### IN THE COURT OF APP EALS OF TENNESS EE A T ME MP H IS Ja nuary19, 200 5 S es sio n MATTI E P. PATTERSON, Su rv iv in g S po us e o f LARRY PATTERSO N,

D ec ea se d v. M U HA M M A D A R IF
Direc t Appeal from the Circ uit Court for Sh elby County No. CT-001771-03 Jam es F . Russell, Jud ge

No. W2004-01837-C OA-R3-C V - F iled Fe bruary 14, 2005

The trial c ourt awa

rded summary

judgme nt to Defe ndant phy sician and dismissed Plaintiff’s ac tion upon finding it was one for medical malpr acticeand that Plaintiff had f ailed to offe r compe tent e xpe rt pr oo f o f n e g lig e nc e a s r e qu ir e d b y Te nn e sse e Cod e An no tate d § 29 -2 6- 11 5. Pla int if f a pp e a ls, asserting the trial court e rre d in determining the ac tion was not one for ordinary neg lige nce and that the a lle g e d ne g lig e nc e of De fe nd a nt wa s no t w ith in the c omm on kn ow le dg e e xce pti on . We a ff irm.
Te nn. R . A pp. P . 3 App e al a s o f Rig ht ; J udgm e nt of t heCi r c uit

Co ur t A ffirm e d; and Rem anded
D AVI D R. F ARMER , J. , d e li v e r e d th e o p in io n o f th e c o u rt, inw h ic h W. F RAN K C RAW FORD , P.J ., W.S ., and H OL L Y M. K I RBY , J ., joined.
Wil liam T. Wi ncheste r, Memphis, Tenne ssee, f or the a ppellant, Mattie P. Patterson.
J err y O

. Potter and Katherine M. Ande rson, Memphis, Tenne ssee, f or the a ppellee, Muhammad Arif, M.D.
OP IN ION
On Marc h 28, 2003, Mattie Patterson (Ms. Patterson) filed a wrong ful death cause of ac tion ag ainst Dr. Muhammad Arif (Dr. Arif), a licensed phy sician whose of fice is on Knight Arnold Road in Memphis. I n her complaint, Ms. Patterson allege s that on April 1, 2002, she telephone d Dr. Arif’s officebeca

use her husband, L arry Patterson (Mr. Patterson), was experiencing shortness of bre ath. She a lle g e s th a t D r. Arif ’s sta ff ins truc te d h e r t o b ri ng Mr . Patte rs on to h is m e dic a l of fi c e a ndtol d her that Mr. Patterson could not be admitt ed to the hos pital from home. Ms. Patterson submits she and her son, L arry

Patterson, J r. (“ Son”), took Mr. Patterson to Dr. Arif’ s office and that Son reque sted that Mr. Patterson be g iven ox y g en and be admitt ed to the adjoining Delta Me dical Center

. Ac c or din g to Ms. Pa tte rs on ’s c omp la int , Dr . Ar if ins truc te d th e m to take Mr . Patte rs on to S t. Franc is Ho sp ita l, w hic h is mil e s a way fr om Dr. Ari f’s off

ic e . M s. Pa tte rs on a lle g e s th a t D r. Arif ’s nu rs eT en ne ssee C o d e A nn o t ated 2 9

- 2 6

- 1 1 5 p ro vid es: 1
( a) I n a m al pr ac t i ce ac t i on , t h e cl ai man t s h al l h av e t h e bu r den of pr ov i n g by e v i den ce a s pr ov i ded by subsect i o n (b): (1) T h e r ec og n i ze d s t an dar d of a cc ept abl e pr ofes s i on al pr ac t i ce i n t h e pr ofes s i on a n d t he
s peci al t y t her eof , i f

an y , t hat t he defendan t p r act i ces i n t he comm un i t y i n w hi ch t he defendan t pra ct i ces or i n a s i mi l ar c ommun i t y a t t h e t i me t h e al l eg ed i n j u r y or w r on g f

