Court Opinion

ID: 9956409
Source: CourtListenerOpinion
Date Created: 2024-04-02 01:08:58.705837+00
Date Added: 2024-06-11T08:17:31.753363
License: Public Domain

04/01/2024
                  IN THE COURT OF APPEALS OF TENNESSEE
                               AT JACKSON
                                  February 1, 2024 Session1

       JAMES A. WELCH ET AL. v. OAKTREE HEALTH AND
 REHABILITATION CENTER LLC D/B/A CHRISTIAN CARE CENTERS
                    OF MEMPHIS ET AL.

                    Appeal from the Circuit Court for Shelby County
                        No. CT-000544-18 Jerry Stokes, Judge
                       ___________________________________

                             No. W2020-00917-COA-R3-CV
                         ___________________________________

At issue in this appeal is whether an individual, now deceased, lacked the requisite mental
capacity when he signed a durable power of attorney for health care. The trial court
answered this question in the affirmative, specifically concluding that there was clear and
convincing evidence that the decedent was incompetent. As a result of this determination,
the trial court further concluded that an arbitration agreement later signed by the decedent’s
brother using the power of attorney was invalid, a conclusion which in turn prompted the
trial court to deny the Defendants’ motion to compel arbitration on the basis of that
agreement. For the reasons stated herein, we affirm the order of the trial court.

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

ARNOLD B. GOLDIN, J., delivered the opinion of the Court, in which J. STEVEN STAFFORD,
P.J., W.S., and W. NEAL MCBRAYER, J., joined.

Craig C. Conley, Quinn N. Carlson, and W. Preston Battle IV, Memphis, Tennessee, and
Christy Tosh Crider, Nashville, Tennessee, for the appellants, Oaktree Health and
Rehabilitation Center LLC, Care Centers Management Consulting, Inc., and Christian Care
Center of Memphis, LLC.

Cameron C. Jehl, Carey L. Acerra, Deena K. Arnold, and Eric H. Espey, Memphis,
Tennessee, for the appellee, James A. Welch, Next of Kin and Administrator ad Litem of
Estate of David Neil Welch, deceased, and on behalf of the wrongful death beneficiaries
of David Neil Welch.

       1
         Oral argument in this case was heard at the University of Memphis Cecil C. Humphreys School
of Law on February 1, 2024.
                                            OPINION

                   BACKGROUND AND PROCEDURAL HISTORY

       This is not the first occasion we have reviewed this case, and in fact, our present
review stems from a reversal and remand by the Tennessee Supreme Court. See Welch v.
Oaktree Health & Rehab. Ctr. LLC, 674 S.W.3d 881, 899 (Tenn. 2023) (reversing our
ruling on one issue and remanding for our consideration of another). To revisit the general
facts and background of the case and further frame the nature of our present task on remand,
we begin this Opinion by liberally citing to, and quoting from, our Supreme Court’s prior
decision.

       David Welch (“David”), who is the decedent in this case, was the brother of James
Welch (“James”), the administrator of David’s estate.2 Id. at 884. David was diagnosed
with Down syndrome shortly after his birth, and he could not read and had difficulty
understanding and following instructions. Id. He had no formal education, and James
described him as having “the mind of a two-year-old.” Id.

       Over a decade ago, in 2012, David needed cataract surgery, and James helped him
to obtain care. Id. Of particular note, this episode culminated in the execution of a durable
power of attorney for health care (“POA”). As specifically relayed by our Supreme Court:

       The physician scheduled to perform the surgery required James to get a
       health care power of attorney for David. James printed out an online durable
       power of attorney for health care . . . form and filled it out, listing James as
       David’s health care agent and giving James authority to make David’s health
       care decisions. At James’s direction, David “scratched his name” on the
       signature line on the last page. The POA also had the signatures of two
       witnesses who declared under penalty of perjury that the principal, David,
       was known to them, signed or acknowledged the document in their presence,
       and “appears to be of sound mind and under no duress, fraud or undue
       influence.”

Id. James used the POA for David’s eye surgery, and thereafter, he continued to use it for
other health care providers for David. Id. James was never appointed as a guardian or
conservator for David, and he was also never appointed as David’s health care agent or
surrogate by any physician. Id.

