### IN THE COURT OF APP EALS OF TENNESS EE AT NAS HVILLE N ove m be r 17, 200 6 S es sio n GAL AD RIEL BA SHA M, IND IVID UA LLY AN D A S N EXT -OF -KIN OF BABY GI RL BASHAM, DECE ASED v . MARK K. GREAVES, M.D.

Appeal f romthe Circ uit Court for Davidson County No. 00C-1558 M ariet ta M. Shipl ey, Judge

No. M2006- 00281-COA-R 3-CV - Dec em ber 11, 2006

I n th is m e dic a l ma lpr a c tic e a c tio n, the plaint if f c on te nd s th e e me rg e nc y roo m ph y sic ia n f a ile d to comply with the applicable standard of car e, which she contends is the standard f or boar d-ce rtified emer g ency

room phy sicians, re g ardle ss of the loca le in which the phy sician prac tices, and that the trial judg e improper ly

instructed the j u ry co n cerning the applica ble community . The nove l issue prese nted is whether

the term “ commu n i t y , ” as i t applies to the so-c alled loca lityrule, c an be construed to mean the medica l communityof spec ialists who are boa rd-c ertified a s emerg ency

room phy sicians without reg ard to the g eog raphic location of their pra ctice. A lthough we find the issue int ri g uin g , th e fa c ts o f this c a se re nd e r the iss ue moo t. A c c or din g ly , w e a ff irm. Tenn. R. App . P . 3 Appeal as of Right; Judgme nt of th e Circ uit Court Aff irm ed
F RAN K G. C L EME NT , J R ., J ., delivere d the opinion of the court, in w hich W I L L I AM B. C A IN , J ., joined. W I L L I AM C. K O CH , J R ., P.J ., M.S., filed a conc urring opinion. W. Gary Bla ckburn, Nashville, Tenne ssee, f or the a ppellant, Gala driel B asham, Individually and as next of kin t o Ba

by Girl Ba sham, dec ease d.
Da le A. Ti pp s a nd Mic ha e l A. Ge ra c iot i, Na sh vil le , Te nn e sse e , f or the app e lle e , M ark

K. Gr e a ve s, M.D.
OP IN ION
Galadriel Ba sham was riding in the passeng er seat i n a car driven by her husba nd when they we re i n v o l v e d i n a s e ri o u s v e h i c u l ar a c c i d e n t o n Ju n e 5 , 1 9 9 9

. A t t h e t i m e o f t h e a c c i d e nt, Mr s. B a sh a m w a s thi rt y -t wo we e ks pr e g na nt wi th the c ou ple ’s c hil d. I mme diate ly fo llo wi ng the a c c ide nt, Mrs. Ba sham, who was experiencing abdominal pains, wa s taken by ambulance to Summ it Medical Center f or examination.
The bab y ’s fetal heartbe at was immediate ly chec ked whe n Mrs. Ba sham arrived at the emer g ency

room at Summit

. The first rea ding indicated a he artbe at of 124 be ats per minute, whic h-2-

put the heartbeat of the fetus at the low e nd of the norma l rang e, which w as 1 2 0-160 beats per minut e. App ro xima te ly

on e -h a lf ho ur a ft e r h e r a

rriva l a t th e e me rg e nc y

ro om, Ma

rk K. Gr e a ve s, M.D., a boa

rd-c ertified e merg ency

room phy sician, first examined Mrs. Ba sham. After his init ial a sse ssm e n t , h e o r d e r e d X

- r a y s o f M r s
. B a s h a m ’ s s p i n e a n d k n e e s
. T h e r e c o r d h o w e v e r fa ils to ind ic a te a ny

sp e c if ic ins truc tio ns re lati ve to th e he a lth of the un bo rnc hil d. I t w a s n ot u nti l approximately

one hour a nd forty -five minutes a fter Mr s. Ba sham’s arrival at the hospital that Dr. Gre aves consulted with an obstetrician. Following that consultation, the obstetrician r ecommende d delaying Mr s. Ba sham’s dischar g e fr om the hospital s o t h at s he could ha ve continuous fe tal monitoring of t h e b aby ’s hea rtbeat. As a conse quence , and pursua nt to the obstetrician’s rec ommendation, Mrs. Ba sham was then taken to the obstetrical unit of the hospital. An ultrasound wa s p e rf orme d, wh ic h in dic a te d an abs ence of f e ta l c ard ia c a c tiv ity . T he re a ft e r, Mr . a ndMr s. Ba sham wer e advise d their child had die d from an undia g nosed plac ental abr uption.
I n J une of 2000, Mr s. Ba sham filed this action ag ainst Dr. Gr eave s. T h e m atter w as tried befor e a jury