u l a ct i on oc cu r r ed; (2) T hat t he d efend ant a ct ed w i t h les s t han o r f ai l ed to act w i t h o rdinar y and reas o nab l e care i n acco rdanc e wi t h s uch st and ard; and ( 3) As a pr oxi mat e r es ul t o f t he defendan t ' s ne gl i gen t ac t or om i s s i on, t he pl ai nt i f f s uf fer ed i n j u r i es w h i ch w ou l d n ot ot h er wi s e h av e occ u r r ed. (b ) N o p e rs o n in a h e a lth c a re p ro fes sio n r e q u iring lic e n su re u n d e r th e law s o f t h is sta te sh a ll be compe t en t t o t es t i f y i n an y c ou r t of

l aw t o e s t abl i s h t h e f ac t s r equ i r ed t o be e s t abl i s h ed by
su b se c tio n (a ), u n le ss th e p e rs o n w a s lice n se d to p ra c tice in the sta te o r a co n tigu o u s b o rd e rin g sta te a p rof ess i o n or special t y whi ch wo ul d m ake t he p ers o n' s exp ert t est i m o ny rel evant to t he i ss ues i n t he case and had practi ced t hi s p rof ess i o n or special t y i n one (1) of t hese s t at es d uri ng t he y ear preced i ng t he dat e t hat t he al l ege d i nj ur y or wr ongf ul ac t occu r r ed. T hi s r ul e sha l l a p p l y t o exper t wi t nes s es te stif y ing fo r th e d e fen d a n t as re b u ttal w itne sse s. T h e c o u rt m a y w a ive this su b se c tio n w h e n it det er mi nes t hat t he appropri at e wi t nes s es ot her wi s e woul d not be av ai l abl e. (c o n tinu e d ...) -2- too k M r. Pa tte rs on ’s blo odpr e ssu re bu t adm ini ste re d n o o the r c are . M s. Pa tte rs on fu rthe r s ub mit s that she and Son assisted Mr. P atterson to the ca r without a whe elchair or any assistance from Dr

. Arif and that, as they

wer e exiting the par

king lot, Mr. Patterson stopped breathing. Ms. Patterson and Son immediately

took Mr. Patterson to the Delta E merg ency Room, wher e Mr. Patterson was dia g no se d to be in f

ull c ard ia c a

rr e st. He wa s r e su sc itate d, bu t re ma ine d co matos e
. Af te r f iveho ur s, Mr. Patterson suff

ere d another

arr est and died. Ms. Patterson asserts t hat on t he day Mr. Patterson die d, Dr . A ri f s tate d to he r that he “ didno t r e a lize [Mr . Patte rs on ] wa s th a t ba d. ” I n h e r c omp la int , Ms. Patterson alleg es that Dr. Arif breac hed his duty of care to Mr. P atterson and that this breac h was the direc t and proxim ate c ause of Mr. Patterson’s ca

rdiac arr est and de ath. She pray ed for a trial by jury and dama g es in the amount of $1,000,000.
Dr. Arif answe red the complaint on April 29. I n his answer, Dr. Arif denied Ms. Patterson’ s a lle g a tio ns of

br e a c h o f the stand ardof c are a ndfu rthe r d e nie d th a t a ny a c tio ns or

omi ssi on s o n h is part proximately cause d Mr. P atterson’ s death. On November 4, Dr. Arif filed a motion for summary jud g me nt andstate me nt o f u nd isp ute d fac ts

. I n his s tate me nt, Dr . A ri f s tate d th a t, b a se d o n h is pr of e ssi on a l op ini on , h e c omp lie d w iththeapp lic ablestand ardof c are . M s. Pa tte rs on re sp on de d to Dr. Arif’s motion on J anuary 2, 2004. I n her r esponse, s he submitted the ac tion was one for wrong ful death based on ordina ry neg l i gence and medic al malpra ctice. She stated, “the or dinary neg lige nce issue does not require a medical expert to raise a disputed materia l issue.” Ms. Patterson didno t f ile a n e xpe rt

a ff ida vit , b ut atta c he d So n’ s a ff ida vit to he r re sp on se
. I n M arc h 2 00 4, Dr . A ri f filed an e x pert a ffidavit ag ain denying br eac h of the st an d ar d o f ca re. O n J une 21, 2004, the tria l c ou rt g rante d D r. Arif ’s mot ionfo r s umm ary jud g me nt and di sm isse d M s. Pa tte rs on ’s c omp la int

