Court Opinion

ID: 9942454
Source: CourtListenerOpinion
Date Created: 2024-02-21 01:12:17.630692+00
Date Added: 2024-06-11T13:48:06.962202
License: Public Domain

02/20/2024
                IN THE COURT OF APPEALS OF TENNESSEE
                           AT KNOXVILLE
                               November 14, 2023 Session

 KENDALL COLLIER EX REL. CHAYCE C. v. PERICLIS ROUSSIS, M.D.,
                           ET AL.

                    Appeal from the Circuit Court for Knox County
                       No. 2-562-12    William T. Ailor, Judge

                              No. E2022-00636-COA-R3-CV

This appeal concerns juror misconduct. Chayce Collier (“Chayce”), a minor, by and
through his parent and next friend, Kendall Collier (“Plaintiff”), sued Periclis Roussis,
M.D. (“Dr. Roussis”), Fort Sanders Perinatal Center, and Fort Sanders Regional Medical
Center (“the Hospital”) (“Defendants,” collectively) in the Circuit Court for Knox County
(“the Trial Court”) alleging health care liability in Chayce’s delivery. A major issue at trial
was whether Dr. Roussis fell below the standard of care by failing to administer
epinephrine to Plaintiff when she had an anaphylactic reaction during labor. The jury found
for Defendants. However, it emerged that a juror had gone home and looked at the warning
on an epipen which said that epinephrine should only be used when the potential benefit
justifies the potential risk to the fetus. The juror shared this information with the rest of
the jury. Plaintiff filed a motion for a new trial, which the Trial Court first granted and
then denied. Plaintiff appeals. Under Tenn. R. Evid. 606(b), jurors may not be asked what
effect, if any, that extraneous information had on them. Instead, courts look to the
extraneous information itself to determine whether there is a reasonable possibility that it
altered the verdict. We hold that there is a reasonable possibility that the extraneous
information shared with the jury in this case altered the verdict, and Defendants failed to
rebut the presumption of prejudice. The Trial Court applied an incorrect legal standard and
thereby abused its discretion in denying Plaintiff’s motion for a new trial. We reverse the
judgment of the Trial Court and remand for further proceedings consistent with this
Opinion.

  Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court Reversed;
                                  Case Remanded

D. MICHAEL SWINEY, C.J., delivered the opinion of the court, in which JOHN W.
MCCLARTY and THOMAS R. FRIERSON, II, JJ., joined.
Joe Bednarz, Sr. and Joe Bednarz, Jr., Hendersonville, Tennessee, for the appellant, Chayce
Collier, a minor, by and through his natural parent and next friend, Kendall Collier.

Raymond G. Lewallen, Jr., Knoxville, Tennessee, for the appellee, Periclis Roussis, M.D.

Rick L. Powers and Rachel P. Hurt, Knoxville, Tennessee, for the appellees, Fort Sanders
Perinatal Center and Fort Sanders Regional Medical Center.1

                                           OPINION

                                          Background

        In June 2009, Plaintiff was admitted to the Hospital in connection with her
pregnancy. Plaintiff tested positive for Strep B and was given ampicillin. Plaintiff had a
major anaphylactic reaction. Dr. Roussis arrived and documented his observations, writing
in part:

          Called to see patient because of SOB [shortness of breath]. . . . She is
          cyanotic with difficulty breathing. . . . BP [blood pressure] 140/95. P
          [pulse]:150-155 in severe distress. . . . Patient was on O2. In view of this
          [reaction] patient given Benadryl and solu-medrol IV and SQ brethine[.] No
          epi pen on floor at that time. . . . By 10:55, patient was doing better. . . .

Plaintiff later gave birth to Chayce, who suffered from brain damage. In October 2012,
Plaintiff sued Defendants in the Trial Court alleging health care liability in Chayce’s
delivery. The case was tried by jury.

        In 2015, the jury returned a verdict in Defendants’ favor and the Trial Court entered
judgment for Defendants. On appeal, in Collier v. Roussis, No. E2016-01591-COA-R3-
CV, 2017 WL 3382801 (Tenn. Ct. App. Aug. 7, 2017), perm. app. denied Dec. 6, 2017
(designated not for citation), we vacated the Trial Court’s judgment and remanded for a
new trial.

       On remand, the case was again tried before a jury, this time from July 8, 2019
through July 22, 2019. A central issue was whether Dr. Roussis fell below the standard of
care in treating Plaintiff by failing to administer epinephrine—a drug used to treat
anaphylactic reaction. Defendants’ experts testified that one must weigh the risks and
benefits before administering epinephrine. According to Defendants, it was within the

1
    Defendants share a common brief.
                                               -2-
standard of care for Dr. Roussis to exercise his judgment and elect not to administer
epinephrine under the circumstances. Plaintiff’s experts acknowledged the general need
to weigh the risks and benefits but that, in cases of anaphylactic reaction such as that
suffered by Plaintiff, the benefits of epinephrine always outweigh the risks. For example,
Dr. H. James Wedner, an expert for Plaintiff, testified:

      Q. Doctor, I don’t think I’ve asked you this question, but what is the
      treatment for anaphylaxis?
      A. The treatment for anaphylaxis is epinephrine.
      Q. Always?
      A. Always.
      Q. Are there any absolute contraindications to the use of epinephrine?
      A. No.

