Court Opinion

ID: 9943282
Source: CourtListenerOpinion
Date Created: 2024-02-23 00:10:10.070952+00
Date Added: 2024-06-11T13:46:45.563994
License: Public Domain

02/22/2024
                IN THE COURT OF APPEALS OF TENNESSEE
                           AT KNOXVILLE
                               September 20, 2023 Session

     WENDY C. CORAM ET AL. v. JIMMY C. BRASFIELD, M.D. ET AL.

                  Appeal from the Circuit Court for Sullivan County
                   No. C16236M        John S. McLellan, III, Judge
                      ___________________________________

                            No. E2022-01619-COA-R3-CV
                        ___________________________________

Plaintiffs filed a health care liability action against several defendants. Following a hearing
on the defendants’ motions to dismiss, the trial court determined that the plaintiffs failed
to substantially comply with Tennessee Code Annotated section 29-26-121(a)(2)(E) and
that the action was untimely. The plaintiffs appealed to this Court and, following our
review, we reverse.

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

KRISTI M. DAVIS, J., delivered the opinion of the Court, in which D. MICHAEL SWINEY,
C.J., and THOMAS R. FRIERSON, II, J., joined.

R. Wayne Culbertson and Joseph W. McMurray, Kingsport, Tennessee, for the appellants,
Wendy C. Coram and Robert L. Coram.

Russell W. Adkins, Kingsport, Tennessee, for the appellees, Jimmy C. Brasfield, M.D.,
and Mark Steven Mehlferber, PAC.

Frank H. Anderson, Jr., Johnson City, Tennessee, for the appellees, Ballad Health and
Bristol Regional Medical Center.

Jimmie C. Miller and Meredith B. Humbert, Kingsport, Tennessee, for the appellees, Ralph
E. Fig, Jr., PAC; Hetvie Kiritkumar Joshi, M.D.; Ballad Health Medical Associates Family
Medicine; and Michael K. Patrick, M.D.
                                             OPINION

                                           BACKGROUND

       On October 21, 2020, Jimmy C. Brasfield (“Dr. Brasfield”) of American Physician
Partners at Bristol Regional Medical Center (“Bristol Regional”) performed back surgery
on Wendy Coram. According to her complaint, Mrs. Coram complained to Dr. Brasfield
about pain, weakness, and paresthesia during a follow-up appointment on October 22,
2020. On October 24, 2020, Mrs. Coram presented to the Bristol Regional emergency
room with post-surgical complications. By October 25, 2020, she was complaining of
severe pain in, and an inability to move, her right leg. Dr. Brasfield ordered an MRI at
approximately 5:07 p.m. which, according to the complaint, showed bleeding. Mrs. Coram
underwent a second surgery around 8:00 p.m. on October 25, 2020.

       On September 7, 2021, Mrs. Coram and her husband, Robert Coram (together,
“Plaintiffs” or “Appellants”), sent a pre-suit notice via certified mail to several of Mrs.
Coram’s medical providers: Dr. Brasfield; Mark Mehlferber, PAC; Ralph Fig, Jr., PAC;
American Physician Partners, PSO, LLC1; Hetvie Kiritkumar Joshi, MD; Ballad Health;
Bristol Regional; Ballad Health Medical Associates Family Medicine; and Michael K.
Patrick, MD (together, “Defendants” or “Appellees”). Attached to the pre-suit notice was
a HIPAA2 authorization. The authorization provides that Mrs. Coram’s birth year is 1971,
when in fact she was born in 1977. It is undisputed that Mrs. Coram’s information is
correct in the pre-suit notice form to which the HIPAA authorization is attached. On
October 29, 2021, Plaintiffs’ counsel sent a letter via certified mail to each of the defendant
medical providers with a corrected HIPAA authorization attached.

      Plaintiffs filed their complaint against Defendants in the Circuit Court for Sullivan
County (“trial court”) on December 21, 2021. Plaintiffs alleged that Defendants failed to
recognize and/or perform to the applicable standard of care and that Defendants’ negligent
conduct caused Mrs. Coram to suffer, inter alia, partial paralysis and severe pain in her
lumbar spine and right leg. Mr. Coram alleged a claim for loss of consortium.