. I n it s o rd e r, the tria l cou rt fo un d Ms. Patte rs on ’s a c tio n wa s one fo r me dic a l malp ra c tic e a ndthat Ms

. Patterson did not offer

competent ex p er t proof that Dr . Arif ha d brea ched the standard of car e as re qu ir e d ina

me dic a l ma lpr a c tic e a c tio n u nd e r T e nn e sse e Cod e An no tate d § 29 -26 -11 5. Ms. 1(

. . . con t i n u ed) 1 ( c) I n a ma l pr ac t i ce a ct i on a s de s cr i bed i n s u b sect i o n (a), t h er e s h al l be n o pr es u mpt i on of negl i gence o n t he p art of t he d efend ant; p ro vi d ed , t here s hal l be a rebut t ab l e p res um p t i o n t hat t he d e fen d a n t wa s n e g lige n t wh e re it is sho w n b y the p ro o f tha t the ins tru m e n ta lit y c a u sin g inj u ry w a s in t he defendan t ' s ( or def end an t s' ) excl us i ve cont r ol an d t hat t he acc i dent or i nj ur y was one w hi ch ordi nar i l y doesn ' t occu r i n t he abs enc e of ne gl i gen ce. (d) In a m al p ract i ce act i o n a s d escri b ed in subsect i o n (a) , t he jur y s hal l be i nst ruct ed t hat t he cl ai m ant has t he b urden o f pro vi ng, by a p re p o nd erance o f t he evi d ence, t he negl i gence o f t he d efend a n t. T h e j u ry s hal l be f urt her i nst ruct ed t hat i njury al o ne d o es not rai se a presump t i o n of t he defendan t ' s ne gl i gen ce.
T enn. C o d e A nn. §2 9

- 2 6

- 1 1 5 (Sup p
. 20 0 4 ). -3- Patterson filed a

timely notice of a

ppeal to this Court on J uly 6, 2004.
Issues Presented
Ms. Patterson raises the following issues for our r eview: (1) Whether the trial c ou rt err ed in g ranting summary judgme nt for the Def endant by finding that this case wa s not a ca se of or dinary neg lige nce, but w a s a m e d i c a l m a l p r a c t i c e c a s e w h i c h r e q u i r e d e x p e rtt e s t i m o n y. (2) Whether the trial c ourt err ed in gra nting summary judgme nt for the Def endant by finding that the ac tions and omissi ons of the De fendant were not within the ordinary

knowledg e of a

lay person. Stan dard of Revie w Summary judgme nt is appropriate on l y wh en the moving pa rty can de monstrate that ther e are no disputed issues of materia l fac t, and that it is entitl ed to judg ment as a matter of law . Tenn. R. C iv. P. 5 6. 04 ; By rd

v . H all , 847 S.W .2d 208, 214 (Tenn. 1993). The party moving f or summary judgme nt must affirmativ el y n egate an esse ntial element of thenonmoving pa rty ' s claim, or conclusively

establish an af

firmative de fense

. McCarley v. W est Quality Food Serv. , 960 S.W .2d 585, 588 (Tenn. 1998)

. Whe n a pa

rty make s a pr op e rl y su pp orte d mot ion fo r su mma ry jud g me nt, the bu rd e n s hif ts to the nonmoving pa

rty to establish the exis tence of disputed material fac ts. Id. A mere assertion that the nonmoving pa

rty has no evide nce doe s not suffice to e ntitle the moving party to summary judgme nt. Id. I n determining whether to awar d summary

judgme nt, the trial court must view the e vid e nc e in the lig ht m os t f a vo ra bleto the no nmo vin g pa

rty a nddr a w a ll r e a so na

bleinf e re nc e s in that party ' s favor

. Sta

ple s v . CBL & Asso c s. , 1 5 S. W.3 d 8 3, 89 (T e nn . 2 00 0) . T he c ou rt sh ou ld awa rd summary

judgme nt only

when a rea sonable person could re ach only one conc lusion based on the fa cts and the infe renc es dra wn from those f acts. Id. Sum mary

jud g me nt i s no t appro priate if there is any doubt a

bout w hether a g enuine issue of materia l fac t exi sts. McCarley , 960 S.W .2d at-4-