                                           ***

      Q. Doctor, do you have an opinion to a reasonable degree of medical
      certainty whether Dr. Roussis violated the standard of care in his care and
      treatment of Kendall Collier?
      A. I think he should have used epinephrine.
      Q. Was that a violation of the standard of care not to do so?
      A. Yes.
      Q. Doctor, in terms of the treatment of anaphylaxis in the administration of
      epinephrine, does it matter whether the blood pressure dropped or not?
      A. No.
      Q. Why not?
      A. Remember that we said in order to make a diagnosis, you need two organ
      systems. In this case, we’ve had more than that.
              There are two reasons that we don’t wait for the blood pressure to
      drop. It may drop and it may drop later, and you don’t want that to happen.
      So by early administration of epinephrine, you literally prevent the blood
      pressure from dropping if it hasn’t.
              So you don’t wait. What we say about epinephrine is, if you think
      you should have used epinephrine, you should already have given it. So you
      don’t wait for the symptoms to mature. You don’t wait for the blood pressure
      to drop. You don’t wait for them to have skin symptoms. If you make a
      diagnosis, you treat the patient right then and there.

                                           ***

                                           -3-
      Q. On cross-examination, you agreed that epinephrine should only be used
      when the benefits outweigh the risk.
      A. That’s correct.
      Q. Is that true with all drugs?
      A. Every drug.
      Q. How often do the benefits outweigh the risk when you’re talking about
      the administration of epinephrine when faced with anaphylaxis?
      A. Always.

Dr. Jerry L. Epps, an expert witness for Defendants, gave an opposing view. He testified
that the decision to administer epinephrine for an anaphylactic reaction is not necessarily
so clear-cut:

      Q. The jury has heard about epinephrine in this case. Could you tell the jury
      your opinion on whether epinephrine would always be the drug of choice for
      a pregnant, laboring patient who has an anaphylactic reaction?
      A. So I think that you have to make a distinction about the use of epinephrine
      in a couple senses.
              One is that there’s no question epinephrine is the drug of choice for
      someone with a severe anaphylactic reaction manifested by a decrease in
      blood pressure. It’s that reason -- for two reasons. One is that epinephrine
      increases the strength of the contraction of the heart. It also causes blood
      vessels to constrict, which raises the blood pressure.
              Even more so, epinephrine will treat the reason why you’re having the
      anaphylactic reaction. So with anaphylaxis, there are certain cells found in
      your body. There’s mast cells, which are out around the cells themselves,
      and basophils, which are actually in the blood system. They have what we
      call granules inside them. Those granules have the mediators, the substances
      that caused anaphylaxis to occur, and there’s a multitude of substances that
      are released when that occurs. Epinephrine stabilizes these granules and
      prevents them from being released.
              The problem with epinephrine is, is that it is not a drug that you can
      give at liberty. It has risks associated with it. As physicians, our goal is to
      assess risks and benefits and make an informed decision based on the clinical
      presentation at the time when we evaluate a patient as what to do next.

                                           ***

      [E]pinephrine has serious side effects when given through intravenous means
      or even intramuscular means, and that means it can cause your blood pressure
      to go exceedingly high. I’ve seen it go as high as 350 torr in that standpoint.
                                            -4-
       It can cause your heart to have a heart attack. It can cause your blood vessels
       to dissect. It can cause your brain to have a bleed in that circumstance.
       There’s just a multitude of problems that epinephrine can cause.

       At trial’s end, the jury returned a verdict in favor of Defendants. Plaintiff
subsequently filed a motion for a new trial. Plaintiff asserted, among other things, that
juror misconduct had occurred. In support of her motion, Plaintiff attached as exhibits to
her memorandum of law the affidavits of jurors Joe Mynatt (“Mynatt”) and David Woods
(“Woods”). In his affidavit, Mynatt stated:

       I, Joe Mynatt, after being duly sworn, hereby depose and state as follows:
       1. That I served as a juror in the case described above.
       2. That during our deliberations, a fellow juror, juror No. 8, Zachary
       Jacobsen, shared with the other jurors that he had gone home over the
       weekend and looked at the warnings on Epipens.
       3. Mr. Jacobsen, shared with us information on those warnings. He said that
       the Epipen stated that caution should be used during pregnancy and that
       epinephrine should only be used when the potential benefit justified the
       potential risk to the fetus.

