### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON FE BR U A RY 15, 200 5 S es sio n R EG IN A HE LD ER M A N an d hu sb an d, TR OY HE LD ER M A N v.

MATTH EW R. SMO LI N, M.D., ET AL 

### . Direc t Appeal from the Circ uit Court for Madison Cou nty

No. C-00- 148 Don H. Allen, Ju dge

No. W2004-01206-C OA-R3-C V - F iled April 18, 2005

This appea l involves a claim for medical malpractice

. The plainti ff’ s car diologist initiallydiag nosed her a s having a hea

rt condition which re quired surg ery to repa ir. The plainti ff’ s car diologist ref err ed the plaintiff to a c ardiothora cic surg eon for surgical r epair

of the c ondition. The plaintiff su bs e qu e ntl y

so ug ht a se c on d op ini on , a nd the se c on d c ard iol og ist de te rm ine d th a t th e plaint if f d id no t ne e d s ur g e ry . T he re a ft e r, the plaint if f’ s o ri g ina l c ard iol og ist app are ntl y c ha ng e d his dia g no sis of the plaintiff’ s condition. After some time pa ssed, the car diothoracic surg eon per formed sur g ery on the plaintiff, which w as ul timately determined to be unnecessary
. The plainti ff sued her origina l car diologist and the c ardiothora ci c s u rgeon for medica l malprac tice. Throug h discovery , it was determined that the ca

rdiothorac ic surg eon did not revie w the plaintiff’ s entire medic al re cords prior to performing the sur g ery
. T h e ca rdiolog ist filed a motion for summary judgme nt arg uing the car diothoracic surg eon wa s the sole proxim ate c ause of the plaint iff’s injuries. In response , the plaintiff submitted an aff

idavit from her

expert witness stating that the car diologist had a duty under the app lic able sta nd ard of c are to dir e c tly c ommun ic a te his c ha ng e d dia g no sis to the c ard iotho ra c ic surg eon, and his a ctions were a “sig nificant c ontributing fa ctor” to the plaintiff’s injuries. The card io log ist

fi le d a mot ion to s tr ike the a ff

ida vit of the plaint if

f’ s e xpe rt a s c on tr a dic tory

to h is deposition testimony . The trial c ourt partially g rante d the ca

rdiolog ist’s moti on. After doing so, the tr ia l c ou rt g rante d the c ard iol og ist ’s mot ion fo r s umm ary jud g me nt. Th e plaint if

f a pp e a le d to thi s Court, and we r ever se.

Te nn. R . A pp. P . 3 ; A ppe al a s o f Rig ht ; J udgm e nt of t he Ci r c uit

Co ur t R e ve r se d and Rem anded
A L AN E. H I G H ERS , J. , d e li v e r e d th e o p in io n o f th e c o u r t, in w h ic h W. F RAN K C RAW FORD , P.J ., W.S ., and D AVI D R. F ARMER , J ., joined.
J. Ho us ton Go rd on , Co vin g ton , T N f or Ap pe lla nts
Charles M. Purce ll, Andrew V . Sellers, J ackson, TN , for Appe lleesA n at r i al sept al d ef ect i s a “ conge ni t al hear t d ef ect i n whi ch t her e i s an openi ng bet ween t he at r i a. ” T ABER ’ S 1 C YCL OPE DI C M E D I C A L D I C T I ONA R Y 1 8 6 (1 9 th e d . 2 0 0 1 ).

A n at ri al s ep t al de fect can b e ei t her hem o d y nam i cal l y s i gni f i cant or hem o d y nam i cal l y i nsi gni f i cant

. I f t he 2
at ri al s ep t al de fect i s d et erm i ned t o be hem o d y nam i cal l y s i gni f i cant , t hen sur gery i s o rdinar i l y re q u ire d t o repair t he d e fec t. S h o u ld t e s tin g re v e a l t h e d e fec t t o b e he m o d yn a m ic a lly ins ign ifi c a n t, the n su rg e ry is u su a lly n o t re q u ire d to re p a ir the d e fec t. -2- OP IN ION
I. F A C TUA L B ACKG ROUND AND P R OC EDU R A L H I S T ORY
I n 1997, Reg ina Helderman’s (“He lderman” or “A ppellant”) primary car e phy sician re fer

red her to Dr . Matthew R. Smolin (“Dr. Smolin” or “Appe llee”) , a ca rdiolog ist practicing in J ackson, Tenne ssee, a fter H elderman re ported ha ving c hest pains. On May 12, 1997, Dr. Smolin performe d a tra nsesophag eal e choca rdiog ram on He lderman to de termi n e wh et her she had an atrial septal defe ct. As a re sult of this t est , Dr

. S m o l in determined that Helderman did, in fac t, have a n atrial

1
se pta l de fe c t. On Ma y 14 , 199 7, Dr . Smoli n pe rf orme d a card ia c c a the te ri zat ion on He lde rm a n to determine whether the atrial septal defe ct was hemody namically signific ant, there b yre quiring su rg e ry to r e pa ir

. As a

re su lt o f this te st, Dr . Sm oli n d ia g no se d H e lde rm a n w ith a he mod y na mic a lly 2 signific ant def

ect.
After perf orming these tests, Dr. Smolin refe rre d Helderman to Dr. Arthur Grim ball (“D r. Grimb a ll” ), a

c ard iotho ra c ic su rg e on , f or a n e va luatio n to de te rm ine wh e the r sur g e ry wa s n e e de d to close the atrial septal def ect. Dr . Grimball ev al u ated He lderman the same da y as the c ardia c cathe terization and determined that Helderman required surge ry to repa ir the defect in her heart. He schedule d Helderman’s surg ery for June 3, 1997. The re cord co n t ai n s a docume nt entitled

“ Ou tpatie nt S umm ary ” date d Ma y 14 , 19 97 , wh ic h ind ic a te s that Dr

. Smo lin c ha ng e d h is d ia g no sis to refle ct t hat Helde rman ha d a hemodynamically insignificant atrial septal de fec t. This document also indicates that Dr. Smoli n forwa rded it to Dr . Grimball. Howe ver, the document states that Dr

. Smoli n did not dictate it until J une 6, 1997, and it wa s not transcribe d until J une 9, 1997.
Helderman subsequently

obtained a r efe rra l from her primary car e phy sician to se ek a se cond opinion. On May

30, 1997, Helderman visited Dr. J ames Crenshaw (“ Dr. Cre nshaw” ), a car diologist. Dr. Cre nshaw re viewed the car diac c ath e te rization report and de termined that the atrial se pta l de fe c t w a s he mod y namic a lly ins ig nif ic a nt, the re fo re , s ur g e ry

wa s n ot r e qu ir e d. Arme d w ith this new information, He lderman le ft Dr. Cre nshaw’s of fice and proc eede d direc tly to D r. Smolin’s office wher e she c onfronted him with Dr. Cre nshaw’s f indings. Acco rdi ng to Dr. Smolin, he revie wed the te sting data and concluded that the l aboratory computer performing the te st had made an er ror. Dr. S molin asserts that he reca lculated the data by hand and determined Helderman’s atrial se pta l de fe c t to be ins ig nif ic a nt, a nd he a dv ise d He lde rm a n that no su rg e ry wo uldbe re qu ir e d to fi x the def ect. Dr . Smoli n’s of

fi ce n o t es fr om May

30, 1997, show that he noted the computer e rror , determined Helderman’s atrial septal d ef ec t t o be insig nificant, a nd advised he r to forg o surg ical-3-

repa ir. Acc ording to Dr. Smolin, he forwa rded a copy of hi s May 30, 1997, office notes indicating the cor rec ted diag nosis to Dr. Grimball. Conversely , Helderman asserts that a differ ent series of eve nts transpired whe n she visited Dr. Smolin on May

