ÿWPC†( …# VUNa %¯ 0 (µw@Ý4 1 @ 0lH 0D´ 1mø 0ce 0JÈ 0T 0^f 0hÄ 0r, 0|ž 0† 0  1u0U,¥ 0dÑ D35 Bh 0@…U,ÅU>ñU 6/B)eDCŽ AMÑU*#H¤k½,Héy1v~ªvÓ( 0wû! 0Šr" 0 ü" 0´œ# 0ÇP$ 0Û% 0ïò% AOá&Æ0' 0Dö' D/:( Bi(˜HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPTÀÌÀääÀÀÌ0 (ÈhH  Z ‹6Times New Roman RegularX($¡¡ ÓEÔÕEÖD×DØÙDÚ[ÛÓ€ç©U!ular3|xç((3üÝ$¤¤Ý ƒ!ÝÝ  Ýà  àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóótuvwxyz#,37=CIQYag­­1.a.i.(1)(a)(i)1)a)(;s˜$´´Ô2,ÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô !"#$% ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)< Œ 9p`(ModernP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ++++'ÿÿdxd d("ÿÿ$££Ò  ÒÒ  Ò< Œ 9p`(Monaco< Œ 9p`(&Times New Roman< Œ 9p`(Courier New% Line 7 d55557Border 1dd€-6Cþÿ << Gÿÿ< Œ 9p`(Arial Ý ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÔ€8ÔÔ€8ÔÓ  ÓÔ YYY ÔFILEDÔ€8XÔÌÌò òAugust€16,€1996ÌÌCecil€Crowson,€Jr.ÌÔ€8ôÔAppellate€Court€Clerkó ó šÝ ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€4ÔÔ€4ôÔPeriodontics€is€ð ða€branch€of€dentistry€that€deals€with€diseases€of€theÏsupporting€and€investing€structures€of€the€teeth.ðð€€ò òòòWebsterððs€Ninth€NewÏCollegiate€Dictionaryó óóó€(1986),€p.€875.Ì Ý ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€4ÔÔ€4ôÔWhile€the€plaintiff€alleges€that€Dr.€Bauguss€failed€to€us€the€properÏtool€in€performing€the€surgery,€he€has€not€provided€us€with€any€proof€of€(1)Ïthe€name€of€the€tool€that€was€used,€or€(2)€the€identity€of€the€tool€thatÏshould€have€been€used.€€Apparently,€the€defendantððs€discovery€deposition€wasÏnot€taken€in€this€case.Ì ³Ý ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€4ÔÔ€4ôÔHowever,€even€if€the€facts€are€undisputed,€a€plaintiff€can€successfullyÏresist€a€motion€for€summary€judgment€if€the€facts€do€not€show€that€theÏdefendant€is€entitled€to€judgment€as€a€matter€of€law.€€Rule€56.03,€Tenn.€R.ÏCiv.€P.Ì >Ý ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€4ÔÔ€4ôÔ"The€evidence€offered€by€the€nonmoving€party€must€be€taken€as€true.ðð€Ïò òòòByrdóóó ó,€847€S.W.2d€at€215.Ì oÝ ƒ!ÝÑ#€d#ÑÔ€'ÔÔ€3ÔÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€4ÔÔ€4ôÔThe€affidavit€of€an€individual€cannot€be€used€to€prove€an€expertÏopinion€outside€the€affiantððs€field€of€competency.€€ò òòòBowmanó óóó,€547€S.W.2d€at€531.ÌPtPtHHÚ(ÿáÿâùFG(üHHØ(d'`Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑMonacoÑÑ ÑÒ  BA Op Monaco ÒÒ  BA Op Monaco Ò(OÞ{$µµà0  àÔ2,ÔÚ  ÚaÚ  Ú.Ô3  Ôà0` (#(#à(b²D$¶¶à0  àà0` (#(#àÔ2,ÔÚ  ÚÚ  Ú.Ô3  Ôà0¸ ` (#` (#à(xÓñ$··à0  àà0` (#(#àà0¸ ` (#` (#àÔ2,Ô(Ú  Ú0Ú  Ú)Ô3  Ôà0¸ (#¸ (#à(ŒÆ‚$¸¸à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àÔ2,Ô(Ú  ÚaÚ  Ú)Ô3  Ôà0h(#(#à(Ÿù…$¹¹à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àÔ2,Ô(Ú  ÚÚ  Ú)Ô3  Ôà0Àh(#h(#à(³¶4$ººà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àÔ2,ÔÚ  Ú0Ú  Ú)Ô3  Ôà0À(#À(#à(Ǫ»$»»à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àà0À(#À(#àÔ2,ÔÚ  ÚaÚ  Ú)Ô3  Ôà0p(#(#à€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€'ÔÓ&€22X„d&ÓÑ#€22Xd#ÑÔ€3ÔÝ  Ý›Ñ P ÑÑ\R AØ'\ÑÓ  ÓÔ€4ÔÑ\R AØ'\ÑÑ7€%4XXdìdÈ7ÑœIN›€THE€COURT€OF€APPEALS€OF€TENNESSEEÌ̜ـ€ÙÙ€€ÙßL€796;+'h|ñY` ¤ `€€Lß›ÌÌÌÓ  ÓDONALD€SHERMAN€BRYANT,à àà à)€C/A€NO.