       On February 14, 2022, Dr. Brasfield and Mr. Mehlferber filed a motion to dismiss
the claims against them, arguing that the erroneous birth year on Mrs. Coram’s HIPAA
authorization constituted a failure to comply with the pre-suit notice requirements of

       1
         Plaintiffs later voluntarily dismissed American Physician Partners, PSO, LLC, pursuant to
Tennessee Rule of Civil Procedure 41.01.
       2
         “HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996,
Pub.L. No. 104–191, 110 Stat.1936 (codified throughout 18 U.S.C., 29 U.S.C., 42 U.S.C., and in 45 C.F.R.
§§ 160 & 164) (2013).” Stevens ex rel. Stevens v. Hickman Cmty. Health Care Servs., Inc., 418 S.W.3d
547, 553 n.4 (Tenn. 2013).

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Tennessee Code Annotated section 29-26-121(a)(2)(E). They also argued that the October
29, 2021 letter and corrected HIPAA authorization could not remedy the deficiency in the
pre-suit notice because (1) it was sent after the one-year statute of limitations ran, and (2)
it was sent less than sixty days before Plaintiffs filed their complaint. The remaining
defendants also filed a motion to dismiss on February 24, 2022, raising largely the same
arguments.

        The trial court held a hearing in August of 2022,3 and another hearing on September
15, 2022. At the September 15, 2022 hearing, the trial court announced that it was granting
Defendants’ motions to dismiss. The trial court entered its final order on October 7, 2022.
In relevant part, the order provides:

        The Court finds that the Plaintiffs’ original notice of intent included a
        defective medical authorization. Due to the Plaintiffs’ failure to substantially
        comply with the requirements of Tennessee Code Annotated
        § 29-26-121(a)(2)(E), the one-year statute of limitations applicable to the
        Plaintiffs’ health care liability action was not extended, and thus, ran prior to
        the filing of Plaintiff’s original Complaint on December 21, 2021 inasmuch
        as the alleged acts of negligence occurred in October of 2020. Extraordinary
        cause does not exist to excuse the Plaintiffs’ noncompliance with the
        requirements of Tennessee Code Annotated § 29-26-121. The second notice
        of intent was provided by the Plaintiffs after the statute of limitations had
        run, and therefore, it was untimely. Pursuant to the Court of Appeals’ holding
        in J.A.C. by & through Carter v. Methodist Healthcare Memphis Hosps., 542
        S.W.3d 502, 520 (Tenn. Ct. App. 2016), a notice of intent is not a pleading,
        and consequently, Tennessee Rule of Civil Procedure 15 does not apply.
        Thus, the second notice of intent does not relate back to the original notice
        of intent.

        Plaintiffs filed a timely notice of appeal to this Court.

                                                ISSUES

        On appeal, Plaintiffs assert that the trial court erred in concluding that their pre-suit
notice did not substantially comply with Tennessee Code Annotated section 29-26-121 due
to a clerical error. Defendants raise no issues in their posture as appellees.

        3
        The transcript states that the hearing was held on August 22, 2022. The parties seem to disagree
about what date the hearing was actually held; however, the discrepancy is not important to our analysis.

                                                  -3-
                                  STANDARD OF REVIEW

      The trial court dismissed Plaintiffs’ complaint pursuant to Tennessee Rule of Civil
Procedure 12.02(6). See Hayward v. Chattanooga-Hamilton Cnty. Hosp. Auth., 680
S.W.3d 252, 259 (Tenn. Ct. App. 2023) (“[T]he proper avenue to challenge a plaintiff’s
compliance with the pre-suit notice requirement in [Tennessee Code Annotated] Section
[29-26-]121 is by a Tenn. R. Civ. P. 12.02(6) motion to dismiss.”). “A trial court’s grant
of a motion to dismiss, filed pursuant to Tenn. R. Civ. P. 12.02(6), is a question of law,
which we review de novo with no presumption of correctness. Id. (citing Ellithorpe v.
Weismark, 479 S.W.3d 818, 824 (Tenn. 2015)).