Woods stated much the same in his affidavit.

        The Trial Court initially granted Plaintiff’s motion for a new trial. Defendants then
filed a motion to alter or amend. It was, and is, Defendants’ position that the information
shared with the jury was nothing new or prejudicial so as to require a new trial. The Trial
Court agreed with Defendants and entered an order this time denying Plaintiff’s motion for
a new trial. The Trial Court attached a transcript of its oral ruling to its order. In its oral
ruling, the Trial Court stated as relevant:

              THE COURT: All right. In reviewing [Tenn. R. Evid.] 606(b),
       competency of a juror as a witness, inquiry into validity of verdict, the rule
       reads as follows. “Upon inquiry into the validity of a verdict or indictment, a
       juror may not testify as to any matter or statement occurring during the course
       of the jury’s deliberation or to the effect of anything upon any juror’s mind
       or emotions as influencing that juror to assent to or dissent from the verdict
       or indictment or concerning the juror’s mental process, except that a juror
       may testify on the question of whether extraneous prejudicial information
       was improperly brought to the jury’s attention, whether any outside influence
       was improperly brought to bear upon any juror, or whether the jurors agreed
       in advance to be bound by a quotient or gambling verdict without further
       discussion, nor may a juror’s affidavit or evidence of any statement by the
                                              -5-
       juror concerning a matter about which the juror would be precluded from
       testifying be received for these purposes.”
               The Court, in reviewing case law cited by all of the parties and the
       statements that have been referred to in the record, looking at the case law,
       the case law seems to have been all over the map with regard to some of the
       interpretation of 606(b).
               Clearly, in this case, the defendants have witnesses who testified with
       regard to the use of epinephrine in a pregnant patient, as well as the warnings
       that have been part of the medical literature concerning the use of epinephrine
       in pregnant patients. Also Dr. Wedner did testify that caution should be used
       in pregnant patients.
               The use of epinephrine in this case is a central issue in this case. It is
       one of the most important issues that the jury had to decide. The defense
       offered its experts with regard to the concerns of using epinephrine in a
       pregnant patient. The plaintiff’s experts testified that epinephrine was
       something that was the, as I recall, the gold standard in a patient in
       anaphylaxis.
               In looking at Rule 606, it is clear that this juror did look at extraneous
       information, that being information outside of what was brought into the trial.
       However, that information clearly had been testified to by defense experts.
       Those warnings were not new.
               So the next question is whether or not that information is prejudicial
       information. There is, from the Court’s review of the affidavits, no testimony
       that this affected the jury in any way, and Rule 606(b) does not preclude the
       question to jurors as to whether or not that information affected them. The
       Caldararo court ruled that the standard is that prejudicial information must
       be proved by clear and convincing evidence.[2]
               The Court’s opinion with regard to this evidence would be that the
       evidence had to have an influence on the jury. However, the Court’s opinion
       with regard to whether or not the plaintiffs have met the standard of clear and
       convincing evidence is that the plaintiffs have not met that burden.
       Therefore, the Court modifies its ruling with regard to that particular issue.

Plaintiff filed a motion to alter or amend, which the Trial Court denied. Plaintiff timely
appealed to this Court.

2
 Caldararo does not mention clear and convincing evidence. See Caldararo by Caldararo v. Vanderbilt
Univ., 794 S.W.2d 738 (Tenn. Ct. App. 1990).
                                                -6-
                                                Discussion

       Plaintiff raises eight issues on appeal.3 However, we discern one dispositive issue:
whether the Trial Court erred in denying Plaintiff’s motion for a new trial on grounds of
juror misconduct.

       The denial of a motion for a new trial generally is reviewed for abuse of discretion.
Allen v. Albea, 476 S.W.3d 366, 373 (Tenn. Ct. App. 2015). In Lee Med., Inc. v. Beecher,
312 S.W.3d 515 (Tenn. 2010), the Tennessee Supreme Court discussed the abuse of
discretion standard at length, stating:

               The abuse of discretion standard of review envisions a less rigorous
        review of the lower court’s decision and a decreased likelihood that the
        decision will be reversed on appeal. Beard v. Bd. of Prof’l Responsibility,
        288 S.W.3d 838, 860 (Tenn. 2009); State ex rel. Jones v. Looper, 86 S.W.3d
        189, 193 (Tenn. Ct. App. 2000). It reflects an awareness that the decision
        being reviewed involved a choice among several acceptable alternatives.
        Overstreet v. Shoney’s, Inc., 4 S.W.3d 694, 708 (Tenn. Ct. App. 1999). Thus,
        it does not permit reviewing courts to second-guess the court below, White
        v. Vanderbilt Univ., 21 S.W.3d 215, 223 (Tenn. Ct. App. 1999), or to
        substitute their discretion for the lower court’s, Henry v. Goins, 104 S.W.3d
        475, 479 (Tenn. 2003); Myint v. Allstate Ins. Co., 970 S.W.2d 920, 927
        (Tenn. 1998). The abuse of discretion standard of review does not, however,
        immunize a lower court’s decision from any meaningful appellate scrutiny.
        Boyd v. Comdata Network, Inc., 88 S.W.3d 203, 211 (Tenn. Ct. App. 2002).