€03A01„9603„CV„00105Ìà àà àà àà àà àà à)€BLOUNT€COUNTYÏCIRCUIT€COURTÌà àà àPlaintiff„Appellant,)Ìà àà àà àà àà àà à)Ìà àà àà àà àà àà à)Ìà àà àà àà àà àà à)Ìv.à àà àà àà àà àà à)€HONORABLE€W.€DALE€YOUNG,€€Ìà àà àà àà àà àà à)€JUDGEÌà àà àà àà àà àà à)Ìà àà àà àà àà àà à)Ìà àà àà àà àà àà à)ÌJACK€T.€BAUGUSS,€JR.,€à àà à)Ìà àà àà àà àà àà à)€Ìà àà àDefendant„Appellee.à à)€AFFIRMED€AND€REMANDEDÌà àà àà àà àà àÌÌÌÌÌKEVIN€W.€SHEPHERD,€Maryville,€for€AppellantÌÌSTEPHEN€C.€DAVES€of€OððNEIL,€PARKER€&€WILLIAMSON,€Knoxville,€forÏAppelleeÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌòòÓ  ÓO€P€I€N€I€O€NÌÌÓ  Óóóà àà àà àà àà àà àà àà àà àà àSusano,€J.ÌÓÓà àà àThis€is€a€malpractice€action€brought€against€a€dentistÏœwho€specializes›€in€periodontics.œ× ƒ: ××  ×›€€The€plaintiff,€Donald€ShermanÏBryant,€alleges€that€the€defendant,€Dr.€Jack€T.€œBauguss,€Jr.,›Ïcommitted€malpractice€when€he€used€an€œimproper,€but›€œotherwiseÏunidentified,€surgical›€œinstrument›€in€œperforming›€oral€surgery€onÏhim.€€œHe€claims€that€a€portion€of€his€face€is€permanently€numb€asÏa€result€of€the€malpractice.€€He›€also€alleges€that€Dr.€BaugussÏfailed€to€fully€inform€him€of€the€risks€attendant€to€the€surgery.€ÏDr.€Bauguss€filed€a€motion€for€summary€judgment€supported€by€hisÏaffidavit€in€which€he€denied€any€deviation€from€the€recognizedÏstandard€of€acceptable€professional€practice.€€Bryant€responded€byÍfiling€his€own€affidavit€and€that€of€Dr.€Louis€œAltshuler›,€an€oralÏsurgeon€from€œthe€St.›€Louis,€œMissouri€area.›€€The€trial€court€foundÏthat€the€œaffidavits›€œfiled€by€the€plaintiff€failed›€to€œcreate›€aÏgenuine€issue€of€material€fact€œon€the€relevant€issues.€€The€court›Ïconcluded€that€the€undisputed€facts€showed€that€Dr.€Bauguss€wasÏentitled€to€œa€judgment›€as€a€matter€of€law.€€Consequently€œthe€court›Ïentered€summary€judgment€for€the€defendant.€€Bryant€œappealed.›€€HeÏcontends€on€appeal€that€Dr.€Bauguss€is€not€entitled€to€summaryÏjudgment.€€We€affirm.ÌÌÓ  ÓIÌÌÓ  Óà àà àœAs€previously€noted,€Bryant›€alleges€that€Dr.€BaugussÏused€an€improper€surgical€tool;œ× ƒ; ××  ×›€and€that€as€a€proximate€result€ofÏthis€act€of€malpractice,€he€sustained€ð ða€permanent€condition€ofÏnumbnessðð€to€a€portion€of€his€face.€€Bryant€further€alleges€thatÏhe€did€not€give€informed€consent€to€the€surgery.€€Dr.€Bauguss€inÍhis€affidavit€controverts€the€allegations€of€the€complaint.€€HeÏstates€that€he€is€familiar€with€the€standard€of€acceptableÏperiodontal€practice€in€the€Blount€County€community,€that€he€didÏnot€deviate€from€that€standard,€and€that€ð ðthe€injury€alleged€inÏthis€case€.