58 8. We r e vie w an a wa rdof su mma ry jud g me nt de novo , w ithno presu mpt ionof c or re c tne ss aff orded to the tria l court . Guy v . Mut. of Omaha Ins. Co. , 79 S.W .3d 528, 534 (Tenn. 2002)

. Anal y sis
Ms. Pa tte rs on ’s arg ume nt b e fo rethi s Co urt, a s w e pe rc e iveit, is t wo -f old . F ir st, sh e a sse rt s that th is i s n ot a

me dic a l ma lpr a c tic e c a se , b ut o ne fo r o rd ina ry ne g lig e nc e
. Se c on d, sh e a sse rt s th a t, if this is a malpractice action, ex pert testimony was not re quired to establish bre ach of the standar d of ca re be cause “[i] t is withi n the common knowledg e of a lay person that a

phy sician, or his staff

, who i s ca l l ed bya patient e x perie ncing shortness of bre ath, should advise that patient to ca ll an a mbu la nc e or

g o to a n e me rg e nc y

ro om. ” We d isa g re e wi th b otha sse rt ion s. Medica l malprac tice is but one particular ty p e o f neg lige nce. Gunter v. Lab. Corp. of America , 121 S.W .3d 636, 639 (Tenn. 2003). Tenne ssee Code Annotated section 2 9 -2 6-115 codifies the c ommon law elements o f n eg lige nce insofa r as they are to be applied to medica l malprac tice actions. Id. When a neg lige nce c laim arises fr om injuries which re sult from neg lige nt medical treatment, the action is one for medic al malpra ctice. Id. at 640. I n Gunter , the Tenne ssee Supreme Court articulated the analy s i s to be used in Tenne ssee to distinguish claims for medica l malprac tice fr om claims for ordina ry neg lige nce. T he Gunter

court he ld,
when a claim alleg es neglig ent conduc t which constitutes or bea rs a substantial relationship t o the re n dition of medical treatment by a medica l professional, the medical malpr acticestatute is applicable.
Id. at 641.
I n light of the alleg ations as put forth in M s. Patterson’s complaint, this action is clea rly one for medic al malpra ctice. T he ac tions and omissi ons which Ms. Patterson’s a lleg es as neg lige nce on the part of Dr. Arif, namely , Dr. Arif ’s fa i l u re t o d irec t Mr. Patterson to g o immediately to the near est emer g ency

room, wer e undisputedly

related to the re ndition of the medical tre atment soug ht by Mr. Patterson. Dr . Arif’ s actions wer e cle arly based on me dical dec isions. According ly , the action is g overne d by

Tenne ssee Code A nnotated sec tion 29-26-115.
Ms. Patterson asserts, however , that the she wa s not requi re d t o o ffer expert proof of Dr. Arif’ s brea ch of the standard of car e beca use it is “w ithin the common knowledg e of a lay person that a person experiencing shortness of breath is experiencing a medical emer g ency
. . . [and] should go, or be t ak e n to , a n e me r g e n c y r o o m. ” Sh e a c c o r d in g ly a s s e rts th a t th e “ c o mm o n k n o w le dg e” exception to the statutory require ment that medi cal ne g lige nce must be e stablished by expert testimonyis applicable in this case

. The “ common knowledg e” e x ception to the g ener al ru l e i s ap p licable whe n “the medic al neg lige nce is a s blatant as a ‘fly floating in a bowl of but termilk’ so that all mankind knows that such things are not done abse nt neg lige nce.” Mu rp hy v . S c hwa rtz , 739 S.W .2d 777, 778 (Tenn. Ct. App.-5-