       In November 2016, James sought to admit David to Oaktree Health and

       2
          Because David Welch and James Welch share a last name, we, like the Supreme Court did in its
decision, use their first names herein to avoid any confusion. No disrespect, of course, is intended.

                                                -2-
Rehabilitation Center LLC, d/b/a Christian Care Center of Memphis (“Christian Care”), a
residential nursing home facility. Id. Christian Care was aware of David’s Down
syndrome diagnosis, and as part of the admission process, James, acting on David’s behalf,
executed several documents for him. Id. at 884-85. Among the included documents was
an arbitration agreement (“Arbitration Agreement”). Id. at 885. It is undisputed that
execution of the Arbitration Agreement was not mandatory; indeed, David would have
been admitted to Christian Care even if James had declined to sign it. Id.

       As our Supreme Court further outlined when discussing the Arbitration Agreement:
       The Arbitration Agreement lists Christian Care as the “Facility,” David
       Welch as the “Resident,” and James Welch as the “Representative.” James
       signed it and filled out his “Relationship to Resident” as “Brother [and]
       POA.” The Arbitration Agreement states it “waives Resident’s right to a trial
       in court and a trial by a jury for any future legal claims resident may have
       against facility.”

              The Arbitration Agreement required the representative of the resident
       to provide Christian Care with a copy of “the document creating the agency
       or guardianship.” Both parties agree that James would have shown the POA
       form to Christian Care in the admission process.

Id.

       Although David lived at Christian Care for several months, he was transferred to
Saint Francis Hospital on April 10, 2017. Id. Four days later, David died at the age of 62.
Id. Following David’s passing, on February 7, 2018, James sued Christian Care and a
number of related entities (collectively, “the Defendants”) in the Shelby County Circuit
Court (“the trial court”). Id. The suit was brought in James’s capacity as the administrator
of David’s estate, and the filed complaint, which includes a demand for a jury trial, alleges,
among other things, a claim for wrongful death. Id.

         In chronicling the ensuing activity that occurred in the trial court prior to this Court’s
initial review of the case, our Supreme Court noted as follows:

              In response [to the complaint], the Defendants filed a motion to
       compel arbitration based on the Arbitration Agreement. The trial court let the
       parties engage in discovery related to arbitration.

              In response to the motion to compel arbitration, Plaintiff asserted that
       James had no authority to sign the Arbitration Agreement because David did
       not have the mental capacity to appoint an agent when David executed the
       POA. In support, Plaintiff submitted David’s medical records, as well as an
       expert affidavit and deposition testimony.
                                            -3-
              In reply, Defendants argued that the trial court could not look beyond
       the face of the POA to consider evidence of David’s mental capacity. They
       based this argument on Tennessee Code Annotated section 34-6-208, the
       immunity provision in Tennessee’s Durable Power of Attorney for Health
       Care Act, as well as a footnote in this Court’s opinion in Owens v. National
       Health Corporation, 263 S.W.3d 876 (Tenn. 2007). In the alternative,
       Defendants argued that the evidence on David’s lack of mental capacity was
       not clear and convincing.

               The trial court entered an order stating that it would consider evidence
       on whether David had the mental capacity to execute the POA. After doing
       so, it entered a second order denying the motion to compel arbitration. The
       trial court found by clear and convincing evidence that David lacked the
       requisite mental capacity to execute the POA. As a result, the POA was
       invalid, and James did not have authority to execute the Arbitration
       Agreement on David’s behalf.

Id. at 885-86 (internal footnotes omitted).

        As our Supreme Court discussed, when the matter was subsequently appealed to
this Court by the Defendants, we reversed the trial court regarding its decision to look
beyond the face of the POA to determine whether David had the mental capacity to execute
it. Id. at 886. Although this, in turn, caused us to pretermit examination into a raised issue
on appeal regarding whether there was, in fact, clear and convincing evidence that David
lacked the required capacity to execute the POA, we ultimately directed that the case be
remanded for the trial court to consider an alternative argument James had raised in the
trial court that had yet to be addressed: whether the Arbitration Agreement is
unconscionable. Id. at 885 n.4, 886-87.