30, 1997. Helderman stated that Dr . Smoli n seeme d puzz led and ag itated by Dr. Cr e ns ha w’ s f

ind ing s, a ndhe c on tin ue d to re pr e se nt t o h e r that sh e ha d a he mod y na mic a lly sig nif ic a nt a tr ia l se pta l de fe c t re qu ir ing su rg e ry to r e pa ir . A c c or din g to H e lde rm a n, Dr . Sm oli n to ld h e r t h a tt h e l ab o r a t o r y c o m p u t e r m a y h a v e m a d e a m i s t ak e , a n d h e d e c i d e d t o p o s tp o n e t h e s u r g e r y. Helderman asserts that, prior t o leaving Dr. Smolin’s office , she neve r re ceive d any further instruct i o n s o r advice. Helderman neve r saw D r. Smolin perform any calc ulations, and he ne ver c a lle d D r. Grimb a ll w hil e sh e wa s p re se nt i n h is of fi c e on Ma y 30 , 1 99 7. Ac c or din g to D r. Grimb a ll, he neve r re ceive d any

commun i cations fr om Dr. Smolin alerting him to the fa ct that the pre vious calc ulations were incorre ct. I n any event, He lderman did not re port for sur g ery on J une 3, 1997.
I n the interim, Helde rman c ontinued to seek treatment f rom Dr. Smoli n at the reque st of her primary car e phy sicians throug h the middle of 1999. On January 19, 1999, Helderman went to the emer g ency

room at the Jackson/Madi s o n C o u n t y Gene ral Hospital complaining of fatigue . The emer g ency

room phy sician’s notes state that “[s] he wa s found to have a v er y s m all atrial septa l de fe c t ba c k in 1 99 7, fe lt t o b e he mod y na mic a lly ins ig nif ic a nt. She , a

pp are ntl y , in iti a lly

g ot s ome conflicting opinion concerning that.”
Acc ording to Helderman, in the early part of 1999, D r. Smolin continuousl y encour ag ed her to ma ke an appointment with D r. Grimball to ha ve the atrial septal defe ct repa ired. On May1 2, 1999, Helderman visited Dr. Grimball’s office and stated that D r. Smoli n told he r to have the atrial septal def ect r epair ed bec ause he r sy mptoms we re worsening

. After meeting with Helderman, Dr. Grimball revie wed his consultation report from 1997 showing a hemody namically signific ant atria l septal def ect, discusse d the oper ation with her, a nd made arr ang ments to a dmit her to the hospital for the ope ration on June 10, 1999. Dr. Grimball admitted to not reviewing any other re cords prior to scheduling the surg ery . Specifica lly , Dr. Grimball stated that he did not revie w his own medica l rec ords on Helde rman prior to scheduling the operation. Thus, he had no knowledg e of w hether the re po rt a lle g e dly pr e pa re d by Dr

. Smo lin re g ard ing the Ma y 30 , 19 97 , of fi c e vis it, wh ic h se t fo rth h is ne w f ind ing of a he mod y na mic a lly

ins ig nif ic a nt at ri a l sep ta l def

e c t, wa s con ta ine d in thos e re c or ds

. Dr . Gr imb a ll p e rf

orme d th e su rg e ry

on He lde rm a n o n Jun e 10 , 1 99 9, a s sc he du le d. As a result, Helde rman e x perie nced complications related to the unnece ssary surg ery
. On J uly 7, 1999, Dr. Cre nshaw re quested, in writing , that Dr. S molin’s office forwa rd to him all recor ds pertaining to H elderman. Dr. Smoli n’s offic e fa x ed the r ecor ds to Dr. Crensha w that same day . Dr. Cre nshaw state d th a t th e re c or ds fo rw ard e d d id n ot c on ta in a c op y of Dr . Smoli n’ s May 30 , 199 7, of fi c e no te indicating a chang e i n d i agn osis, nor did he rec eive a ny documents indicating Helderman’s atrial septal def ect ha d subsequently

been de termined to be he mody namically insignificant. On May 5, 2000, Helderman, along with her husband, f iled a complaint in the Circuit Court of Ma dis on Cou nty , T e nn e sse e , a g a ins t D r. Smo lin ind ivi du a lly a nd his bu sin e ss, Me dic a l Sp e c ia ltyIn M ay o f 20 0 3 , t he ci rcui t co urt ent ered an ord er, at H el d erm an’ s reque st , dis m i ssin g D r. G rimb al l and 3 C ardiot ho raci c Surgery C ent er, P

. L.C

. , f rom t he l awsui t fo l l o wi ng a s et t l em ent agreem ent ent ered i nt o be t ween t he p art i es. T herefo re, t he i nst ant ap p eal i s o nl y co ncerned wi t h t he res o l ut i o n of t he i ss ues as t hey rel at e t o D r. Sm o l i n and H e ld e rm a n
. -4- Clin ic , P. C., a lle g ing me dic a l ma lpr a c tic e . In a dd iti on , H e lde rm a n n a me d D r. Grimb a ll i nd ivi du a lly and h i s b u s iness, Cardiothorac ic Surg ery Center, P.L .C., as defe ndants. She also secur ed the 3 service s of an e x pert witness, Dr . David Ha nsen (“ Dr. Ha nsen”)

. There afte r, Dr. Smolin f

iled a motion for summary judgme nt with the trial court alleg ing that Dr. Grimball was the sole proximate cause of He lderman’ s injuries. I n support of his motion, Dr. Smoli n submitt ed his own deposition testimony ; the deposition testimony o f Dr . Crenshaw , Dr. Grimball, and Dr. Hanse n; e x cer pts f rom the deposition of Stephanie Ge ibel (“Ms. Ge ibel”), r ecor ds c us tod ia n f

or Dr . Gr imb a ll; a nd re le va nt portio ns of He lde rm a n’ s med ic a l re c or ds

. Dr . Sm oli n a lso submitt ed the aff

idavit of his ow n expert, Dr. Dale Wortham, w ho opined that Dr. Smolin complied wi th the app lic able sta nd ardof c are , a ndthat D r. Grimb a ll’ s ac tio ns we re the so le pr oximate c a us e of H eld erm an’s in

ju ri es. I n res po ns e to Dr. S mo li n’s mo ti on , He ld erm an fi led Dr. Han sen ’s a ff ida vit and his deposition testimony . Helderman also submitted releva nt portions of her medic al re cords and excer pts from the depositions of various witnesses.
I n h is a ff ida vit , D r. Ha ns e n s ta te d, in r e le va nt p art , a s f oll ow s:
7. Th e mis dia g no sis a ndmis re fe rr a l in the fi rs t in sta nc e wa s a situation that could have been and s hould have be en avoide d by the proper communication betwe en Dr . Smoli n and Dr

. Gr i m b a l l , t h e c ar d i o v a s c u l ar s u r g e o n , w h e n D r
. S m oli n learned th at h e had made an er ror in his ana ly sis and diag nosis of Ms. H elderman’s condition. Dr. Smolin had an aff irm ati v e du ty , u nd

e r th e ap pli c ab le sta nd

ar d o f c are , to dire c tly c om mu nic ate with Dr . Gri mb all tha t th e te st re su lts
re po rte d to Dr

. G rim ba ll c all ing for

su rg e ry we re inc or re c t. If , in fac t, a s D r. Gr im ba ll t e sti fie d, he fa ile d to so communic ate, such would be a violation of the standard of
c are .