€.€.€was€not€caused€by€any€negligence€or€malpractice€onÏœmy›€part.ðð€€Regarding€informed€consent,€he€states,€ð ð[i]t€is€furtherÏmy€opinion€within€a€reasonable€dental€certainty€that€the€rareÏpotential€for€nerve€injury€in€this€procedure€does€not€requireÏdescription€of€this€complication€in€obtaining€informed€consent.ðð€€€ÌÌà àà àAs€previously€noted,€Bryant€counters€Dr.€BaugussððÏaffidavit€with€Dr.€œAltshuler›ððs€affidavit€which€states,€in€itsÏentirety,€as€follows:ÌÓÓÌÌà àà8 à1.€€Attached€is€a€copy€of€my€curriculum€vitae,Ïwhich€is€incorporated€herein€by€reference.€€IÏhave€the€education€and€experience€to€state,€asÏa€medical€expert,€the€following€observationsÏand€opinions.ÌÌà8 àà8 à2.€€I€have€received€the€available€records€ofÏDr.€Jack€à àBauguss,€Jr.€in€his€treatment€ofÏDonald€Bryant€on€and€after€November€29,€1993.ÌÌà8 àà8 à3.€A€preliminary€review€of€the€records€and€x„rays€indicated€that€there€was€nerve€damageÍfollowing€the€amputation€of€the€distal€root€ofÏa€lower€molar€tooth€in€Mr.€Bryantððs€jaw,€to€anÏextent€not€common€or€expected€in€this€type€ofÏsurgery.€€Prior€to€the€surgery,€Dr.€BaugussÏrecorded€that€he€was€not€sure€he€would€be€ableÏto€amputate€the€root€successfully.ÌÌà8 àà8 à4.€€The€record€is€very€meager€regarding€theÏactual€procedure€and€there€was€no€record€inÏthe€chart€addressing€a€discussion€of€anyÏdetails€of€the€proposed€surgery,€whatÏalternatives€there€were€or€any€complicationsÏthat€could€follow€or€result€from€the€surgery.ÌÌà àà à5.€€Dr.€Bauguss€was€aware€that€endodontic€treatmentÏà àà àfollowing€a€root€amputation€was€indicated,€but€theÏà àà àendodontia€was€not€accomplished€until€months€later.ÌÌà8 àà8 à6.€€Following€my€review€of€the€availableÏrecords,€my€opinion,€based€on€a€reasonableÏmedical€and€dental€certainty,€is€that€theÏstandard€of€care€expected€of€a€qualified,Ïlicensed€dentist€was€not€met€by€Dr.€Bauguss€inÏœhis›€treatment€of€Mr.€Bryant.€ÌÌÌÓÓÌÓ  ÓIIÌÌÓ  Óà àà àOur€standard€of€review€in€a€summary€judgment€case€isÏwell„defined.€€In€deciding€whether€a€grant€of€summary€judgment€isÏappropriate,€we€must€determine€ð ðif€the€pleadings,€depositions,Ïanswers€to€interrogatories,€and€admissions€on€file,€together€withÍthe€affidavits,€if€any,€show€that€there€is€no€genuine€issue€as€toÏany€material€fact€and€that€the€moving€party€is€entitled€to€aÏjudgment€as€a€matter€of€law.ðð€€Rule€56.03,€Tenn.€R.€Civ.€P.€€WeÏare€required€to€take€the€strongest€legitimate€view€of€the€evidenceÏin€favor€of€the€nonmoving€party,€allow€all€reasonable€inferencesÏfrom€that€evidence€in€œhis€or€her›€favor,€and€discard€allÏcountervailing€evidence.€€òòSee€ò òByrd€v.€Hall,óóó ó€847€S.W.2d€208,€210„11Ï(Tenn.€1993).€€ÌÌà àà àœSummary›€œJudgment›€is€œgenerally›€not€appropriate€inÏœmalpractice›€œcases.€€òòò òBowman€v.€Henard,€ó óóó547€S.W.2d€527,€530€(Tenn.Ï1977).