        James thereafter sought permission to appeal to our Supreme Court and argued that
this Court had erred in holding that the trial court could not consider evidence pertaining
to David’s lack of mental capacity in connection with the POA’s execution. Id. at 887.
Our Supreme Court granted permission to appeal and later held as follows in connection
with its review of the case: “[W]e reverse the Court of Appeals’ ruling that the trial court
in this case erred in considering evidence on the circumstances surrounding execution of
the durable power of attorney for health care and whether the principal lacked the requisite
mental capacity to sign the document.” Id. at 887, 899. Upon observing that this Court’s
holding, however, had pretermitted examination into the issue of whether the trial court
had erred in finding there was clear and convincing evidence that David lacked the requisite
mental capacity when he signed the POA, the Supreme Court concluded its review by
remanding the case back to this Court “for consideration of whether the trial court erred in
finding clear and convincing evidence that David lacked the requisite mental capacity when
he signed the durable power of attorney for health care, and any other issues raised on
                                            -4-
appeal not pretermitted by our holding in this opinion.” Id. at 899. In light of this
disposition and these instructions from our Supreme Court, we now turn to addressing the
issue of David’s mental capacity incident to his execution of the POA. A specific overview
of the evidence that is relevant to an examination of this issue is interwoven below in
connection with our included analysis and discussion.

                                    STANDARD OF REVIEW

       The issue before us is connected to the trial court’s denial of the Defendants’ motion
to compel arbitration, and the record reflects that the trial court’s decision involved its
reliance on documentary evidence. As is relevant to our review under such circumstances,
we observe that this Court has previously noted as follows:

        This court reviews the denial of a motion to compel arbitration under the
        same standards applicable to bench trials. Therefore, the trial court’s findings
        of fact are reviewed “de novo upon the record of the trial court, accompanied
        by a presumption of the correctness of the finding, unless the preponderance
        of the evidence is otherwise.” Tenn. R. App. P. 13(d). Generally speaking,
        when findings of fact are based on the credibility of witnesses, appellate
        courts must give considerable deference to the trial court’s findings based on
        live testimony, as it had the opportunity to see and hear the witnesses.
        However, the trial court in this case did not rely on live witnesses but rather
        made findings of fact based on documentary evidence only. In such a case,
        appellate courts need not give similar deference to such findings, but instead
        an “appellate court may make an independent assessment of credibility of
        documentary proof it reviews, without affording deference to the trial court’s
        findings.” Additionally, the trial court’s conclusions of law are also reviewed
        de novo with no presumption of correctness given.

Farmer v. S. Parkway Assocs., L.P., No. W2012-02322-COA-R3-CV, 2013 WL 5424653,
at *4 (Tenn. Ct. App. Sept. 25, 2013) (internal citations to case law omitted).

                                            DISCUSSION

      As a result of the directions from our Supreme Court, we are presently tasked with
addressing the Defendants’ raised concern that the trial court erred in finding clear and
convincing evidence that David lacked the requisite mental capacity when he signed the
POA.3 With respect to the question of a party’s mental capacity, Tennessee law provides
        3
          We observe that after the oral argument in this Court that occurred on remand from the Supreme
Court, the Supreme Court held in a separate case that “entering an optional arbitration agreement with a
health care facility is not a ‘health care decision’ within the meaning of the Durable Power of Attorney for
Health Care Act.” Williams v. Smyrna Residential, LLC, --- S.W.3d ----, ----, 2024 WL 655014, at *14
(Tenn. Feb. 16, 2024); see also id. at ----, 2024 WL 655014, at *19 (Lee, J., dissenting) (“Under today’s
                                                   -5-
that “[t]he degree of mental capacity required to enter into a contract[4] is a question of
law,” Rawlings v. John Hancock Mut. Life Ins. Co., 78 S.W.3d 291, 297 (Tenn. Ct. App.
2001), whereas “whether a party possessed the required degree is a question of fact.” Duke
v. Kindred Healthcare Operating, Inc., No. W2010-01534-COA-R3-CV, 2011 WL
864321, at *7 (Tenn. Ct. App. Mar. 14, 2011). Capacity itself “is not an abstract, all-or-
nothing proposition.” In re Conservatorship of Groves, 109 S.W.3d 317, 333 (Tenn. Ct.
App. 2003). Rather, capacity “involves a person’s actual ability to engage in a particular
activity.” Id. The concept is “task-specific,” id., and “[a] person may be incapacitated with
regard to one task or activity while retaining capacity in other areas because the skills
necessary in one situation may differ from those required in another.” Id. at 333-34.