in October

of 2005. Du ri n g t he trial, Mrs. B asham (he reina fter “ the plaintiff”) introduced e x pert testimony conce rning the standar d of ca re to be provided a preg nant woman who suffe red a bdominal trauma. The plaintiff’s expert testified that all board- certified emer g ency room phy sicians studied from a nd wer e tested on the applicable protocol spec ified in a certain text book. Dr. Gr eave s admitted that he and all other phy sicians seeking board certification as eme rg ency room phy sicians studied from the sa me textbook. The protocol at i ssue emphasiz ed the importanc e of f our ho ur s o f c on tin uo us fe ta l mo nit oring wh e n a n e xpe c ta nt m oth e r w ho wa s tw e nty we e ks or mor e int o he r p re g na nc y , wa s subj e c te d to trauma
. Dr . G re a ve s’ e xpe rt didno t r e fu te the so -c a lle d “ natio na l” protocol as discusse d by the plaintiff’s expert; ne verthe less, he testified that the a pplicable standa

rd of ca re in the N ashv i l l e ar ea m edica l communitywas less string ent. He f urther opine d that the tr e a tme nt p ro vid e d b y

Dr . G re a ve s c omp lie d w ith the app lic able stand ard of c are fo r the Na sh vil le medical c ommunity

. At the close of

all th e p ro of, the trial judg e invited the par ties to submit reque sted jury instructions. The only

instruction sub m i t t ed b ythe plaintiff wa s the reque st that the jury be instructed in ac corda nce w ith the locality rule set f orth in Tenn. Code Ann. § 29- 26-115(a )(1) . The trial court c omplied with this reque st and instructed the jury as the plaintiff r equeste d. Following de lib e ratio ns , th e jury re turne d a def e nd a nt’ s ver dic t, with a fin din g that Dr. Gr e a ve s “di d not f a il to comply

with the rec og niz ed s t an d ar d of ca re a s it ex isted in Nashville, Tenne ssee, a nd simil ar communities.” The plaintiff f

iled a Motion for Ne w Trial arg uing that the jury should have be en instructed to d e te rm ine wh e the r Dr . Gr e a ve s viol a te d the “ natio na l sta nd ard of c are ” fo r me dic a l tr e a tme nt i n this instance as the s tandar d of care in this are a is so well understood and universally rec og nized that all communities are “ simil ar” to Nashville within the meaning of t he law. The trial court de nied the Motion. The plaintiff a

ppeals c halleng ing only

the prope r scope and application of the locality rule.-3- A N A L Y SIS
I n a m ed ical malpra ctice a ction, the plaintiff has the burden of proving “[t] he re cog nized standard of

acc eptable pr ofessional pra ctice in the pr ofession and the specia lty there of, if any , that the de fe nd a nt p ra c tic e s in t he c om mu nit

y in w hic h th e de

fe nd an t pr ac tic e s o r in a s im ila r c om mu nit y at th e t i m e t h e alleg ed injury or wrong ful ac tion occurr ed.” T enn. Code Ann. § 29- 26-115(a )(1) (e mph a sis a dd e d)

. He re , the plaint if f c on te nd s the app lic a

ble stand ardof

c are fo r D r. Gr e a ve s is to be dete rm ined base d upon the medica l communityof spec ialists who are boa rd-c ertified a s emer g ency

room phy sicians without reg ard to the g eog raphic location of their pr actice

. The plaintiff’ s arg ument can be summari z ed as fo l lows. First, she c ontends that boardcertified phy sicians ar e tested ba sed upon national standards and obtain ce rtification base d upon the national standar ds for that spec ialty ; the ref ore, a phy sician who repr esents that he or she is boardc e rt if ie d s ho uldbe jud g e d b y

thesta nd ardof

c are re qu ired by th e certif y ing bo ard . B a se d o n th is premise, the plaintiff contends that a board-ce rtified phy sician shoul d not be permitted to int roduce e vid e nc e that he or sh e pr a c tic e s to a le sse r s ta nd ardof

c are than is c us tom ary

fo r h is o r h e r “ loc a l” community . Essentially , the plaintiff conte nds the local c ommunity ’s standar d of ca re is irre levant when e valuating the per formanc e of a board c ertified phy sician and, the ref ore, the jury

should not be instructed or

permitted to consider

a lesser , local community standard of

car e.
Th e tr ia l c ou rt

pe rm itt e d th e plaint if

f t o s ub mi t reque ste d ju ry ins truc tio ns . T he on ly ins truc tio n s ub mit te d b y the plaint if f wa s the re qu e st that th e jury be ins truc te d ina c c or da nc e wi th the loc a lit y