. . . . 15. I n sum, as a result of the negligence of Dr. Smolin which was a signifi cant contributing factor to Regina Helderman be ing operated on , Reg ina Helde rman re ceive d a ser ious operation for a condition that she neve r had a nd was operated on unnece ssarily

. (empha sis added).-5-

Ba sed on these a ssertions by Dr. Ha nsen, Dr. Smolin filed a motion to strike Dr. Ha nsen’s a ff ida vit a s c on tr a dic tory

to h is p ri or

de po sit ion te sti mo ny
. Dr . Sm oli n a rg ue d th a t, d uring his deposition testimo n y , Dr. Ha nsen testified that Dr . Smoli n adequately communicated to Dr

. Grimball, throug h written communications, that Helderman ha d a hemodynamically insigni fica nt atrial septa l defe ct which did not re quire surg ery . Additionally , Dr. Smolin arg ued that Dr . Hanse n previously

testified in his deposition that Dr. Grimball’s failure to review the medica l rec ords was the sole cause of the unne cessa ry surg ery
. On April 26, 2004, the trial c o urt enter ed an or der g ranting in part and de ny ing in pa rt Dr. Smoli n’s motion to st rike the aff idavit of Dr. Hanse n. The trial court conclude d that Dr. Ha nsen’s a f f i d a v i tc o n t a i n e d i n c o n s i s t e n t a n d c o n tr a d i c t o r y s t a t e m e n t s r e g ar d i n g m a t e r i a l f a c t s
. S p e c i f

i c a l l y, the tr ia l c ou rt

or de re d s tr ic ke n th e la st s e nte nc e in p ara g ra ph se ve n ( 7) of

Dr . H a ns e n’ s a ffidavi t. Ad dit ion a lly , th e tr ia l c ou rt or de re d s tr ic ke n f

ro m Dr. Ha ns e n’ s af

fi da vit pa ra g ra ph fi ft e e n ( 15 ) i n its entirety . I n turn, the trial court conclude d that no g enuine issues of m aterial fac t remaine d to be de c ide d, a ndthat H e lde rm a n f a ile d, a s a ma tte r o f l a w, to p ro ve that Dr . Sm oli n w a s a pr oximate cause of her

injuries. Acc ord i ng ly , the trial court gr anted Dr . Smoli n’s motion for summary judgme nt.
Helderman subsequently

filed a timely

notice of a

ppeal to this Court presenting the following issues for our r eview:
I

. Whe the r the tr ia l c ou rt e rr e d in pa

rt ia lly g ranti ng App ell ee’s mot ion to s tr ike the a ff ida vit of Ap pe lla nt’ s e xpe rt

wi tne ss; I I

. Whether the trial c ourt err ed in g ranting Appellee ’s motion for summary judgme nt; and I I I

. Whe the r the tr ia l c ou rt e rr e d b y inv a din g the pr ov inc e of

the jury wh e n th e un de rl y ing fa c ts relied upon by

Appellant’s e x pert witness a re “ hotly contested.”
For the re asons set forth more fully here in, we re verse the dec ision of the trial court.

II. L AW AND A N A LY SI S
I n o rd ert o es t ab l i s h a c l ai mfo r m ed i ca l m al p ra ct i ce , t h e p l ai n t i ff h as t h e b u rd en o f p ro v i n g, b y a p re p o n d er an ce o f t h e e v i d en ce , t h e f o l l o wi n g: (1) The rec og nized standard of acc eptable profe ssional pr actice in the profe ssio n a n d th e s p e c ia lt y th e r e o f, if

a n y , th a t th e d e f

e n d a nt prac tices in the community in which the def

endant pr actice s or in a simil ar c ommunityat the time the alleg ed injury or wrong ful ac tion occur red; (2 ) T hat th e de fe nd a nt a c te d w ith le ss tha n o r f a il e d to a c t w ith ordinary and re asonable car e in ac corda nce w ith such standard; a nd-6- (3) As a proxi mate re sult of the defe ndant’s neg lige nt act or omission, the plaintiff suff

ere d injuries which would not otherw ise have occur red.
Te nn . Co de An n. § 29-2 6-1 15 (a ) ( 20 03 ); see also Kelley v. Middle Tenn. Em ergenc y Phy sicians , P. C. , 133 S.W .3d 587, 591–92 (Tenn. 2004)

. “A pa rty is entitled to summ ary

judgme nt wher e he or she esta blishes that there is no g enuine is s u e a s to a n y mate r ia l f a c t a n d th a t a ju d g me n t may b e r e n d e r e d a s a matt e r o f la w.” S t o va ll v. Clarke , 1 1 3 S

. W

. 3 d 7 1 5 , 7 2 1 (T en n
. 2 0 0 3 ) ( ci t i n g Penley v. Honda M otor Co. , 31 S.W .3d 181, 183 (T e nn . 2 00 0) ); see also Tenn. R. Civ. P. 56.04 (2003). The party moving f or summary

judgme nt has the burden of proving that the motion satisfies these re quirements. Ba in v . W e lls , 936 S.W .2d 618, 6 2 2 (T en n
. 1 9 9 7 ) ( ci t i n g Downen v. Allstate Ins. Co. , 811 S.W .2d 523, 524 (Tenn. 1991) ). Onc e the moving pa

rty has established that there is no g enuine issue of materia l f act, the bur den shifts to the nonmoving pa

rty to demonstrate, by aff

idavits or other disc overy materia ls, that there is a g enuine issue of m aterial fac t to be re solved by trial of the matter

. By rd

v . H all , 847 S.W .2d 208, 211 (Tenn. 1993) (c itations omi tted). “I n revie wing a motion for summary judgme nt, the Court must ex amine the evidenc e and all rea sonable infe renc es fr om the evidenc e in the lig ht most favorable to the nonmoving pa

rty .” Sto v all , 113 S.W .3d at 7 2 1 (citing W ebber v . State Farm Mut. Auto Ins. Co. , 49 S.W. 3d 26 5, 26 9 ( Te nn . 2 00 1) ). Th e tr ia l c ou rt sh ou ld g rant a

mot ion fo r s umm ary

jud g me nt “ on ly wh e n b ot h th e fact s and the c on c lus ion s to be dr a wn fr om the fa c ts p e rm it a re a so na ble pe rs on to rea ch only

one conc lusion.” Carvell v. Bottoms , 9 0 0 S

. W

. 2 d 2 3 , 2 6 (T en n
. 1 9 9 5 ) ( ci t i n g By rd , 847 S.W .2d at 210–11)).
“Our task on appe al is to review the rec ord to d et er m i n e wh ether the re quirements for g ranting summary

judgme nt have be en met.” Church v. Pe rales , 3 9 S. W.3 d 1 49 , 1 57 (T e nn . Ct