       Adults are presumed to be competent enough to enter into contracts, and persons
seeking to invalidate a contract for mental incapacity must prove that one or both of the
contracting parties were mentally incompetent when the contract was formed. Rawlings,
78 S.W.3d at 297. The requisite proof must be “clear, cogent, and convincing in order to
set the contract aside.” Duke, 2011 WL 864321, at *7. In order to have the capacity to
contract, the contracting party must reasonably know and understand “the nature, extent,
character, and effect of the transaction.” Rawlings, 78 S.W.3d at 297. Persons will be
excused from contractual obligations on the ground of incompetency when: “(1) they are
unable to understand in a reasonable manner the nature and consequences of the transaction
or (2) when they are unable to act in a reasonable manner in relation to the transaction, and
the other party has reason to know of their condition.” Id. Ultimately, the person with the
burden of proof regarding the issue of mental incapacity “must establish, in light of all the
surrounding facts and circumstances, that the cognitive impairment or disease rendered the
contracting party incompetent to engage in the transaction at issue . . . .” Id. (internal
footnote omitted).

       Having reviewed the record transmitted to us on appeal, we agree with the trial court
that there is clear and convincing evidence that David was “incompetent, and unable to . .
. appreciate the gravity of signing the [POA]” and that he suffered from diminished

decision, it appears an individual acting on behalf of another person during the health care admission
process must have a health care power of attorney to execute the admission agreement that contains the
arbitration agreement and a general durable power of attorney to execute the arbitration agreement
contained in the admission agreement.”). James has not attempted to separately raise an issue in this appeal
that the POA, being a health care power of attorney, was insufficient to confer him authority to sign the
Arbitration Agreement due to the subject matter of the POA and the Arbitration Agreement’s non-
mandatory nature, and in any event, as discussed herein based on our consideration of the specific issue
tasked for our review from the instructions of the Supreme Court, we are able to affirm the trial court’s
denial of the Defendants’ motion to compel arbitration due to our agreement that the evidence is clear and
convincing that David lacked the requisite capacity to execute the POA.
         4
           In this case, the document in question is a power of attorney. “[A] power of attorney establishes
an agency relationship. . . . [T]o have an agency relationship under a power of attorney, the principal must
have the capacity to contract.” Rawlings v. John Hancock Mut. Life Ins. Co., 78 S.W.3d 291, 296 n.1 (Tenn.
Ct. App. 2001).
                                                   -6-
cognition that prevented him from appreciating the effect of the POA. In pertinent part,
we note the evidence offered by James through his deposition, as well as the expert
testimony offered through licensed physician Dr. A. Jefferson Lesesne (“Dr. Lesesne”) by
way of affidavit and deposition, regarding David’s lifetime history with Down syndrome
and associated cognitive impairment.

       As mentioned in the Supreme Court’s prior opinion in this matter, see Welch, 674
S.W.3d at 884, and as testified to by James, David could not read and had no formal
education. According to James’s testimony, David also “didn’t have the ability to learn.”
James further characterized David as “[v]ery similar” to “a two-year-old in an 18-year-old
body.” David’s cognitive ability simply “wasn’t there,” and James indicated that this was
true throughout David’s life, stating as follows on the subject: “Whether it was upon
admission to Christian Care or any time prior to that during his life, his cognitive ability
was very, very, very not existent.” According to James, David could not write, save for
writing his name, although, as discussed below, the record actually contains evidence of
multiple instances where David misspelled either his first or middle name.

       James’s testimony reflected that, before living at Christian Care, David had lived
with their parents and, after leaving the care of their parents, at The Baddour Center, which
the record indicates is a residential home located in Senatobia, Mississippi for adults with
disabilities who cannot live alone.5 As the trial court would later note, “David . . . lived at
The Baddour Center for twenty-eight (28) years . . . .” The trial court was presented with
detailed records from The Baddour Center, and these records evidence multiple instances
of misconduct on the part of David that are generally corroborative of James’s likening of
his brother to a young child. For instance, in a number of records created in the months
leading up to the signing of the POA, David is depicted as fighting with others and refusing
to follow instructions.