                                          DISCUSSION

        The trial court determined that Plaintiffs’ claims were untimely. “The statute of
limitations in health care liability actions shall be one (1) year as set forth in § 28-3-104.”
Tenn. Code Ann. § 29-26-116(a)(1). Before a plaintiff may file a complaint for medical
malpractice, however, he or she “must give written notice of the claim to each health care
provider that will be named as a defendant in the lawsuit.” Martin v. Rolling Hills Hosp.,
LLC, 600 S.W.3d 322, 331 (Tenn. 2020). When pre-suit notice is properly provided, “the
applicable statutes of limitations and repose shall be extended for a period of one hundred
twenty (120) days from the date of expiration of the statute of limitations and statute of
repose applicable to that provider.” Tenn. Code Ann. § 29-26-121(c).

        The purpose of pre-suit notice is to afford a potential defendant in a health care
liability action timely notice to allow the defendant to investigate the merits of the claim
and pursue settlement negotiations prior to the lawsuit being filed. Runions v.
Jackson-Madison Cnty. Gen. Hosp. Dist., 549 S.W.3d 77, 86 (Tenn. 2018). “Pre-suit
notice benefits the parties by promoting early resolution of claims, which also serves the
interest of judicial economy.” Id. Pre-suit notice is governed by Tennessee Code
Annotated section 29-26-121, which provides in pertinent part:

        (a)(1) Any person, or that person’s authorized agent, asserting a potential
       claim for health care liability shall give written notice of the potential claim
       to each health care provider that will be a named defendant at least sixty (60)
       days before the filing of a complaint based upon health care liability in any
       court of this state.

       (2)    The notice shall include:

              (A) The full name and date of birth of the patient whose
              treatment is at issue;

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              (B) The name and address of the claimant authorizing the
              notice and the relationship to the patient, if the notice is not
              sent by the patient;

              (C) The name and address of the attorney sending the notice[];

              (D) A list of the name and address of all providers being sent
              a notice; and

              (E) A HIPAA compliant medical authorization permitting the
              provider receiving the notice to obtain complete medical
              records from each other provider being sent a notice.

Tenn. Code Ann. § 29-26-121(a). The first three content requirements of section -121(a)(2)
“facilitate early resolution of healthcare liability claims by requiring plaintiffs to advise
defendants who the plaintiff is, how to reach him or her, and how to contact his or her
attorney.” Stevens ex rel. Stevens v. Hickman Cmty. Health Care Servs., Inc., 418 S.W.3d
547, 554 (Tenn. 2013). Section 29-26-121(a)(2)(E), which deals with HIPAA
authorizations, “serve[s] an investigatory function, equipping defendants with the actual
means to evaluate the substantive merits of a plaintiff’s claim by enabling early discovery
of potential co-defendants and early access to a plaintiff’s medical records.” Stevens, 418
S.W.3d at 554. “Because HIPAA itself prohibits medical providers from using or
disclosing a plaintiff’s medical records without a fully compliant authorization form, it is
a threshold requirement of the statute that the plaintiff’s medical authorization must be
sufficient to enable defendants to obtain and review a plaintiff’s relevant medical records.”
Id. at 555 (citing 45 C.F.R. § 164.508(a)(1)).

       The “statutory requirement of timely, written pre-suit notice is mandatory and may
be satisfied only by strict compliance[.]” Martin, 600 S.W.3d at 331. On the other hand,
“[t]he statutory content requirements are directory and may be satisfied by substantial
compliance.” Id. Accordingly, “plaintiffs cannot satisfy [section] 29-26-121(a)(2)(E) by
simply notifying defendants that a healthcare liability claim may be forthcoming.” Stevens,
418 S.W.3d at 555. In Stevens, our Supreme Court elaborated on how a plaintiff
“substantially satisfie[s] the requirements of [section] 29-26-121(a)(2)(E)”:

       [A] plaintiff “shall” include in the pre-suit notice a “HIPAA compliant
       medical authorization permitting the provider receiving the notice to obtain
       complete medical records from each other provider being sent a notice.”
       Federal regulations state that a HIPAA compliant authorization must include
       the following six elements:

                                            -5-
      (i) A description of the information to be used or disclosed that identifies the
      information in a specific and meaningful fashion.

      (ii) The name or other specific identification of the person(s), or class of
      persons, authorized to make the requested use or disclosure.

      (iii) The name or other specific identification of the person(s), or class of
      persons, to whom the covered entity may make the requested use or
      disclosure.

      (iv) A description of each purpose of the requested use or disclosure....

      (v) An expiration date or an expiration event that relates to the individual or
      the purpose of the use or disclosure....