. App. 2000). “ This court must use t he same standard in reviewing a trial c ourt’s judg ment g ranting summary judgme nt.” Pr inc e v . Sain t Th om as Ho sp ., 945 S.W .2d 731, 733 (Tenn. Ct. App. 1996) (c i t i n g Clif

ton v . B as s , 908 S.W .2d 205, 208 (Tenn. Ct. App. 1995)). Since our inquiry on appea l involves purely

questions of law, Car

v e ll , 900 S.W .2d at 26, “[t] he standa rd for revie wing a g rant of su mma ry jud g me nt i s de novo without an ypresumption that the trial cour t’s conclusions wer e corr ect.” W

ebber , 4 9 S. W.3 d at 26 9; se e als o Kelley , 1 33 S.W. 3da t 59 1; Ba in , 936 S.W .2d at 622.
Be fore determining whe ther the tria l court p ro p er l y g rante d Dr. Smolin’s moti on for summary judgme nt, w e must a ddress the trial court’s decision to strike portions of Dr

. Ha nsen’s aff idavit. See W

ilson v. Patterson , 73 S.W .3d 95, 101 (Tenn. Ct. App. 2001). “In Tenne ssee, e x pert testimonyis require d to establish ne g lige nce and proxi mate cause in malprac tice ac tions unless the alleg ed malpractice is within the common knowledg e of la y men.” Aye rs v
. Rutherford Hosp., Inc. , 6 8 9 S

. W

. 2 d 1 5 5 , 1 6 0 (T en n
. C t

. Ap p
. 1 9 8 4 ) ( ci t i n g Ph e lps v . V an de rb ilt Un iv

. , 520 S.W .2d 353 (T e nn . Ct. A pp . 1 97 4) ); see also Te nn
. Cod e An n. § 2 9- 26 -1 15 (b ) ( 20 03 ); Kenyon v . Handal , 122 S.W. 3d743, 75 8 (Ten n. Ct. Ap p. 20 03 ); Stokes v . Leung , 651 S.W .2d 704, 706 (Tenn. Ct. App. 1982). “In g ener al, questions reg arding the admissibili ty , qualifications, re levanc y and compe tency of expert testimony are left to the discretion of the trial court.” McD aniel v. CSX Transp., Inc ., 955-7-

S

. W

. 2 d 2 5 7 , 2 6 3 (T en n
. 1 9 9 7 ) ( ci t i n g Sta te v . B all ar d , 85 5 S.W. 2d 55 7, 56 2 ( Te nn . 1 99 3) ); se e als o Se ffe rn ic k v . Sain t Th om as Ho sp ., 969 S.W .2d 391, 393 (Tenn. 1998) ; Kenyon , 122 S.W .3d at 759.
A trial court’s decisions in this reg ard are revie wed by this Court under an abuse of discre tion standard of

revie w. Seffernick , 9 69 S .W .2 d at 3 93 ; Ba lla rd , 8 55 S.W. 2da t 56 2; Kenyon , 122 S

. W

. 3 d at 7 5 9

. I n em p l o y i n g t h i s s t an d ar d o f r ev i ew , we ar e m i n d fu l o f t h e f o l l o wi n g: Discre tionary

d ecisions require consc ientious judgment. See B IF v. Se rv ic e Con str

. Co ., 1988 Tenn. App. L

EXI S 430, 1988 WL

72409, a t *2 . T he y

mus t ta ke the app lic ablela w i nto a c c ou nt andmus t a lso be c o n sistent with the facts bef ore the court. See O verstree t v. Shoney's, Inc ., 4 S.W .3d at 6 9 4 . Appellate c ourts will set aside a discretionary

decision only when the trial court has misconstrued or mis app lie d th e c on tr oll ing le g a l princ ipl e s or ha s a c te d in c on sis te ntl y with the subs t anti al weig ht of the evide nce. See O verstree t v. Shoney's, Inc ., 4 S.W .3d at 695. Thus, a tria l court' s discret ionary decision should be re viewed to de termine: (1) whether the fa ctual basis for the de cision is s upported by the evidenc e, (2) whether the trial court identifie d and applied the applicable leg al principles, a nd (3 ) wh e the r the tr ia l c ou rt ' s d e c isi on is w ith in the rang e of a c c e pta ble a lte rn a tiv e s. See B IF v. Se rvice Constr. C o. , 1 9 8 8 T e n n
. A p p
. LE X IS 43 0, 19 88 WL

72 40 9, a t *3 . A pp e llate c ou rt s sh ou ld p e rm it a discretionary

decision t o stand if rea sonable judi cial mi nds can dif fer conce rning its soundness. See O verstree t v. Shoney 's, Inc ., 4 S.W .3d at 695.
W hit e v . V an de rb ilt Un iv ., 21 S.W .3d 215, 223 (Tenn. Ct. App. 1999).
Th e c ou rt s o f this state a dh e re to the ru le that c on tr a dic tory state me nts by

the sa me wi tne ss reg arding a sing le fa ct will canc el each other out. W ilson v. Patterson , 73 S.W .3d 95, 103–04 (Tenn. Ct. App. 2001) (citing Sta te v . M att he ws , 888 S.W .2d 446, 449 (Tenn. Crim. App. 1993) ); se e als o Tib ba ls Flo or ing Co. v . S tan fil l , 4 10 S.W. 2d89 2, 89 6 ( Te nn . 1 96 7) ; Church v. Pe rales , 39 S.W .3d 14 9, 16 9– 70 (T e nn . Ct . A pp . 2 00 0) ; G a m b il l v . Mid d le Te n n . M

e d

. Ctr., Inc

. , 751 S.W .2d 145, 149–50 (Tenn. Ct. App. 1988); Taylor v. Nashville Banner Publ’g Co. , 573 S.W .2d 476, 482 (Tenn. Ct. Ap p. 19 78 ). I f de te rm ine d by the tr ia l cou rt to be c on tr a dic tory , the state me nts by the wi tne ss are considere d to be “no evidenc e” of the fact soug ht to be proved. W ilson , 73 S.W .3d at 104 (c iting Johnston v. Cincinnati N.O. & T.P. Ry. Co. , 240 S.W

. 429, 436 (Tenn. 1922)). The poli cy for suc h a ru le c a n b e state d a s f

oll ow s:
I f p art ie s in c ou rt

we re pe rm itt e d to a ssu me inc on sis te nt p os iti on s in the tr ia l of

the ir c a us e , th e us e fuln ess of c ou rt s o f j us tic e wo uldin mos t ca se s be p ara ly zed . T he c oe rc ive po we rs of the la w, a va ila

ble only betwee n those who cons ented to its exercise, c ould be set at-8- naug ht by

all. But t h e ri g hts of all men ar e in the kee ping of the cou rt s, and con si st encyof p roce edi ng is th erefo re req ui red o f al l t ho se wh o c ome in o r a

re br ou g ht b e fo re the m. I t may a c c or din g ly be la id down as a broad pr oposition that one, w ithout mi stake induce d by the opposite party , who has take n a particular position deliberately , in the co u rs e of lit igation, must act c onsistentlywith it. One cannot play fast and loose