€€This€is€because›€œin€most€of€these€cases€the›€facts€areÏusually€œdisputed,€sometimes€sharply€so;›€œhowever,€in€an€appropriateÏcase,€summary€judgment€is€the€proper€relief.€€òòSeeóó,›€e.g.,€òòò òœAyers›€v.ÏRutherford€Hospital,€Inc.ó óóó,€689€S.W.2d€155€œ(Tenn.App.›€1984);€òòò òDolanÏv.€Cunninghamó óóó,€648€S.W.2d€652€œ(Tenn.App.›€1982).€€A€plaintiff,€inÏresisting€a€œproperly€supported€motion›€for€summary€judgment,€doesÏnot€have€to€fully€prove€his€œor€her€case›€in€order€to€be€successfulÏat€this€pre„trial€stage.€€Such€a€party€must€only€œdemonstrate,Ïgenerally€by€expert€testimony,›€that€there€are€disputed€œmaterial›Ífacts€as€to€each€œof€the€controverted€elements›€of€the€œcause€ofÏaction.× ƒ< ××  ×€€In›€ò òòòSchaefer€v.€Larsen,€ó óóó688€S.W.2d€430€(Tenn.App.€œ1984),Ïthis€court€stated€the€applicable€principle:›ÌÓÓÌÌà8 àà8 àIn€order€to€withstand€a€defendantððs€motion€forÏsummary€judgment,€the€plaintiff€does€not€haveÏto€ð ðshowðð€breach€and€causation€in€the€sense€ofÏproving€those€elements,€but€must€simplyÏestablish€by€competent€means€that€there€is€aÏdispute€over€those€material€issues€of€factÏraised€by€the€record.ÌÌÌÌòòÓÓId.€óóat€432.€€The€law€in€Tennessee,€however,€has€also€consistentlyÏrecognized€thatÌÓÓÌÌà8 àà8 à[w]hile€motions€for€summary€judgment€areÏgenerally€inappropriate€in€professionalÏmalpractice€cases,€if€the€only€issue€is€oneÏwhich€requires€expert€testimony€and€there€isÏno€expert€response€to€an€affidavit€by€anÏexpert,€then€summary€judgment€is€proper.€€€ÌÌÌÌÓÓò òòòGambill€v.€Middle€Tenn.€Med.€Center,€Inc.,€ó óóó751€S.W.2d€145,€146Í(Tenn.App.€1988);€ò òòòBowman,€ó óóó547€S.W.2d€at€530„31.Ì€ÌÓ  ÓIIIÌÌÓ  Óà àà àOur€analysis€of€this€case€begins€with€an€examination€ofÏthe€œprovisions›€of€Tennesseeððs€malpractice€œstatutes.›€€The€œelements›Ïof€a€malpractice€claim,€and€the€plaintiffððs€burden€of€proof€withÏrespect€to€those€elements,€œare€codified€at›€T.C.A.€ðð€œ29„26„115:›ÌÓÓÌÌà8 àà8 à(a)€In€a€malpractice€action,€the€claimantÏshall€have€the€burden€of€proving€by€evidenceÏas€provided€by€subsection€(b):ÌÌà8 àà8 à(1)€The€recognized€standard€of€acceptableÏprofessional€practice€in€the€profession€andÏthe€specialty€thereof,€if€any,€that€theÏdefendant€practices€in€the€community€in€whichÏhe€practices€or€in€a€similar€community€at€theÏtime€the€alleged€injury€or€wrongful€actionÏoccurred;ÌÌà8 àà8 à(2)€That€the€defendant€acted€with€less€than€orÏfailed€to€act€with€ordinary€and€reasonableÏcare€in€accordance€with€such€standard;€€andÌÌà8 àà8 à(3)€As€a€proximate€result€of€the€defendant'sÏnegligent€act€or€omission,€the€plaintiffÏsuffered€injuries€which€would€not€otherwiseÏhave€occurred.