      To be sure, The Baddour Center records also contain several positive entries
regarding instances of good behavior on David’s part, and they also reflect, as the
Defendants have emphasized, that David was able to perform certain tasks. That David
was able to perform certain tasks at The Baddour Center, such as washing dishes, did not
dissuade James’s expert, Dr. Lesesne, from concluding that David was incompetent with
regard to the transaction at issue here. Indeed, when asked whether the competency
required to appreciate the POA is a different level of understanding than the understanding
it would take for somebody to wash a set of dishes, Dr. Lesesne responded, “Absolutely
there’s a difference.”

       During his testimony, Dr. Lesesne distinguished between “basic” and “instrumental”
activities of daily living. Concerning basic activities of daily living, which involve

       5
        James’s testimony reflected that David had been admitted to the hospital immediately before his
subsequent admission to Christian Care.
                                                 -7-
activities such as ambulation and toileting, Dr. Lesesne testified that David was
“moderate.” When asked for his assessment in relation to instrumental activities of daily
living, which Dr. Lesesne noted involved activities like “[s]hopping, you know, managing
your affairs, those kind of things,” Dr. Lesesne testified as follows: “I don’t think -- you
know, I don’t think you could say, hey, David here’s 50 bucks and a shopping list and come
back out with these 25 items.” Whereas certain records from The Baddour Center indicated
that David had been involved in cooking meals, an activity which Dr. Lesesne indicated
may be considered an instrumental activity depending on what is cooked, and other records
indicated that David had been involved in cleaning, an activity which Dr. Lesesne noted
was instrumental, Dr. Lesesne also stated the following: “David didn’t do any of these
things independently. He was supervised in nearly every instance.” When subsequently
stressing this fact in relation to a subsequent question asked of him, Dr. Lesesne testified
as follows:

        [A]gain, he was supervised. I mean, I think any of these -- you could have a
        ten-year-old child standing next to one of their parents, potentially cooking
        and/or putting up groceries or washing dishes or anything like that. That’s
        not the context with which you decide whether somebody is independent in
        their IADLs or not.

       Dr. Lesesne, who had reviewed multiple records concerning David,6 including The
Baddour Center records, noted in his affidavit that the impairments and limitations
associated with Down syndrome were indicated “throughout the entirety of the records” he
had reviewed. In pertinent part, he attested that the records from The Baddour Center
indicated that David “exhibited clear indications of impairments, limitations, and
behaviors” consistent with Down syndrome throughout David’s residency and also that
David “had a history of limited cognitive and mental capabilities.” David was, according
to Dr. Lesesne, “on the lower end of the [Down syndrome] spectrum in terms of somewhere
between total care and needing . . . virtually 24-hour supervision.”7 When testifying about