. Sta mp e r v . V

e na ble , 9 7 S. W. 8 12, 8 13 (T e nn . 1 90 6) ; see also Sipe v . Porter , No. E2002-02938- COA-R9-CV, 2003 Tenn. A pp. LEXI S 763, at *9 (Tenn. Ct. App. Oc t. 30, 2003).
The “ canc ellation rule” only applies, howe ver, “ when the inc onsistency in the witness’s testimonyis unex plained and w hen neither version of his testimony is co rr o b orate d by

other evidenc e.” Taylor , 573 S.W .2d at 483. As our supre me court has stated,

The que stion here is not one of the cr edibilityof a w itness or of the we ig ht o f e vid e nc e ; bu t it is w he the r the re is a ny

e vid e nc e a t a ll to prove the f

act. I f two witnesses c ontradict e ach othe r there is proof on bo th s ide s, a ndit i s f

or the jury to s a y wh e re the truthlie s; b ut i f the pr oo f o f a fa c t lie s wh oll y wi th o ne wi tne ss, a ndhe bo th a ff ir ms a ndde nie s it , a ndthe re is n o e xpla natio n, it c a nn ot s ta ndoth e rw ise than u np ro ve n. F or his te sti mon y to p ro ve it i s n o s tr on g e r tha n h is testimonyto disprove it, and it w ould be mere caprice in a jury upon such evide nce to de cide it either way
. Johnston , 2 4 0 S

. W

. at 4 3 6

. “W h en t h e can ce l l at i o n ru l e is i n v o k ed at t h e su m m ar y j u d gm en ts t age to challeng e evide nce opposing the motion, the courts m ust view the challeng ed evidence in the lig ht most favora

ble to the opponent of the motion.” Church , 3 9 S. W.3 d at 17 0; see also W ilson , 73 S.W .3d at 104. Upon re viewing the statements made by Dr. Ha nsen i n h i s affidavit and deposition in the light mos t favor able to He lderman, w e conc lude that, contra ry to the trial court’ s holding, they are not c ontradictory

. Reg arding para g raph se ven (7) of Dr. H ansen’ s aff idavit, addre ssing the sta ndard of c are app lic able in this c a se , th e tr ia l c ou rt fo un d, in r e le va nt p art , a s f oll ow s:
I n c omp ari ng Dr . H a ns e n’ s a ff ida vit te sti mon y

to that of his de po sit ion te sti mon y , thi s Cou rt c on c lud e s tha t if D r. Sm oli n c om mu nic ate d “v e rb all

y or in writ ing ” his op ini on to D r. Gr im ba ll that surgery for Mrs. Helderman’ s condition w a s not neede d, then either form would be acc eptable un d er t h e applicable standard of care and thus no vi o l a t i o n of the standard of care would be found

. Th is c on c lus ion is r e a c he d w he the r the tre a tin g c ard iotho ra c ic surg eon, Dr . Grimball rea d , fo l l owed, or ignor ed such a dvice that-9- su rg e ry wa s not n e e de d. Con se qu e ntl y , th e Cou rt or de rs that th e la st sentenc e of pa

rag raph 7 f

rom Dr. Hansen’s affida vit is to be stricke n. This sentence specif

i ca lly provides, “ if, in f

ac t, a s D r. Gr im ba ll testi f i ed , h e fai led to so communic ate, such would be a violation of the sta nd ar d o f c are .” (e mph a sis a dd e d)

. I n his de po sit ion , Dr . Ha ns e n te sti fi e d c on c e rn ing the sta nd ardof c are a s f oll ow s: Q. Wha t is the sta nd ardof c are fo r a c ard iol og ist

pr a c tic ing in the J ackson- Madison County are a to c ommunicate his or her finding s about whethe r surg ery is or is not necessitated to the car diothoracic surg eon? A. I thi nk tha t com mu nic ati on c an oc c ur v e rb all y or it ca n — it can occ ur in the form of a wri tten communic ation, either one
wou ld b e ac c e

pta ble

. (empha sis added).
I n a n e ff ort to sh ow a n in c on sis te nc y be tw e e n D r. Ha ns e n’ s state me nts , Dr

. Smo lin po int s to the following testimonyoffe red by Dr. Ha nsen during his deposition: Q. L e t’ s ta lk about c ommun ic a tio n f or jus t a mom e nt. Communi cation come s in ma ny differ ent forms, I take it, does it n ot? A. Ye s. Q. Th ere is th e c ommun ic a tio n w he re y ou a ndI are ta lki ng to one anothe r direc tly

here , and there’s also the communication of jus t lik e Mr

. Go rd on wh o s e nt y ou a le tte r, pr ov ide d s ome information to y ou and communicated to y ou his perspec tive of the c ase. Tr

ue? A. Ye s.

. . . . Q. L e t me take a c ou ple of e xamp le s w ith y ou a ndy ou te ll m e if they ’re acc eptable. L et’s say t h at I ’m the ca rdiolog ist and y ou ’r e the c ard iotho ra c ic su rg e on a ndI de te rm ine that a patient has an insignificant atrial septal defe ct.

. . . And let’s sa y that I ha ve ma de that de te rm inatio n a s th e c ard iol og ist , a n d I s e e yo u o u ti n t h e h a l l w a y a t t h e h o s p i t a l

. O b v i o u s l y I g o up to y ou and I s ay , Dr . Hanse n, I want to tell y ou I

saw Mrs. Helde rman the other day and she does not need to ha ve surg ery beca use the atrial septal defe ct is insignifica nt. That would be an e x ample of pe rfe ctly acceptable verba l-10- c o m m u n i c a t i o n t o —f

r o mm e t o y o u a s t h e c ar d i o t h or a c ic surg eon. True ? A. Yes.

. . . . Q. L et’s take the written communication. Suppose that I as the car diologist examine Mrs. Helderman and I make the de te rm inatio n tha t she do e s n ot n e e d to ha ve su rg e ry to r e pa ir the atria l septal defe ct. I writ e that up in my

report and I car bon copy y ou on that report. I s that within the standard of c are fo r c ard iol og ist s c ommun ic a tin g to c ard iotho ra c ic surg eons in Jackson- Madison Countyabout the ca rdiolog ist’s opinions that surge ry

is not needed? A. Yes.
Re g ard ing the ou tpatie nt s umm ary c re a te d b y

Dr . Sm oli n, Dr . H a ns e n te sti fi e d a s f oll ow s: Q. At the bottom of the outpatient summary there are two names that are c arb on c op ie d. Th e fi rs t is Dr . G ri mba ll, c or re c t? A. Ye s.

. . . . Q. I n y ou r o pin ion , this wo uld be a n a c c e pta ble a ndc omp le te ly complian t w ith th e s tan d ar d o f c ar e f o r c o mmu n ic a ti o n s of car dio l o gi sts in the J ackson- Madison Countyare a of D r. Smoli n’s o p i n i o n t h at t h i s wa s h em o d y n am i ca l l y i nsignific ant to D r. Grimb a ll? A. Yeah, that’s an a cce ptable way of commun icating to Dr. Grimball, although i t strikes me that it’s only acc eptable by virtue of the fac t that the patient fa iled to show for surg ery on J une the 3 beca

use this document was not — which wa s the rd ori g ina lly sc he du le d d a te fo r s ur g e ry — b e c a us e thi s document is not dictated until five da y s after she would have had the ope ration to beg in with. So I think, y ou know, had the patient actua lly had the operation and then some t ime later this note shows up on Dr