               Discretionary decisions must take the applicable law and the relevant
        facts into account. Konvalinka v. Chattanooga-Hamilton County Hosp.
        Auth., 249 S.W.3d 346, 358 (Tenn. 2008); Ballard v. Herzke, 924 S.W.2d
        652, 661 (Tenn. 1996). An abuse of discretion occurs when a court strays
        beyond the applicable legal standards or when it fails to properly consider
        the factors customarily used to guide the particular discretionary decision.
3
  These are: (1) whether the Trial Court erred in failing to grant a new trial because of juror misconduct -
bringing extraneous prejudicial information to the entire jury; (2) whether the Trial Court erred in allowing
Defendants to “blame shift” without ever pleading comparative fault; (3) whether the Trial Court erred in
granting partial summary judgment to Defendant Dr. Roussis with regard to the administration of
Amoxicillin on June 1, 2009; (4) whether the Trial Court erred in allowing Nurse Hensley and Nurse Ott
to testify; (5) whether the Trial Court erred in refusing to charge the jury regarding spoliation of evidence;
(6) whether the Trial Court erred in unduly restricting fact witnesses’ testimony relating to the use of blue
blood pressure cuffs; (7) whether the Trial Court erred in refusing to charge the jury regarding the prior
trial; and (8) whether the Trial Court erred in excluding evidence of pre-majority expenses. (Format
modified).
                                                     -7-
        State v. Lewis, 235 S.W.3d 136, 141 (Tenn. 2007). A court abuses its
        discretion when it causes an injustice to the party challenging the decision by
        (1) applying an incorrect legal standard, (2) reaching an illogical or
        unreasonable decision, or (3) basing its decision on a clearly erroneous
        assessment of the evidence. State v. Ostein, 293 S.W.3d 519, 526 (Tenn.
        2009); Konvalinka v. Chattanooga-Hamilton County Hosp. Auth., 249
        S.W.3d at 358; Doe 1 ex rel. Doe 1 v. Roman Catholic Diocese of Nashville,
        154 S.W.3d [22,] 42 [(Tenn. 2005)].

               To avoid result-oriented decisions or seemingly irreconcilable
        precedents, reviewing courts should review a lower court’s discretionary
        decision to determine (1) whether the factual basis for the decision is
        properly supported by evidence in the record, (2) whether the lower court
        properly identified and applied the most appropriate legal principles
        applicable to the decision, and (3) whether the lower court’s decision was
        within the range of acceptable alternative dispositions. Flautt & Mann v.
        Council of Memphis, 285 S.W.3d 856, 872-73 (Tenn. Ct. App. 2008)
        (quoting BIF, a Div. of Gen. Signal Controls, Inc. v. Service Constr. Co., No.
        87-136-II, 1988 WL 72409, at *3 (Tenn. Ct. App. July 13, 1988) (No Tenn.
        R. App. P. 11 application filed)). When called upon to review a lower court’s
        discretionary decision, the reviewing court should review the underlying
        factual findings using the preponderance of the evidence standard contained
        in Tenn. R. App. P. 13(d) and should review the lower court’s legal
        determinations de novo without any presumption of correctness. Johnson v.
        Nissan N. Am., Inc., 146 S.W.3d 600, 604 (Tenn. Ct. App. 2004); Boyd v.
        Comdata Network, Inc., 88 S.W.3d at 212.

Beecher, 312 S.W.3d at 524-25.

       Plaintiff asserts that the standard for proving juror misconduct is preponderance of
the evidence, not clear and convincing evidence as stated by the Trial Court.4 Defendants,
on the other hand, argue that the standard is clear and convincing evidence. In a 2013
criminal case, the Tennessee Supreme Court engaged in a lengthy discussion concerning a
jury’s exposure to extraneous information:

              In Walsh [v. State, 166 S.W.3d 641 (Tenn. 2005)], this Court settled
        any question as to the scope of inquiry permitted under Tennessee Rule of
        Evidence 606(b), explicitly holding that the rule “prohibits introduction of
4
  Plaintiff points out by way of contrast that a petitioner in a post-conviction criminal setting has a clear
and convincing burden of proof, but that is specifically provided for by statute. See Tenn. Code Ann. § 40-
30-110(f).
                                                    -8-
juror testimony concerning the effect on the juror of an improper
communication . . . during jury deliberations.” 166 S.W.3d at 643. The terms
of the rule therefore prohibit the State from introducing what might otherwise
be perceived as the most relevant evidence to rebut the presumption of
prejudice—juror testimony as to whether the extraneous prejudicial
information or improper outside influence actually had any effect on the
verdict. While we acknowledge the limitations this presented to the State in
its efforts to overcome the presumption, there are sound policy reasons for
the exclusion of such proof.