        6
           Dr. Lesesne did not personally meet with David in this case as David was deceased. In addition
to reviewing various records concerning David, Dr. Lesesne reviewed certain depositions, including
James’s. Although Dr. Lesesne candidly acknowledged that an in-person assessment is “always better,” he
testified that it was not inappropriate for a person reviewing medical records to make a determination about
prior cognitive abilities of someone who was deceased, stating as follows: “[I]t doesn’t mean it’s not held
as valid.” Dr. Lesesne testified that, in the past, he had also done other competency evaluations based on
medical records.
         7
           We note that, during a hearing before the trial court, defense counsel represented that Dr. Lesesne
“was unable to testify or determine where [David] was on that spectrum.” The trial court interjected soon
thereafter, stating, “Let me stop you just a moment[.] . . . Didn’t he indicate that he thought it was his
opinion that [David] was operating or functioning on the low spectrum of functionality and cognition? I
thought I saw that.” Defense counsel stated that it was his “recollection that [Dr. Lesesne] was unable to
offer any opinions as to exactly where on the Down syndrome spectrum . . . [David] could be placed,” but
also added, “I stand to be corrected by the record or [James’s counsel] or whomever else.” James’s counsel
then read from the testimony where Dr. Lesesne had stated that David had been on the “lower end” of the
                                                    -8-
The Baddour Center records, Dr. Lesesne stated that “most of those behavior records . . .
indicated somebody who was very childlike in their behavior with both the staff and other
residents,” leading him to conclude that David did not really have much competency “for
any high-level understanding of anything, whether it was medical conditions, financial
conditions, anything of that sort.” In his affidavit, Dr. Lesesne stated that The Baddour
Center records showed that David had “continuous poor oral hygiene and needed constant
reminders to brush and floss his teeth, as well as wear his compression boots at night for
his Lymphedema.” Further, Dr. Lesesne observed that David “would eat excessive
amounts of food to the point of making himself sick, and at times, vomiting.” In the view
of Dr. Lesesne, “[r]eminding an adult, like [David], about the importance of brushing and
flossing his teeth, wearing compression boots at night to prevent leg pain and swelling, and
the need to eat slowly and not in excess to avoid abdominal pain, nasusea, and/or diarrhea
is demonstrative of a person . . . who is unable to understand in a reasonable manner the
nature and consequences of his/her actions.” In a similar vein, whereas Dr. Lesesne
acknowledged that David had the ability to report complaints to health care providers, he
testified that the types of complaints David made were of a “rudimentary” nature and that
the records suggested David had the inability to know what to do about a problem as basic
as dry skin that was cracked. In any event, Dr. Lesesne noted that the competency at issue
here was in relation to the POA, which he stated involved something “different . . . than
saying, hey, my skin is cracking or my feet hurt.” Continuing on, he testified as follows:
“A person who’s deemed incompetent for some of these higher-order things can . . . make
certain complaints known.” This testimony, like much of the testimony Dr. Lesesne
offered, was certainly in accord with the principle we highlighted earlier, i.e., that capacity
is not an all-or-nothing proposition but is instead a “task-specific” concept. In re
Conservatorship of Groves, 109 S.W.3d at 333.

       As for David’s ability to write his name, Dr. Lesesne observed that multiple records
indicated that David could not always write or spell his name correctly. When discussing
this in his deposition, Dr. Lesesne noted that this had even occurred when David’s name
was spelled correctly on the top of the same document. According to Dr. Lesesne, this
proof concerning misspellings was “a piece of evidence that goes into the stack to tell you
that he, you know, is not coherent enough most of the time to correctly write his name
repeatedly.” Although Dr. Lesesne acknowledged that David had spelled his name
correctly on the POA, this did not alter Dr. Lesesne’s ultimate conclusion regarding his
competency. Pointing to the fact that he found significance in David’s failure to
consistently spell his name the same way, Dr. Lesesne noted as follows: “[T]here’s
probably six variations. Maybe one of them is right. But there’s six variations of it. So
that is -- it’s in totality that I’m saying -- that is further credence around his abilities both

Down syndrome spectrum, following which defense counsel replied as follows: “Yes. Thanks for correcting
me on that . . . .” Curiously, on appeal, the Defendants again submit through their briefing that Dr. Lesesne
failed to offer an opinion as to where David fell on the Down syndrome spectrum. Clearly, this is not the
case.
                                                   -9-
cognitively and otherwise to understand what’s going on.”

      James testified that he did not think David was able to understand, in a reasonable
manner, the nature and consequences of signing the POA, and according to him, it was not
accurate to say that David had appointed him as health care power of attorney.8 In
explaining this, and when discussing the context in which the POA was signed incident to
David’s need for eye surgery, James noted that doctors had indicated that he would have
to have David’s medical power of attorney in order to get the eye procedure scheduled and
done. He thus testified that he had taken it upon himself to go online and print out the POA
form and then have David scratch his name on the page. David, he said, “had absolutely
no concept of what this was all about.”

       According to James’s recollection, any time he was asked for a power of attorney in
relation to David, he would respond, “I don’t know whether it’s valid or not, but,
nonetheless, I have it.” This was also the case concerning the admission process at
Christian Care, during which, per James’s testimony, he had informed the Christian Care
representative that he was not sure whether the POA was valid. James stated that this was
because he did not believe David had been competent to execute the POA. Carol Reeves,
who had served as a marketing and admissions coordinator at Christian Care, testified that,
if James had a specific memory concerning the admissions meeting, she would not have a
basis to dispute it.