ÌÌà8 àà8 à(b)€No€person€in€a€health€care€professionÍrequiring€licensure€under€the€laws€of€thisÏstate€shall€be€competent€to€testify€in€anyÏcourt€of€law€to€establish€the€facts€requiredÏto€be€established€by€subsection€(a)€unless€heÏwas€licensed€to€practice€in€the€state€or€aÏcontiguous€bordering€state€a€profession€orÏspecialty€which€would€make€his€expertÏtestimony€relevant€to€the€issues€in€the€caseÏand€had€practiced€this€profession€or€specialtyÏin€one€of€these€states€during€the€yearÏpreceding€the€date€that€the€alleged€injury€orÏwrongful€act€occurred.€€This€rule€shall€applyÏto€expert€witnesses€testifying€for€theÏdefendant€as€rebuttal€witnesses.€€The€courtÏmay€waive€this€subsection€when€it€determinesÏthat€the€appropriate€witnesses€otherwise€wouldÏnot€be€available.ÌÌÌÌÓÓThe€Supreme€Court€has€stated€the€following€in€construing€thisÏstatute:ÌÓÓÌÌà8 àà8 àWe€see€no€ambiguity€or€lack€of€clarity€in€theÏdictates€of€T.C.A.€Sec.€29„26„115.€€ItÏprovides€unequivocally€that€each€of€the€threeÏbasic€elements€of€a€medical€malpracticeÏaction„„the€standard€of€care,€the€breach€ofÏthe€standard,€and€proximate€cause„„be€provenÏby€testimony€of€experts€who€were€licensed€andÏpracticing€in€Tennessee€or€a€contiguousÏbordering€state€during€the€year€preceding€theÏdate€that€the€alleged€injury€or€wrongful€actÏoccurred.€ÌÌÌÌÓÓòòò òPayne€v.€Caldwell,€ó óóó796€S.W.2d€142,€143€(Tenn.€1990).€€ÌÌà àà àIn€moving€for€summary€judgment€in€a€malpractice€case,€aÏdefendant€must€present€facts€œrefuting›€the€operative€allegations€ofÏthe€plaintiffððs€complaint€as€to€œat€least€one€of€the›€three€elementsÏenumerated€in€the€statute.€€œòòò òWhite›€v.€Methodist€Hosp.€South,€ó óóó844ÏS.W.2d€642,€648€(œTenn.App›.€1992).€€Dr.€Baugussðð€affidavitÏœaddresses€all€three.›€€He€states,€as€noted€earlier,€that€he€isÏfamiliar€with€the€local€standard€of€care,€that€he€did€not€breachÏthat€standard€in€any€way,€and€that€Bryantððs€œcondition›€was€notÏproximately€caused€by€any€negligence€on€his€part.ÌÌà àà àœIn€resisting€Dr.€Baugussðð€motion,€Bryant€reliesÏprimarily€on€Dr.€Altshulerððs€affidavit.€€He€argues€that€thisÏaffidavit€negates€the€defendantððs€affidavit.€€We€disagree.€€Dr.ÏAltshuler€does›€not€state€that€he€is€familiar€with€the€recognizedÏstandard€of€acceptable€periodontal€practice€in€œBlount›€County€or€aÏsimilar€community.€€Bryant€œrecognizes€this€deficiency€but€contends›Ïthat€since€Dr.€Altshuler€states€that€ð ðthe€standard€of€careÏexpected€of€a€qualified,€licensed€dentist€was€not€met€by€Dr.ÍBauguss,ðð€it€can€be€inferred€that€Dr.€Altshuler€œknows€the›€standardÏof€care€in€œa›€œcommunity›€œsuch€as›€Blount€County.€€œAgain,€we›€œdisagree.›€ÏThe€statute,€œT.C.A.›€ðð€29„26„115,€clearly€requires€the€plaintiff€toÏœaffirmatively€prove›€the€recognized€standard€of€acceptableÏprofessional€œpractice›€ð ðin€the€community€in€which€[the€defendant]Ïpractices€or€in€a€similar€œcommunity.ðð€€We€cannot€assume€that€Dr.›ÏœAltshuler„„who€does€not€practice€in€Blount€County„„knows›€theÏstandard€of€professional€care€in€the€Blount€œCounty›€œarea›€or€œin€a›Ïsimilar€œcommunity.€€Dr.€Altshulerððs€statement„„that€Dr.