                                      ***

       We believe that the analysis in Walsh, as supplemented by a
combination of the factor tests employed by the federal circuit courts of
appeals, provides the proper framework for determining the probable,
objective effect upon a verdict of a juror’s exposure to either extraneous
prejudicial information or an improper outside influence. In determining
whether the State has rebutted the presumption of prejudice in circumstances
such as these, trial courts should consider the following factors: (1) the nature
and content of the information or influence, including whether the content
was cumulative of other evidence adduced at trial; (2) the number of jurors
exposed to the information or influence; (3) the manner and timing of the
exposure to the juror(s); and (4) the weight of the evidence adduced at trial.
No single factor is dispositive. Instead, trial courts should consider all of the
factors in light of the ultimate inquiry—whether there exists a reasonable
possibility that the extraneous prejudicial information or improper outside
influence altered the verdict. Applying these factors to the case before us,
we find no reasonable possibility that the note received by the jury foreman
altered the verdict.

                                      ***

       As a final matter, because the right to a trial by an impartial jury is
grounded in the federal and state constitutions, a trial court’s analysis under
Tennessee Rule of Evidence 606(b) should be reviewed by the appellate
courts as a mixed question of law and fact. In consequence, this issue is
subject to the de novo standard of review. The trial court’s factual findings—
such as the credibility and weight to be given a juror’s testimony or the
weight of the evidence presented at trial—should be reviewed de novo,
accompanied by a presumption of correctness unless the evidence
preponderates otherwise. However, the trial court’s conclusions of law—
                                       -9-
      such as whether a jury’s verdict was affected by extraneous prejudicial
      information or an improper outside influence—should be reviewed under a
      purely de novo standard, with no accompanying presumption of correctness.

State v. Adams, 405 S.W.3d 641, 651-54, 656 (Tenn. 2013) (footnotes and some citations
omitted). Notably, Adams does not mention clear and convincing evidence in connection
with juror misconduct and Rule 606(b). In 2015, in the wake of Adams, this Court
discussed juror misconduct as follows:

             It is well settled that a jury’s verdict must be grounded on the evidence
      that was introduced at trial. Patton v. Rose, 892 S.W.2d 410, 413 (Tenn. Ct.
      App. 1994) (citation omitted). A verdict that is “based on something other
      than the evidence introduced at trial is improper and should not be allowed
      to stand.” Id. “However, in order to be granted a new trial due to such jury
      misconduct, there must be admissible evidence on the issue.” Id. Rule
      606(b) of the Tennessee Rules of Evidence controls the admissibility of juror
      evidence. The Rule provides:

             Inquiry Into Validity of Verdict or Indictment. Upon an
             inquiry into the validity of a verdict or indictment, a juror may
             not testify as to any matter or statement occurring during the
             course of the jury’s deliberations or to the effect of anything
             upon any juror’s mind or emotions as influencing that juror to
             assent to or dissent from the verdict or indictment or
             concerning the juror’s mental processes, except that a juror
             may testify on the question of whether extraneous prejudicial
             information was improperly brought to the jury’s attention,
             whether any outside influence was improperly brought to bear
             upon any juror, or whether the jurors agreed in advance to be
             bound by a quotient or gambling verdict without further
             discussion; nor may a juror’s affidavit or evidence of any
             statement by the juror concerning a matter about which the
             juror would be precluded from testifying be received for these
             purposes.

             As a matter of law, juror testimony regarding the jury’s deliberations,
      “including the juror’s own internal thoughts, motivations, or emotions[,]”
      generally is not admissible. Walsh v. State, 166 S.W.3d 641, 647 (Tenn.
      2005) (citations omitted). Rule 606(b) is based on the common-law rule
      prohibiting the admission of a juror’s testimony to impeach the jury’s verdict
      and on the common-law exception for testimony concerning extraneous
                                           -10-
influences. Id. at 646 (citation omitted). It “promotes full and frank
discussion in the privacy of the jury room and protects jurors from
harassment by the losing party who might seek to impeach the verdict.” Id.
The “overarching purpose” of Rule 606(b) “is to protect the integrity of the
jury’s deliberative process.” Id.