1986) (quoting German v. Ni ch o p oulos , 5 7 7 S

. W

. 2 d 1 9 7 ( T e n n
. A p p
. 1 9 7 8 ) )

. In Murphy v

. Sc hwa rtz , Ms. Murphy

suffe red a stroke while at home and was taken by ambulanceto the Madison CountyGene ral Hospital. Id. She was left unattended and unrestrained on a c ot in the emerg ency room, fell fr om the cot, and suff ere d injuries. Id. Ad dit ion a lly , th e de fe nd a nt p hy sic ia ns a lle g e dly failed to tr eat her properly for the injuries which resulted from the fa ll. Id. Def endants in Murphy filed a motion for summary judgme nt with an aff

idavit of one o f t h e d ef

en dant phy sicians that he “wa s familiar with the medic al standar d of ca re in the c ommunityand that neither the aff iant or the other doc tor defe ndant at any time fell below the community standard of

car e in the examination or treatment of Mrs. Murphy .” Id. Plaintiffs in Murhpy failed to offe r ex pert proof of neg lige nce, and the trial court a war ded summary judgme nt to the defe ndants. Id. Upon appe al, plaintiff asse rted the“ c omm on kn ow le dg e ” e xce pti on , a rg uin g that
it is p lain a n d p a te n t me d ic a l n e g li g e n c e to le a v e a s tr o k e v ic ti m u n a ttended or unrestrained in an eme rg ency room, and there fore no medical aff idavits a re r equire d. F u rt h e r , t h e f

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

f' s d i s l o c a t e d s h o u l d e r

f o r a p e r i o d o f f o u r d a ys under the circ umstances is also plain medical malpractice which requires no medic al expert proof to show.
Mu rp hy v . S c hwa rtz , 7 3 9 S. W. 2 d 7 7 7 , 7 7 8 ( T e n n
. Ct

. App. 1986)

. This court af firmed summary j u d gm en tfo r t h e d ef

en d an t s , h o l d i n g,

we wo uldbe ha

rdpu t to say

that the plaint if

f' s fa c t c re a te a

" c omm on kn ow le dg e to thewo rl d" e xce pti on to the ru le , wh e n the re is me dic a l e xpe rt pr oo f i n th e re c or d to the ef fec t that under plaintiff' s fac t there is no medica l neg lige nce. The re al issue cr eate d by this appeal is not wh et h er t h e plainti ffs, by lay opinion, show blatant buttermilk fly floati n g n eg lige nce; but, whe ther the pla intiff may ref ute admissible expert opinion evidence by lay opinion evidence . Plaintiffs may not do so.
Id. at 779.
As in Murphy , in the casebefore us, thereis ex pert proof in the rec ord that therewas no medical ne g lige nce. Further, w e cannot say that it is wit hin the common knowledg e of the lay person t h ata p er s o n s u ff

er i n g s h o rt n es s o f b re at h , wi t h o u tm o re , an d M s
. P a t t e r s o n d o es n o tal l ege a dd iti on a l sympt oms , s ho uldbe take n imm e diate ly to the e me rg e nc y ro om. I nd e e d, thi s o bv iou sly was not w ithin the common knowledg e of Ms. Patter son or Son. Ms. Patterson may not refute Dr. Arif’ s exp e rt o p in io n r e g ar d in g a d e c is io n ma d e in th e c o u r s e o f r e n d e r in g me d ic a l c ar e w ith lay opinion evidence in this case.
Hol ding
I n light of the fore g oing, we affirm t he trial court’s awa rd of summary

judgme nt to Dr. Arif.-6-

This cause of ac tion sounds in m edica l malprac tice, and Ms. P at t er s o n failed to off er c ompetent e xpe rt pr oo f, a s re qu ir e d by se c tio n 29 -2 6- 11 5, to re fu te the e xpe rt pr oo f o ff e re d b y Dr . A ri f. Cos ts of this appea l are taxed to the Appellant, Mattie Patterson, and her sure ty , for whic h execution may i s s u e i f n e c e s s ar y.

___________________________________ DAVID R. FARMER, J UDGE