ru le se t f orth i n T e nn . Co de An n. § 2 9- 26 -1 15 (a )( 1) . T he tr ia l c ou rt c omp lie d wi th this reque st and instructed the jury as the plaintiff r equeste d. After the jury was instructe d, the plaintiff did not object to the instruction give n or re quest a c orre cted instruction.
The Te nnessee Rules of Civil P roce dure a ddress the rig hts and responsibilities of the parties a s th e y pe rt a in t o e rr on e ou s in str

uc tio ns a ndomi tte d in str

uc tio ns
. Spe c if

ic a lly , Ru le 51 .0 2 p ro vid e s:
Af te r the jud g e ha s in str

uc te d th e jury , th e pa

rt ie s sh a ll b e g ive n o pp ortun ity to object, out of he aring of the jury , to the content of an instruction g iven or to failure to g ive a reque sted instruction, but failure to make objection shall not prejudice the rig ht of a pa

rty to assign the basis of the objec tion as err or in support of a motion for a new trial.
Th e ins truc tio n g ive n to the jury c a me fr om the Ten nes see Patte rnJury I ns truc tio ns
. Although the instruction give n corr ectly states the law applicable to me dical malprac tice ac tions, the plaintiff contends a

differ ent instruction should have be en gi v en
. Significantly , howeve r, the plaintiff did not reque st the instruction until afte r the ve rdict wa s rende red.
We h a ve c on c lud e d th e plaint if f is not en tit le d to the re lie f sou g ht. Th is i s b e c a us e a pa rt y has an o b li g a ti o n to a idth e tria l c o u r t, w h e n s u c h is r e a s o n ab ly a v a il ab le , to p r e v e n t th e h armful eff ect of an omission in a jury

char g e. See Tenn. R. App. P. 36(a) . Her e, the plaintiff f ailed to takeW e are not unmi ndf ul o f t he f act t he T enn es s ee Supreme C our t has p r evi ous l y ad dres s ed t he i s s ue of a n at i onal 1
sta n d a rd o f m e d ic a l ca re fo r b o a rd -ce rtifi e d sp e c ia lists. S e e R o b in so n v . L e C o rp s M .D

. 8 3 S

. W

. 3 d 71 8 (T enn. 20 0 2 ). In Robi ns on , t h e C o u rt sp e c ifi c a lly n o te d tha t the sta n d a rd o f c a re is “p ro p e rly left to the d isc re tio n o f t h e leg islatu re .” Id

. at 72 4

. W het her t he reasoni ng and rul i ng i n Robi ns on p ert ai ns t o t he m eani ng of t he t erm “ co m m uni t y ” wi l l have to b e d e te rm ine d in a n o the r p ro c e e d ing . It sho u ld a lso b e no te d tha t t h e C o u rt h a s a d d it io n a lly sta te d in Ch ap m an v. B e a rfield , N o. E 20 04

- 02 59 6- SC

- R 11 C V , 200 6 W L 31 62 92 3, at * 3 (T enn
. N ov. 6, 200 6), t hat t he l egi s l at ur e c reat ed t h e medi ca l ma l pr ac t i ce s t an dar d, a n d t h e cou r t s a r e n ot a t l i ber t y t o c h an g e t h at s t an dar d. -4- action that wa s rea sonably available to preve nt or nullify the harmful eff

ect of the allege d err or. Id

. Ba sed upon the fore g oing, we have conclude d it would be inappropriate for us to opine on the issue of whe ther term “community ” under Tenn. Code Ann. § 29-26-115( a)( 1) can be interpr eted a s being lim ite d to the c ommun ity of bo ard -c e rt if

ie d e me rg e nc y

ro om p hy sic ia ns
. 1
The a ppellee insists the appeal i s frivolous and requests damag es. We do not find the appe al frivo lou s. Th e plaint if

f a c kn ow le dg e d inher bri ef th at th is C ou rt is b ou ndby

the pr e c e de nt w ith re g ard to thi s iss ue ; ne ve rthe le ss, sh e se e ks the op po rtun ity to a dd re ss the iss ue to th e S upre me Court. Wit hout pe rfe cting an appea l to this Court, the plaintiff cannot speak t o h er i n t ended audienc e. She is entitled to seek a n extension or modification of t he law. Acc ording ly , we do not find the appe al frivolous. The judg ment of the trial c ourt is affirme d, and this matter is rema nded with costs of a ppeal a sse sse d a g a ins t th e Ap pe lla nt.

____________________________________ FRANK G. CLEMENT, JR ., J UDGE