        Under Rule 606(b), a juror may testify in order “to establish the fact
of extraneous information or improper influence on the juror[.]” Id. at 649
(emphasis added). The Tennessee Supreme Court held in Walsh, however,
that juror testimony “concerning the effect of such information or influence
on the juror’s deliberative processes” is not admissible. Id. Additionally, we
have held that a trial court abuses its discretion when it admits juror
testimony regarding the effect of extraneous information on the jury’s
decision-making process. Gaines v. Tenney, No. E2008-02323-COA-R3-
CV, 2010 WL 199628, at *2 (Tenn. Ct. App. 2010) (citing Walsh, 166
S.W.3d at 649).

       “‘[E]xtraneous information’ is information from a source outside the
jury.” Caldararo by Caldararo v. Vanderbilt University, 794 S.W.2d 738,
742 (Tenn. App. 1990) (citing State v. Coker, 746 S.W.2d 167, 171 (Tenn.
1987)). The Caldararo court noted:

       External influences that could warrant a new trial if found to be
       prejudicial include: (1) exposure to news items about the trial,
       (2) consideration of facts not admitted in evidence, and (3)
       communications with non-jurors about the case. Internal
       influences that are not grounds to overturn a verdict include:
       (1) discussions among jurors, (2) intimidation or harassment of
       one juror by another, (3) a juror’s personal experiences not
       directly related to the litigation, and (4) a juror’s subjective
       thoughts, fears, and emotions.

Id. (emphasis added) (internal citations omitted). Thus, a juror’s notes taken
during trial, for example, are not considered extraneous information and use
of such notes during jury deliberations is not considered outside influence.
Id. at 743. Additionally, while a juror’s personal experiences that are
unrelated to the litigation do not constitute external information, a juror’s
personal experiences that relate directly “to the parties or to the events
directly involved in the litigation may[.]” Id. at 744 (citations omitted).
“[E]xtraneous information could enter the jury room through the mouth of a
juror[ ]” if, for example, the juror conducts independent research or performs
                                     -11-
      his own tests. Id. n.7 (citation omitted). “[T]he effect of anything upon any
      juror’s mind or emotions” is not admissible, however. State v. Adams, 405
      S.W.3d 641, 651 (Tenn. 2013) (quoting Tenn. R. Evid. 606(b)). Pressure and
      intimidation by other jurors also are not extraneous information or outside
      influence. State v. Hailey, 658 S.W.2d 547, 553 (Tenn. Crim. App. 1983).

             The party seeking a new trial on the ground of juror misconduct bears
      the burden of proving misconduct by a preponderance of the evidence.
      Worley v. Rarity Communities, Inc., No. M2012-01373-COA-R3-CV, 2013
      WL 3958444, at *1 (Tenn. Ct. App. July 29, 2013) (perm. app. denied Dec.
      11, 2013). In this case, that portion of Mr. Lofton’s affidavit regarding Mr.
      Pinson’s statement to the jury is admissible with respect to the fact of alleged
      extraneous information. However, that portion of his affidavit with respect
      to the effect, or intended effect, of that information is not admissible. See
      Walsh, 166 S.W.3d at 649.

Allen, 476 S.W.3d at 374-76; see also Parker v. Epstein Enterprises, LLC, No. W2019-
00311-COA-R3-CV, 2020 WL 2731234, at *15 (Tenn. Ct. App. May 26, 2020), no appl.
perm. appeal filed (“The party seeking a new trial on the ground of juror misconduct bears
the burden of producing admissible evidence ‘proving misconduct by a preponderance of
the evidence.’” (quoting Allen, 476 S.W.3d at 376)). In Allen, we concluded:

      [T]he issue presented by this appeal is whether the juror misconduct alleged
      by Mr. Allen provided the jury with extraneous information that was
      prejudicial to Mr. Allen. Notwithstanding Mr. Pinson’s disregard of the trial
      court’s instructions, Mr. Pinson introduced no information not already placed
      before the jury by Mr. Allen. Thus, Mr. Pinson’s statement did not constitute
      “extraneous prejudicial information” under Rule 606(b). Further, in light of
      the totality of the evidence, we find no reasonable possibility that Mr.
      Pinson’s statement altered the verdict. Accordingly, we find no error on the
      part of the trial court and affirm its denial of Mr. Allen’s motion for a new
      trial.

Allen, 476 S.W.3d at 377.

      In another case from this Court addressing juror misconduct, we articulated the
approach this way:

            Denim & Diamonds relies upon the extraneous prejudicial
      information exception found in Rule 606(b) to question the verdict. The
      burden of introducing evidence sufficient to support a finding that Rule
                                           -12-
       606(b) has been satisfied rests with Denim & Diamonds. State v. Stinnett,
       958 S.W.2d 329, 330 n. 5 (Tenn. 1997). If this burden is met, then a
       rebuttable presumption of prejudice arises and the burden shifts [to] the other
       party to explain the conduct or demonstrate it was harmless. Walsh, 166
       S.W.3d at 647.

Collins v. Arnold, No. M2004-02513-COA-R3-CV, 2007 WL 4146025, at *31 (Tenn. Ct.
App. Nov. 20, 2007), perm. app. denied April 14, 2008.