. Grimball’s desk sa y ing, by the way , y ou shouldn’t have done the surg ery

beca use it’s hemody namically insignificant. I think that w o u l d have be en a br eac h and so it’s only by the g oo d fort un e that th e patie nt d idn ’t sh ow up that th is i s acc eptable.
Furthermore , during his deposition, Dr. Hansen e x presse d his opinion t hat Dr. Grimball did, in f a c t, r e c e ive no tic e fr om D r. Smo lin of his c ha ng e d d ia g no sis , te sti fying a s f oll ow s:-11- TH E WI TN ESS: I t’ s my un de rs ta nd ing that th e ou tpatie nt summary that was dictated on J une 8 , 1997, was c arbon th copied to Dr . Grimball. I t’s — an d Ihave — it is my belief that more li kely than not that actua lly arrived in his office and wa s in his me dic a l r e c or ds a ndhis po ss essi on . So me tim e there afte r it was tra nscribed on June 9 , 1997. th B Y M R

. P U R C E LL: Q

. So i s i ty o u r

o p i n i o n t h e n t h a tD r
. S m o l i n d i d c o m m u nic a te with Dr. Grimball by

way of that outpatient summary and advised Dr . Grimball that Mrs. Helde rman ha d a he mod y na mic a lly

ins ig nif ic a nt atr ia l se pta l de fe c t? A. I think that — I

think that communication throug h the ca rbon c op y do e s th a t.
Ho we ve r, Dr. S mol in and the tr ia l c ou rt

ov e rl oo k th e fa c t th a t w he the r D r. Smo lin did , in fac t, send notice of his a mended diag nosis to Dr. Grimball rema ins a disputed fac t in this case . Dr. Grimb a ll t e sti fi e d in his de po sit ion that he ne ver rec e ive d n oti c e fr om D r. Smo lin . D r. Smo lin testified in his deposition that h e forwarde d a copy of his chang ed diag nosis to Dr. Grimball. Dr. Crenshaw testified in his deposition that, when he requested Helderma n’s m edica l rec ords from Dr. Smo lin fo llo wi ng he r su rg e ry , the y c on ta ine d no do c ume nt sh ow ing Dr

. Smo lin ha d ch anged his dia g no sis to r e fl e c t th at H e ld erma n h a d a he mod y na mic a lly

ins ig nif ic a nt atr ia l se pta l de fe c t. M s. Geibel testified that, while Dr. Smolin’s amended dia g nosis was curr ently in Helderman’s medica l rec ords, she c ould not say when that doc ument was plac ed in the re cords.
Dr . H a ns e n re c og nize d the e xiste nc e of thi s dis pu te d fa c t wh e n he state d in his a ff ida vit : “ If , in fact , as Dr. Grimball testified, [Dr. Smoli n] failed to so communicate, such w ould be a violation of the standa

rd of c are .” (e mphasis a dded). That this fac t remains to be de cided is further e vidence d by Dr. Ha nsen’s own de position t estimony , wher ein he state d:

Q. “Dr . Hanse n is e x pecte d to testify that Dr. Smolin had an aff irmative duty

to directly

communicate to Dr. Grimball that his report of a hemody namically insignificant atrial septal de fe c t a ndhis c ommun ic a tio n to Dr

. Gri mb a ll o f the sa me w e r e i n c o rr e c ta n d , t h e r e f o r e , n o s u r g e r y

w a s i n d i c a t e d

. ” Is t h a ta c o rr e c ts t a t e m e n to f

yo u r a n t i c i p a t e d t e s t i m o n y? A. Ye s. Q. “ Assuming Dr. Grimball’s testimony to b e co rrect that no
su c h c om mu nic ati on was e v e r re c e iv e d b y him , D r. Ha ns e n is expected to rende r an opinion that there was a violation of the sta nd ardof

c are on th e part o f D r. Smo lin a nd /or his c lin ic staff f or which he is responsible.” I s that a cor rec t statement o f yo u r a n t i c i p a t e d t e s t i m o n y? A. Ye s.-12- . . . . Q. I s it y our opin i o n t h at at no ti me did Dr. Smolin ever co m m unicate to Dr . Grimball that Mrs. Helde rman ha d an ins ig nif ic a nt atr ia l se pta l de fe c t? A. Ba sed on my

rea ding of

both Dr. Gr i mball’s deposition and Dr

. Smoli n’s deposition, I did not find either one of them c la imi ng the re wa s su c h a c ommun ic a tio n. Th a t’ s my ba sis for that opinion. I’d be happy to change that opinion if under oath either or both o

f t h em swor e to the fact that there was such a com munication

. (empha sis added).
I n o rd e r for th e tr ia l c ou rt to c on c lud e that D r. Ha ns e n’ s st a te me nts we re inc on sis te nt, it nec e ssa ri ly ha d to fi ndthat D r. Grimb a ll r e c e ive d s ome fo rm of no tic e fr om D r. Smo lin prior to conducting Helderman’s surg ery . I n order so to find, the court would ne ed to weig h the evidenc e a ndde te rm ine that D r. Grimb a ll d id, in f a c t, r e c e ive Dr . Smoli n’ s cor re c te d dia g no sis

. We r e a c h th is co n cl u s i o n b y

re fe re n ci n g t h e l an gu age o f t h e c o u rt ’s o rd er , s t at i n g:
I n c o m p ar i n g D r
. H a n s e n ’ s a f f i d a v i t t e s t i m o n y t o t h a t o f his de po sit ion te sti mon y , th is C ou rt c on c lud e s th at if Dr. Smo lin c ommun ic a te d “ ve rball y or in writi ng ” his op ini on to D r. Grimb a ll that surg ery

for Mrs. H elderman’s condition was not ne eded, the n either f orm would be a cce ptable under the applica

ble standar d of ca

re and thus no violation of the standar d of ca re w ould be found.
The c ourt g oes on to note that Dr. H ansen te stified that it is acce ptable for a ca rdiolog ist to send the su rg e on a c arb on c op y

of his re po rt , a ndou tpatie nt s umm ari e s a nd oth e r r e po rt s a re a c c e pta ble fo rm s of written c ommunications betwee n the ca rdiolog ist and the surg eon. Thus, in orde r to find an inconsistency , the court nece ssarily had to conc lude that the p arties did not dispute whethe r Dr. Smoli n ever

sent notice to Dr. G rimball. At this pre liminary stag e in the proce eding s, the trial court is not permitted to weig h the evidenc e. Church v. Pe rales , 39 S. W .3d 149, 171 (Tenn. Ct. App. 20 00 ); se e als o B

y rd v . H all , 8 47 S.W. 2d20 8, 21 1 ( Te nn . 1 99 3) . “ Whe n a mat e ri a l fa c t is in d isp ute cre ating a g enuine issue, when the cre dibilit y of witnesses is a n integ ral part of the fa ctual proof , or wh e n evid e nc e mus t be we ig he d, a tr ia l is ne c e ssa

ry be c a us e su c h is su e s a

re no t app ro pria te ly resolved on the basis of af fidavits.” By rd , 847 S.W .2d at 216.
Ba sed upon our r ev i ew o f the testimony proff ere d by Dr. Ha nsen in his affida vit and deposition, we conc lude that Dr. H ansen’ s statements reg arding the standar d of ca re a re not inconsistent. The term “ direc tly communicate” is susceptible of being interpr et ed t o m ean either v erb al o r w ri t t en co m m u n i ca t i o n , wh i ch i s co n s i s t en t wi t h h i s p ri o r d ep o s i t i o n t es t i m o n y
. Al t h o u gh Dr. Ha nsen ex p re s sed his opinion that Dr. Smoli n did provide written notice of his chang ed diag nosis to Dr. Grimball, he also noted t hat t his opinion is continge nt upon the evidenc e off ere d at-13-