      (vi) Signature of the individual and date. If the authorization is signed by a
      personal representative of the individual, a description of such
      representative’s authority to act for the individual must also be provided.
      45 C.F.R. § 164.508(c)(1).

      *      *      *

      In determining whether a plaintiff has substantially complied with a statutory
      requirement, a reviewing court should consider the extent and significance
      of the plaintiff’s errors and omissions and whether the defendant was
      prejudiced by the plaintiff’s noncompliance. Not every non-compliant
      HIPAA medical authorization will result in prejudice.

Id. at 555–56.

       More recently, our Supreme Court expounded on the concept of “prejudice,”
explaining that

      prejudice is not a separate and independent analytical element; rather, as
      Stevens explained, prejudice is a consideration relevant to determining
      whether a plaintiff has substantially complied. Stevens, 418 S.W.3d at 556
      (stating that whether a plaintiff “has substantially complied with a statutory
      [content] requirement, a reviewing court should consider the extent and
      significance of the plaintiff’s errors and omissions and whether the defendant
      was prejudiced by the plaintiff’s noncompliance”). Prejudice, or the absence
      of prejudice, is especially relevant to evaluating the extent and significance
      of the plaintiff’s noncompliance. If a plaintiff’s noncompliance with Section

                                           -6-
       121 frustrates or interferes with the purposes of Section 121 or prevents the
       defendant from receiving a benefit Section 121 confers, then the plaintiff
       likely has not substantially complied with Section 121. See id. at 563 (noting
       that the focus should be “on the extent of the shortcomings and whether those
       shortcomings have frustrated the purpose of the statute or caused prejudice
       to the adversary party”). On the other hand, if the plaintiff’s noncompliance
       neither frustrates or interferes with the purposes of Section 121 nor prevents
       a defendant from receiving a benefit the statute confers, then a court is more
       likely to determine that the plaintiff has substantially complied.

Martin, 600 S.W.3d at 333–34.

        In the wake of both Stevens and Martin, this Court tends to find that a plaintiff has
not substantially complied with section 29-26-121(a)(2)(E) when a medical authorization
lacks one or more of the core elements provided in 45 C.F.R. § 164.508(c)(1). See, e.g.,
Vandergriff v. Erlanger Health Sys., No. E2022-00706-COA-R3-CV, 2023 WL 8257876,
at *5 (Tenn. Ct. App. Nov. 29, 2023) (authorization not substantially compliant where “the
form did not provide any authorization for the [d]efendants to obtain medical records from
any other providers, as required by the statute”); Woods v. Arthur, No. W2019-01936-
COA-R3-CV, 2021 WL 1110920, at *4 (Tenn. Ct. App. Mar. 23, 2021) (authorization not
substantially compliant because it lacked a description of the purpose for which the records
could be disclosed and used); Carrasco v. North Surgery Ctr., LP, No. W2019-00558-
COA-R3-CV, 2020 WL 2781588, at *3 (Tenn. Ct. App. May 28, 2020) (trial court found
and plaintiff conceded on appeal that initial authorizations were defective because, inter
alia, they contained several blanks); Williams v. Gateway Med. Ctr., No. M2018-00939-
COA-R3-CV, 2019 WL 1754692, at *6 (Tenn. Ct. App. Apr. 18, 2019) (failure to include
a description of the protected information to be used or disclosed fatal to authorization).
Moreover, “‘[p]laintiffs who sent imperfect medical authorizations have been found
substantially compliant in very few instances.’” Woods, 2021 WL 1110920, at *4 (quoting
Martin, 600 S.W.3d at 345 (Holly Kirby, J., concurring in part and dissenting in part)); but
see Hamilton v. Abercrombie Radiological Consultants, Inc., 487 S.W.3d 114, 120 (Tenn.
Ct. App. 2014), perm. app. denied (Tenn. May 15, 2015) (authorization was imperfect but
substantially complete where “the only allegation of error in the HIPAA form [was] the
missing date that is required under C.F.R. § 164.508(c)(1)(vi)”).