        Just as James had testified that he did not think David could understand the nature
and consequences of the POA, Dr. Lesesne attested in his affidavit that it was his opinion,
“to a reasonable degree of medical certainty, that David . . . was not able to understand and
appreciate the nature, scope, effect, and implications of power of attorney documents
during his adult life, including the [POA].” (emphasis added) Further, he attested that it
was his specific opinion, to a reasonable degree of medical certainty, that David “was not
competent to execute, read, and understand the [POA].” In his subsequent deposition
testimony, he specifically stated that he had “no belief that [David] had any understanding
or concept,” while also adding, “I don’t think there’s any question in my mind that David
didn’t -- that David had any concept of what it meant to sign this thing.” Dr. Lesesne did
not think David could understand the nature of the POA in a reasonable manner and also
testified that he had not seen anything, whether before or after the execution of the POA,
that would suggest David had the ability to understand and appreciate the consequences of
it.

      It is evident through Dr. Lesesne’s testimony that his conclusion regarding David’s
incompetency in relation to the POA was not the product of any particular fact alone.
Explaining the scope of his review, he stated as follows:

        8
         In fact, according to James, David had never even told him that he could make medical or financial
decisions for him.
                                                  - 10 -
       Again, none of this is simply one thing or another. It’s -- I’m taking all this
       in totality and reviewing his behavior, the circumstances around the care he
       was given, some of his more elementary behaviors, and concluding that I
       don’t think he was competent to make higher-level decisions. So it’s not any
       one thing.

       Just as Dr. Lesesne looked at this matter in its “totality,” our review herein has taken
into account all of the facts and circumstances of the case based on the record transmitted
to us on appeal, and as signaled earlier, it is based on that record, in particular the evidence
adduced by way of Dr. Lesesne and James, and through David’s various records, that we
agree with the trial court’s conclusion that the evidence is clear and convincing that David
was not competent to execute the POA. Undoubtedly, David was able to perform certain
tasks during his tenure at the The Baddour Center, and as the trial court found, there is no
question that he “could engage in some basic living functions” there. Again, though,
capacity is not an all-or-nothing proposition but is instead a “task-specific” concept, id.,
and here, all the facts and circumstances of the case being considered, the evidence clearly
paints a picture in our view that David did not have the mental capacity to reasonably know
and understand the nature, extent, character, and effect of signing the POA. As such, we
agree with the trial court that the POA was not valid, and given our conclusion on this
matter, we hereby affirm the trial court’s order denying the Defendants’ motion to compel
arbitration. Indeed, as the trial court noted, “[b]ecause there was no valid power of attorney
granting James . . . the authority to execute Defendants’ Arbitration Agreement on
[David’s] behalf, there is no valid agreement to arbitrate this matter . . . [.]”

       In connection with our decision in this appeal, we expressly decline an alternative
suggestion from the Defendants that we “should remand the case to the trial court for
additional expert discovery before deciding to strip David of his ability to contract.” The
Defendants’ request to this end is, respectfully, an unduly belated one. Although the
Defendants maintain that they were previously litigating this case under the premise that
the trial court should not look beyond the four corners of the POA, the Defendants were
clearly aware that the trial court was inquiring into the question of David’s competency.
Indeed, the trial court expressly ruled as such in January 2020, and yet in the face of this
ruling and despite thereafter deposing James’s expert, Dr. Lesesne, there is no indication
in the record that the Defendants ever attempted to pursue developing proof by way of their
own competing expert. Moreover, the Defendants did not even attempt to raise this desire
for “additional expert discovery” as an alternative issue in their principal briefing in this
Court. The request was only pursued in supplemental briefing submitted after the remand
from our Supreme Court. In light of these circumstances, we consider the desire for
additional expert discovery to be waived. See Smith v. Hauck, 469 S.W.3d 564, 576 (Tenn.
Ct. App. 2015) (“It is well-settled that issues not raised in the trial court may not be
presented for the first time on appeal.”); see also Jones v. Jones, No. M2022-00624-COA-
R3-CV, 2023 WL 4559880, at *7 (Tenn. Ct. App. July 17, 2023) (concluding that an issue
was waived when, among other things, the “argument was not raised in [the party’s] initial
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appellate brief”).

                                    CONCLUSION

        In light of the foregoing discussion, we affirm the trial court’s denial of the
Defendants’ motion to compel arbitration and remand the case for such further proceedings
that are necessary and consistent with this Opinion.

                                                    s/ Arnold B. Goldin
                                                  ARNOLD B. GOLDIN, JUDGE

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