tr ia l. Wh e n th e te sti mon y of a wi tne ss is susc e pti ble of mul tip le int e rp re ta tio ns , one of wh ic h w ou ld produce no inconsistency , we are reluc tant to a pply the “c ance llation rule.” Se e Ga mb ill v . Middle Tenn. Med. Ctr., Inc ., 751 S.W .2d 145, 151 (Tenn. Ct. App. 1988). I nstead, “the meaning of re levant oral stateme nts made by

or to a pa rt y
. . . is a fac t question for a jury to consider in we ighing the possible contradic tions in and credibility of the testimony

of t he witness, rathe r than a law question for de t er m i n at i o n by

the Trial Judge on motion for summary judgme nt or direc ted ver dict.” Id

. (c i t i n g P acke t Co. v. Hobbs , 5 8 S. W. 2 78 (T e nn . 1 90 0) ); se e als o Le dfo rd v . Fra nc is , 1988 Tenn. App. LEXI S 813, at *13–14 (Tenn. Ct. App. De c. 14, 1988).
Tu r n in g to p ar a g r ap h f

if te e n ( 1 5 ) in D r
. H a n s e n ’ s a f f id a v it c o n c e r n in g c a u s a ti o n , the trial court he ld that this paragr ap h s hould be stricken in its entirety as contra dictory

to Dr. Ha nsen’s de po sit ion te sti mon y . D r. Ha ns e n o ff e re d th e fo llo wi ng te sti mon y du ri ng his de po sit ion : Q. Is it not the ca s e t h a t the cardiothoracic surgeon is the one who wil l determine whethe r he or she wi l l o p erat e on the patient ? A. Y es
. Q. The de cis ion whether to ultim ately

perf orm an atrial septal defe ct r es ts with the cardiothora cic surg eon in J acksonMa dis on Cou nty , d oe s it

no t? A. Yes.

. . . . Q. Are you of the opinion the n that Dr. Grimball breached the sta nd ar d o f c are for

c ar dio tho ra c ic su rg e on s p ra c tic ing in Jack son-Madison County, Tennessee , in c ompletely ignoring the ho sp ita l re c or

ds be fore pe rfo rm ing the su rg e ry on Mr s. Helderm an ? MR. GORDON: Object to the f orm of the que stion. TH E WI TN ESS: Ye s Q. Are y ou also of the opinion that Dr. G rimball brea ched the sta nd ardof

c are fo r c ard iotho ra c ic su rg e on s p ra c tici ng in Jac ks on -M a dis on Cou nty in p e rfo rm ing su rg e ry

on Mr s. Helderman wit hout the benefit of a history perta ining to what had happe ned to her

in her c are and tre atment from Ma y 17 , th 1997, until May

19 , 1997? th A. Yes.

. . . . Q. And Mr. Gordon has asked y ou to a ssume certain things that may or may not ha ve been said, but f rom y our perspe ctive on wh a t w e kn ow , g ive n th a t y ou jus t sai d the re , tha t D r. Smo lin say s it’s hemody namically insignificant, wha t we do k no w is tha t ha d D r. Grim ba ll re v ie we d th e ho sp ita l c ha rts an d h is own re c or ds , h e wou ld h av e fou nd

the sa me thi ng tha t y ou did-14- re v ie wi n g h is r e c o r

d s , a n d th a t i s th a t y o u , a n d

th a t i s th at Dr . S mo lin and Dr . Cre ns ha w be lie v e thi s wa s a hemody namically insignificant atri al septal defect

. A. I’d go stronger than that

. I ’d say not only would he have, but he had an obligation to find that, so y eah, I ag ree with y ou but I ’d be a littl e strong er about it. I rea lly condemn the f

act that this patient got a n oper ati on without looking at the medic al rec ords. That just seems like a pr actice that needs to be condemne d. Q. And bec ause he failed to fulfill t hat obligation, the surg ery happene d? A. That’s the only way it could have happe ned, ye s
. (empha sis added). Upon re viewing Dr. Ha nsen’s de position as a whole, J oh ns ton v . Ci nc inn ati , N.O. & T.P. Ry. Co. , 240 S.W . 429, 435 (Tenn. 1921), we conclude that Dr. Hanse n’s statements re g arding causation are n o t co n t ra dictory . Fr om the afor ementioned testimony , it is clear that Dr . Hanse n’s opinions re g ard ing c a us ati on are b a se d u po n h is assumption that Helderman’s medica l rec ords containe d docu m en t at i on indicating that Dr. Smolin had chang ed his diag nosis. As previously discussed, whether such docume ntation was, i n fac t, contained in he r medica l rec ords at the time of he r surg ery is a disputed issue of fa ct which we must view in the light most favora ble to the oppone n t o f the motion at this preliminary stag e. W il s o n v . P a tt e rson , 7 3 S

. W

. 3 d 95, 104 (Tenn. Ct. App. 2001); Church v. Pe rales , 39 S.W .3d 149, 170 (Tenn. Ct. App. 2000). Additionally , we note that the aforementioned deposition testimony relied upon by the trial court in ruling on Dr. Smolin’s moti on to s t rike wa s offe red in re sponse to questions addre ssing wh e the r D r. Grimb a ll breache d th e sta nd ardof c are . D uring his de po sit ion , D r. Ha ns e n a lso p r o v i d e d t h e f

o l l o w i n g t e s t i m o n y: Q. “ As s u mi ng Dr. Grimball’s testimony to be c orrect that no
su c h c om mu nic ati on was e v e r re c e iv e d b y him , D r. Ha ns e n is expected to re nder an opinion that there was a violation of the sta nd ardof

c are on the pa

rt of Dr. S molin a nd

/or his c lin ic staff for which he is responsible.” I s that a cor rec t statement o f yo u r a n t i c i p a t e d t e s t i m o n y? A. Yes.

. . . . Q. Is it yo u r o

pinion that Dr. Smoli n breache d the standard of
c are in his ini tia l diag no sis tha t the atr ial se pta l de fe c t wa s, in fact, signif

icant and surgery was therefore warranted ? A. My answer to that would be, yes, I

believe it’s below the standard of care to hav e eve r thought that this pati ent had a-15- hemody namically significant atrial septal defect . I think that was a mistake that it was possible to recove r fr om them beca use the pa t i en t actually

didn’t g o off to surg ery , so it’s one of the se m i s t akes where at least initially there was no ha rm do ne a ndso the re ’s a c ha nc e fo r c or re c tio n a t th a t po int

.