        By contrast, in Mayo v. Shine, 392 S.W.3d 61, 65 (Tenn. Ct. App. 2012), this Court
stated that the applicable standard is clear and convincing evidence: “‘[C]lear and
convincing evidence of prejudice is required to meet the standards of Tennessee Rules of
Evidence 606(b),’ and the burden is on the appellant to prove prejudice.” (quoting
Whiteside v. Hedge, No. E2004-02598-COA-R3-CV, 2005 WL 1248975, at *3 (Tenn. Ct.
App. May 26, 2005), no appl. perm. appeal filed).5 The Court of Criminal Appeals has
also cited Whiteside for this proposition. See State v. Booker, No. E2018-01439-CCA-R3-
CD, 2020 WL 1697367, at *31 (Tenn. Crim. App. April 8, 2020), reversed on other
grounds in State v Booker, 656 S.W.3d 49 (Tenn. 2022).

       We note the discrepancy in the caselaw as to the applicable burden of proof for juror
misconduct vis-à-vis Tenn. R. Evid. 606(b). Defendants are correct in that cases like Mayo
and Whiteside support clear and convincing evidence as the applicable standard. However,
in 2013, the Tennessee Supreme Court in Adams did not mention clear and convincing
evidence in connection with its extensive articulation of the law on juror misconduct and
Rule 606(b). In the 2015 Allen case, this Court likewise engaged in a lengthy discussion
on juror misconduct and never mentioned clear and convincing evidence. Meanwhile,
Whiteside and Mayo, the chief cases supporting Defendants’ position, are from 2005 and
2012 respectively. We conclude that, in the wake of Adams and more recent published
caselaw, the burden of proof for a party alleging juror misconduct is preponderance of the
evidence, not clear and convincing evidence. By holding Plaintiff to a clear and convincing
evidentiary burden, the Trial Court applied an incorrect legal standard.

       The Trial Court also stated that “Rule 606(b) does not preclude the question to jurors
as to whether or not that information affected them.” However, as shown in the authorities
above and the rule itself, the opposite is the case. Jurors may not be asked what effect, if
any, that extraneous information had on them. They can only be asked what information

5
  “Clear and convincing evidence means evidence in which there is no serious or substantial doubt about
the correctness of the conclusions drawn from the evidence.” Hodges v. S.C. Toof & Co., 833 S.W.2d 896,
901 n. 3 (Tenn. 1992). Meanwhile, the preponderance of the evidence standard simply means proving
something is more likely than not. See Marks, Shell, & Maness v. Mann, No. M2002-00652-COA-R3-CV,
2004 WL 1434318, at *2 (Tenn. Ct. App. June 23, 2004), no appl. perm. appeal filed.
                                                 -13-
they received, not what effect it had. As a result, we are left to look to the alleged
extraneous information itself to determine its possible impact on the verdict. Here, the
information was shared with the whole jury during its deliberations. The information was
thus broadly shared and shared at a crucial time in the jury’s decision-making process.
Defendants nevertheless argue that the information was inconsequential. Defendants’
arguments focus on the content of the information at issue as well as the weight of the
evidence adduced at trial. In their brief, Defendants state among other things that “these
two affidavits [by Mynatt and Woods] do not establish that information was presented to
the jury that was prejudicial or had an influence on the jury, because this specific
information had already been offered as evidence to the jury by no less than eight
expert witnesses.” (Emphasis in original). Defendants state further that “the information
allegedly conveyed by Mr. Jacobson was nothing new to the jury.” (Emphasis in original).
Finally, Defendants state that “the jury heard numerous times that caution should be used
in administering epinephrine to pregnant patients and epinephrine can have adverse effects
on a fetus.”

        Defendants do not dispute that Juror Zachary Jacobsen (“Jacobsen”) did what the
affidavits said he did. Instead, they argue that the information shared by Jacobsen was not
prejudicial. In fact, Defendants go so far as to say that “[t]hese affidavits [by Mynatt and
Woods] do not establish that Mr. Jacobson conducted independent research.” We
respectfully disagree. Jacobsen served on a jury in a case in which a central issue was a
doctor’s decision not to administer epinephrine in response to an anaphylactic reaction.
Jacobsen and the other jurors were obliged to refrain from investigating the case on their
own. They had to base their decision on the duly-admitted evidence from trial.
Notwithstanding that, Jacobsen went home, looked at the warning on an epipen, and
reported his observations to the jury. While not in-depth medical research by any stretch,
this action nevertheless constituted independent research as the warning label on the epipen
was not admitted into evidence. The warning “that caution should be used during
pregnancy and that epinephrine should only be used when the potential benefit justified the
potential risk to the fetus” could have swayed jurors to accept Defendants’ position that it
was consistent with the standard of care for Dr. Roussis to weigh the risks and benefits and
decide in his judgment not to administer epinephrine to Plaintiff over Plaintiff’s position
that the benefits always outweigh the risk concerning giving epinephrine to a pregnant
anaphylaxis patient.