       Here, we conclude that Plaintiffs’ HIPAA authorization substantially complied with
Tennessee Code Annotated section 29-26-121(a)(2)(E). Defendants concede that the
authorization contains all of the core elements required by 45 C.F.R. § 164.508. They also
concede that Mrs. Coram’s birth year is correct on her pre-suit notice letter and that there
is no requirement that the HIPAA authorization reflect her birth year. Indeed, the parties
agree that a HIPAA authorization containing all of the core elements required by 45 C.F.R.
§ 164.508, but not including the patient’s date of birth, would be compliant. Defendants

                                            -7-
assert, however, that because Plaintiffs chose to include the birth year and then used the
wrong one, Plaintiffs provided false, material information fatal to the authorization. This
argument is based on 45 C.F.R § 164.508(b)(2)(v), which provides that an authorization is
defective when, among other instances, “[a]ny material information in the authorization is
known by the covered entity to be false.” Defendants argue in their brief that

       [a]lthough an individual’s date of birth is not included among the “core
       elements” listed by 45 CFR 164.508(c)(1), it is nonetheless material
       information for an individual. By virtue of the [Plaintiffs’] decision to
       include Wendy Coram’s date of birth on the medical authorization, they
       included information that was material to the identity of Wendy Coram. Due
       to the recognition by the [Defendants] that the date of birth provided for
       Wendy Coram was false, the [Defendant] medical providers were unable to
       use the defective medical authorization to exchange medical records pre-suit,
       which is the purpose of Tennessee Code Annotated § 29-26-121.

       Respectfully, we disagree. The applicable regulations do not define “material.”
Defendants’ argument assumes that “material” as used in the above regulation has the
narrow meaning of being “material to the identity of” the plaintiff. Nonetheless,
Defendants cite no case law explaining the meaning of “material” in this context or
supporting their argument that Mrs. Coram’s birth year is “material” as contemplated by
the regulation. Nor did our research reveal any such cases. Moreover, the authorization
contains correct identifying information for Mrs. Coram, such as her name. Inasmuch as
Defendants could identify Mrs. Coram from the authorization notwithstanding the birth
year, and they admit the information need not be included in the authorization at all, we
disagree that Mrs. Coram’s birth year is “material information” under the circumstances.

        Further, this case is distinguishable from previous cases in which a HIPAA
authorization is deemed not in substantial compliance with section 29-26-121(a)(2)(E). In
Stevens, for example, the authorization at issue “was woefully deficient[,]” and “[t]he
errors and omissions were numerous and significant.” 418 S.W.3d at 556. Indeed, in most
cases in which a HIPAA authorization is deemed defective, at least one core element is
either missing or incorrect. See Vandergriff, 2023 WL 8257876, at *5; Woods, 2021 WL
1110920, at *6; Carrasco, 2020 WL 2781588, at *3; Williams, 2019 WL 1754692, at *6.
While “substantial compliance [ ] as it is used in the context of pre-suit notice [ ] does not
refer solely to the number of satisfied elements,” Lawson v. Knoxville Dermatology Grp.,
P.C., 544 S.W.3d 704, 711 (Tenn. Ct. App. 2017), this trend is nonetheless notable. See
Vandergriff, 2023 WL 8257876, at *4 (“Under federal law, a medical authorization is not
HIPAA compliant if ‘[t]he authorization has not been filled out completely, with respect
to’ a core element.” (quoting Martin, 600 S.W.3d at 334)).

                                            -8-
        In this case, “the extent and significance of the plaintiff’s errors and omissions” are
minor. Stevens, 418 S.W.3d at 556. The authorization contains the requisite core elements,
and Defendants point to no precedent suggesting that the small error at issue frustrates or
interferes with the purposes of section 29-26-121(a)(2)(E). See id. Our Supreme Court
has stated that “[n]ot every non-compliant HIPAA medical authorization will result in
prejudice.” Id. That directive rings hollow should this Court determine, without any
supporting legal authority, that a clerical error unrelated to the core elements renders an
authorization defective.

       The trial court erred in determining that Plaintiffs did not substantially comply with
Tennessee Code Annotated section 29-26-121(a)(2)(E). Accordingly, the trial court also
erred in concluding that Plaintiffs’ action was untimely and in dismissing same. We
therefore reverse the trial court’s decision.

                                        CONCLUSION

      The judgment of the Circuit Court for Sullivan County is reversed. This case is
remanded for proceedings consistent with this opinion. Costs on appeal are assessed to the
Defendants, for which execution may issue if necessary.

                                                   _________________________________
                                                   KRISTI M. DAVIS, JUDGE

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