. . . . Q. We’ ve be e n ta lki ng abo ut c ard iol og ist s andc ard iotho ra c ic surg eons without rea lly

allowing y o u t o d efine those, . . . I would like for y ou t o define for me the scope of the c ard iol og ist ’s wo rk

ve rs us the sc op e of

the c ard iotho ra c ic surg eon’s wor

k. Would y ou please do that for me? A. Certainly . Cardiolog ists and c ardiova scular sur g eons sta rt fr om d if fe re nt s tart ing po int s.
. . . T hat th e c ard iol og ist is inv olv e d w it h the a sse ssm e nt, dia gn os is a nd tre atm e nt of disorders of

the hea rt and the va scular sy stem, and — but would not perf

orm a surgica l proce dure that require d an open heart surg ery
. . . . Th e su rg e on , o n th e oth e r h a nd , is no t so inv olv e d in the dia gn os is a nd

me dic al t re atm e nt o

f a pa tie nt as he is w ith the su rg ic al t re atm e nt of

the ir — the pr ob le ms that r e la te to the hea rt and the va s cu l ar sy stem. So that would be the differ ence betwee n the two. (e mph a sis a dd e d) . It is no t e nt ire ly c le ar, a s th e tr ia l c ou rt

he ld, that D r. Ha ns e n te sti fi e d in his de p o s i t i o n t h a t D r
. G r i m b a l l i s t h e s o l e p r o xi m a t e c a u s e o f H e l d e r m a n ’ s i n j u r i e s
. A s w ith his testimonyreg arding t he standa rd of c are , any

contra dictions in Dr. Hanse n’s testimony reg arding i s s u e s o f d i s p u t e d f

a c tar e p r o p e r l y l e f

t t o t h e j u r y i n w e i g h i n g h i s t e s t i m o n y a n d a s s i g n i n g c r e d i b i l t y. Gambill v. Middle Tenn. Me d. Ctr., Inc ., 751 S.W .2d 145, 151 (Tenn. Ct. App. 1988).
“A t t h e p re s ent pre liminary stag e of the proce eding s, there should not be a dismiss al for inc on sis te nc y

in t e sti mon y

of a wi tne ss unl ess it re pr e se nts a n u ne qu ivo c a l a ndir re c on c ila ble conflict.” Id

. at 151–52. Acc ording ly , we f ind that the trial court a

bused its discretion in striking portions of Dr. Hansen’s a ffidavit.
After striking portions of Dr. Ha nsen’s a ffidavit re lating to the sta n d a r d o f c a r e and c ausation, the tr ia l c ou rt

pr oc e e de d to g rant D r. Smo lin ’s mot ion fo r s umm ary jud g me nt, statin g :
2. The Motion for Summary J udg ment on behalf of the De fe nd a nts , D r. Smo lin a ndthe Me dic a l Sp e cia lt y Clin ic , P. C. i s g rante d. Th e Cou rt

fi nd s th a t no g e nu ine iss ue a s to a ny ma te ri a l f a c ts exis t in this cause . Furthermore , the P l ai n t iffs have failed to show any proof that Dr . Smoli n or his clinic was a proxi mat e ca u s e or a-16- contributing cause to Mrs. Helderman’s surg ery or to her suf

fering injuries. Plaintiff’s own ex p ert, Dr. Hanse n, in his deposition te sti mon y c le a rl y pla c e s th e so le pr oximate c a us a tio n o f M rs
. Helderman having to underg o surg ery upon Dr. Grimball’s actions or inactions. The Plaintiff has f ailed to meet the bur den of pr oving by expert evidenc e that Dr . Smoli n or hi s clinic breache d the standar d of car e in this cause, or

that Dr. Smolin’s neg lige nt act or omissi on was the pr oximate c a us e of

Mr s. He lde rm a n’ s su ff

e ri ng sa me inj urie s. Upon c o nducting a de novo revie w of the r ecor d, we c annot ag ree . As previously discussed, the seeming ly

inconsistent opinions offere d by Dr. Ha nsen re g arding the standar d of ca re a nd causation are based upon the ultimate resolution of fac tual disputes to be decide d by a jury

. “The re c an be mor e than one proxi mate cause of an injury .” Stokes v . Leung , 651 S.W .2d 70 4, 70 8 ( Te nn . Ct . A pp . 1 98 2) ; see also Robe rts v. Robertson C o u n t y Bd. of Educ ., 692 S.W .2d 863, 871 (Tenn. Ct. App. 1985). “ There is no require ment that a ca use, to be re g arde d as the proxi mate ca

use of a n injury , be the sole cause, the last ac t, or the one ne are st to the injury , provided it is a substantial f

actor in pr oducing the end result.” McClenahan v . Cooley , 806 S.W .2d 767, 775 (T e nn . 1 99 1) ; se e als o J

e nn ing s v . Ca se , 1 0 S

. W

. 3 d 6 2 5 , 6 2 9

– 3 0 (T en n
. C t

. Ap p
. 1 9 9 9 ) ( ci t i n g Ba ss v . B ar k sd ale , 671 S.W .2d 476 (Tenn. Ct. App. 1984)) . As our supre me court has stated,

The g ener al rule is th at wh at is the proxi mate ca use of a n injury is a question for the jury ; the court instructing them as to what the law r equire s to constitute it, and the jury apply ing the law to the fac ts. But whethe r the que stion is one to be dete rmined by the jury depe n d s o n th e f

a c ts o f e a c h c a s e
. T h u s w h e r e th e f a c ts of the particula r c as e ar e contr overte d, and ar e of suc h a cha rac ter that differ en t minds m ight r easona bly draw differ ent conc lusions there from, a que stion of fac ts is presented pr operly determinable by the jury

. . . . But when the facts are undisputed and ar e susce ptible of but one infer ence , the question is one of law for the c ourt.
Fa irb an k s, Mor se & Co. v . G am bil l , 222 S.W . 5, 10 (Tenn. 1919) (citations omitted); se e als o Southeastern Grey hound Lines, Inc. v. G roves , 136 S.W .2d 512, 517 (Tenn. 1940)

. Helderman has e stablished that a g enuine issue of materia l f act r emains in this case, i.e ., at wh a t po int , if

a t a ll, didDr . Sm oli n’ s a me nd e d d ia g no sis fi ndits way in to her me dic a l r e c or ds

. Held er m an ’s ex p er twi t n es s , d ra wi n g ce rt ai n i n fe re n ce s fr o mt h e f ac t s i n h erfa v o r, p u rp o rt s t o testify that Dr

. Smo lin br e a c he d the app lic able sta nd ardof c are a ndwa s a

pr oximate c a us e of

he r i nju ri e s. Conversely , Dr. Smolin’s ex pert witness, dra wing cer tain infere nces f

rom the fa cts in his favor, pu rp orts t o te sti fy

that D r. Smo lin didno t bre a c h the app lic able sta nd ard of c are , a ndDr . G ri mba ll was the sole pr ox imate cause of He lderman’ s injuries. Se e An de rs v . S tub ble fie ld , No

. 1 8 9, 1989 Tenn. App. L

EXI S 3 4 1 , at * 5 (Tenn. Ct. App. May 9, 1989) (f

inding summary

judgme nt-17-

ina pp ro pria te wh e re the pa

rt ie s’ e xpe rt s a ssu me d c e rt a in fa c ts we re true wh e n re nd e ri ng thei r opinions). Taking the fac ts in the light most fa vorable to H elderman, the evidenc e reg arding whether Dr . Sm oli n a c tua lly

c ommun ic a te d h is c ha ng e d dia g no sis to D r. Grimb a ll r e ma ins in d isp ute a ndis subject to nume rous infere nces. Se e Pr inc e v . Sain t Th om as Ho sp ., 945 S.W .2d 731, 733–35 (Tenn. Ct. App. 1996). Acc ording ly , the t rial court err ed in taking this fac t to be undis puted and g ranting Dr. Smolin’s moti on for summary judgme nt.
III . C ONCL US I ON
F or the re a so ns se t f

orth h e re in, we re ve rs e the de c isi on of the tr ia l c ou rt

a ndre ma ndthi s c a se for f urther pr ocee dings c onsistent with thi s o p i n i o n
. C o sts of this appeal ar e to be taxed to the Appellee , Dr. Matthew Smoli n, for whic h execution may issue if nec essary
.

___________________________________ ALAN E. HI GHERS, J UDGE