        Defendants are correct in that the jurors were presented with expert testimony at
trial that there are risks and benefits to epinephrine and that caution should be used when
administering it. That much is uncontroversial. Both sides agree that caution should be
exercised when administering drugs as a matter of course. However, Plaintiff’s experts
testified that, irrespective of the general need to weigh the risks and benefits, the benefits
of epinephrine always outweigh the risks when confronted with an anaphylactic reaction
                                            -14-
such as that suffered by Plaintiff. The distinction is crucial and goes to the heart of the
trial. If the standard of care required that Dr. Roussis administer epinephrine to Plaintiff
to treat her anaphylactic reaction, the jury would have had a basis for finding in Plaintiff’s
favor. If, as Defendants contend, the issue was not so clear-cut, and Dr. Roussis could have
adhered to the standard of care by exercising his judgment not to administer epinephrine,
the jury could have found for Defendants. It was for the jury to decide this question based
solely on the properly-admitted evidence before it. The extraneous information shared by
Jacobsen likely polluted the jury’s deliberations.

       While Defendants argue that the extraneous information was nothing new, it was
materially different from the testimony at trial. Since the extraneous information came
from a warning on an epipen—a warning issued for general public consumption and
unconnected to Plaintiff’s lawsuit—the jury could have accorded it undue, added credence.
The jury could have further viewed the warning as an unbiased source, or a tiebreaker.
Thus, we disagree with Defendants’ argument that the warning was nothing new. It was
information not in evidence touching on a main issue at trial. In short, it was extraneous,
presumptively prejudicial information. Clearly Jacobsen thought his new information
relevant enough to tell the other jurors all about it. What is more, Plaintiff never had an
opportunity to counter this information. The epipen warning, which on its face favored
Defendants’ position, went unanswered. We agree that the Trial Court had it right when it
stated “[t]he Court’s opinion with regard to this evidence would be that the evidence had
to have an influence on the jury.” While it was “information” and not “evidence,” all that
was required of Plaintiff on this point was to show that there is a “reasonable possibility”
that this extraneous information altered the jury’s verdict. It was incumbent upon
Defendants to rebut the presumption of prejudice arising as a result of this extraneous
information being shared with the jury. Defendants failed to rebut the presumption of
prejudice or otherwise show that the information was harmless.

        Plaintiff has successfully proven juror misconduct by a preponderance of the
evidence. Even if the burden of proof were clear and convincing evidence as Defendants
state, Plaintiff would have met that burden too because based on this record there is no
serious or substantial doubt that Jacobsen shared what he is alleged to have shared with the
jury. Under our “purely de novo standard” of review on the question of whether the jury’s
verdict was affected by the extraneous prejudicial information as required by the Tennessee
Supreme Court in Adams, 405 S.W.3d at 656, we hold that there is a reasonable possibility
that the extraneous information at issue altered the jury’s verdict. We hold further that the
Trial Court abused its discretion in denying Plaintiff’s motion for a new trial.6 We,

6
 We recognize the tension between the de novo element of the juror misconduct analysis and the abuse of
discretion standard generally applied to motions for a new trial. Motions for a new trial are also granted or
denied on grounds other than juror misconduct. Here, as relevant to the abuse of discretion standard, the
Trial Court applied an incorrect legal standard by applying a clear and convincing evidentiary burden of
                                                    -15-
therefore, reverse the judgment of the Trial Court and remand for further proceedings
consistent with this Opinion.7

                                                 Conclusion

       The judgment of the Trial Court is reversed, and this cause is remanded to the Trial
Court for collection of the costs below and further proceedings consistent with this
Opinion. The costs on appeal are assessed against the Appellees, Periclis Roussis, M.D.,
Fort Sanders Perinatal Center, and Fort Sanders Regional Medical Center.

                                                    ______________________________________
                                                    D. MICHAEL SWINEY, CHIEF JUDGE

proof and in ruling that jurors may be asked whether extraneous information affected them. In addition,
denying Plaintiff’s motion for a new trial was not within the range of acceptable alternative dispositions in
view of the reasonably possible effect of the extraneous information on the verdict.
7
  In view of our ruling that Plaintiff has proven juror misconduct and that the Trial Court abused its
discretion in denying Plaintiff’s motion for a new trial, Plaintiff’s remaining issues are pretermitted. “It is
well-settled that the role of the court is to adjudicate and settle legal rights, not to give abstract or advisory
opinions.” Thomas v. Shelby Cnty., 416 S.W.3d 389, 393 (Tenn. Ct. App. 2011).
                                                      -16-