed thathe coul d nots t at e w i t h m edi cal cert ai nt yt hatt he ac ci dent w ith th e d e f

e n d a n t c a u s e d th e ro ta to r c u f f te a r t h a t r e s u lte d in th e p la in tif f ’s s u rg e ry. I

d. at 9 2 6

. T h e a p p e l l a t e c o u r tn o t e d , h o w e v e r , t h a t“ [ c ] a u s a t i o n m a y b e e s t a b l i s h e d b y a combi nat i on of m edi cal and l ayt es t i m ony . ” I d. T he t r i al cour t had found a s a fa ctt hatt he i nj ur i es s us t ai ned byt he pl ai nt i ff i n t he ac ci dentw i t h t he def endantw er e the more s ev er e. I d. R el y i ng on t hi s fac tual fi ndi ng byt he tr i al cour t , al ong w i t h expert tes t i m onyt hatw as s o m e w h a t eq u iv o c a l, th e a p p e lla te c o u rt a f f ir m e d th e tr ia l co u rt ’s f

in d in g o n c a u s a tio n . I

d. In the inst ant cas e, N orthw estargues t hat D r. S t ei n’s t est i m on y shou l d b e dis cou nted becau se M s. R ivers d id n o t i n fo rm h im o f h er h ist o ry o f lon g stan d ing arthrit is in h er righ t sho u lder. H ow ever , t he t es t s conducted b y D r . St ei n s how ed hi m t hatM s . R i ver s had s uffe r ed fr om ch ron ic arthrit is i n h er sh o u lder, so h er fail u re t o d iscl o se th is fa ct d o es no t un d erm ine D r. St ei n’ s opi ni on. N or t hw es t ar gues per s uas i vel y t hatt he fa ctt hatD r . W i l l i amson’ s r ecor ds cont ai n no not at i on t hatM s . R i ver s compl ai ned of pa i n i n herr i ghts houl derunt i l t w o m ont hs aft ert he ac ci dentcas t s doubton t he ac cur acyof th e h is t or yM s . R i ver s gave t o D r . St ei n. H o w e v e r, th e trial c o u rt d e ter m in e d o v e ra ll th a t M s. R iv e rs w a s a tru th f u l w itn e ss , an d th is determ i nati on i nfo rm s our analy si s.-10-

I n l i ghtof al l of thes e fa ct or s , w e m us t eval uat e D r . V arner ’ s opi ni on and D r . St ei n’ s opi ni on. D r. V a rn e r, in h is te stim o n y , n o ted th e a b se n c e o f a n y tim e ly c o m p lain ts of sh o u ld e r p a in in D r . W i l l i amson’ s r ecor ds , butdi d not expr es s l y cons i der t he hi s t or yD r . St ei n t ook, i n w hi ch M s. R iv e rs r e c o u n ted th a t h e r sh o u ld e r p a in b e g a n sh o rtlya f ter th e a c c id e n t. D r. S tein test ifi ed clea rl ythat, assu m ing the truth o f th e hist o ry g iven to h im b yM s. R ivers, th e su rge ry w a s c a u sa llyre late d to th e a c c id e n t. W h ile th e q u e stio n is a c lo se o n e , co n sid e rin g h e a v ily the tri al co u rt ’s ev alua ti o n o f M s. R ivers as a t ruth fu l w itn ess, w e a g ree w ith the tri al co u rt ’s deci s i on t o cr edi t D r . St ei n’ s t es t i m ony t hat t he ac ci dentw i th t he N or t hw es tvan nec es s i t at ed M s . R i v e r s ’ s u r g e r y. C ons i der i ng t he r ecor d as a w hol e, w e fi nd t hat t he evi dence pr eponder at es i n favorof the t ri al cou rt ’s f

in d in g thatt he A pri l 24 , 20 07 acci den tw as causal l yrel at ed to M s. R i vers’ ensuing sho uldersurger yand associ at ed ex pen ses. C ONC L US I ON T he dec i s i on of the tr i al cour ti s aff i r m ed. T he cos t s of thi s appea l ar e t axed t o t he A ppel l ant N or th wes t Te n n e s s e e Huma n Re s o u r c e s Age n c y , a n d i t s s u r e t y , f o r whi c h e x e c ut i on m ay i s s u e i f n e c e s s a r y.

_________________________________ HOL L Y M

. KI RB Y, J UDGE