€BaugussÏdid€not€measure€up€to€the€ð ðstandard€of€care€expected€of€aÏqualified€licensed€dentistðð„„does€not€permit€us€to€make€the€ð ðleapÏof€faithðð€urged€by€the€plaintiff.€€The€statement€quoted€from€Dr.ÏAltshulerððs€affidavit€begs€the€question.€€What€is€the€locale€ofÏthe€standard€to€which€Dr.€Altshuler€makes€reference?€€We€do€notÏknow€the€answer€to€this€question€from€his€affidavit.€€ThisÏdeficiency€is€fatal€to€the€plaintiffððs€claim€of€malpractice.›ÌÌà àà àPertinent€Tennessee€œcaselaw›€is€clear€in€requiring€expertÏtestimony€on€all€three€elements€of€the€statute,€includingÏknowledge€of€the€relevant€standard€of€professional€care.€€òòSee,Íe.g.,€ò òPayne,€ó óóó796€S.W.2d€at€143.€€Further,€the€cases€œthat›€deal€withÏthe€issue€of€a€medical€expertððs€familiarity€(or€lack€thereof)€withÏlocal€standards€of€practice€clearly€œimply€that›€the€assumptionÏsuggested€by€the€plaintiff€is€one€that€we€cannot€make.€€òòCf.€œò òAyers,›Ïó óóó689€S.W.2d€œ155;›€ò òòòCardwell€v.€Bechtol,€ó óóó724€S.W.2d€739,€754€(Tenn.Ï1987)€(affirming€directed€verdict€for€defendant€where€noÏadmissible€evidence€on€local€standard€of€care€was€presented)òòò ò;ÏOsler€v.€Burnett,ó óóó€œNo.›€œ02A01„9202„CV„00046,€1993€WL€90381›Ï(Tenn.App.,€W.S.,€filed€March€30,€1993,€Crawford,€œJ.);›€ò òòòMoore€v.ÏWalwyn,€œó óóóNo.›€œ01A01„9507„CV„00295,€1996€WL€17143›€(Tenn.App.,€filedÏJan.€19,€1996,€Lewis,€J.);€ò òòòRoddy€v.€Volunteer€Med.€Clinic,€Inc.,Ïœó óóóNo.›€œ03A01„9506„CV„00194,€1996€WL€79487›€(Tenn.App.,€filed€Feb.€26,Ï1996,€Sanders,€J.).ÌÌà àà àAlthough€we€have€concluded€that€the€malpractice€statutesÏand€relevant€caselaw€do€not€allow€us€to€assume€that€Dr.€AltshulerÏknows€the€appropriate€standard€of€care,€œwe€must€go€further.€€ThisÏis€because€Bryantððs›€own€affidavit€presents€the€issue€of€whetherÏthe€œrelevant€standard›€has€been€effectively€established€by€œcommentsÏallegedly€made€by€Dr.›€œBauguss€in€Bryantððs€presence.›€€The€SupremeÍCourt€has€held€that€ð ðthe€standard€of€care€may€be€established€byÏthe€defendantððs€own€admissions.€.€.ðð€€ò òòòCardwell,€ó óóó724€S.W.2d€at€754;Ïò òòòTutton€v.€Patterson,€ó óóó714€S.W.2d€268,€270€(Tenn.€1986).€€Bryant€hasÏsworn€to€the€following€in€his€affidavit:ÌÓÓÌÌà8 àà8 àWhile€Dr.€Bauguss€was€performing€surgery€uponÏme,€he€commented€in€my€presence€to€hisÏassistant€that€he€needed€a€smaller€tool€inÏorder€to€properly€perform€the€surgery.€HeÏstated€that€he€looked€diligently€for€such€aÏtool,€but€none€was€immediately€available,€soÏhe€preceded€[sic]€with€the€surgery€anyway.€€ÌÌÌÌÓÓWe€accept€this€statement€as€true€for€summary€judgment€purposes.œ× ƒ= ××  ×›€ÏDr.€Bauguss€does€not€specifically€deny€making€this€statement€inÏhis€affidavit,€nor€does€he€discuss€the€surgical€œinstruments›€usedÏby€him€in€the€course€of€the€surgery.€€He€instead€relies€upon€œhisÏgeneral›€œdenial›€of€any€and€all€negligence€in€his€œaffidavit.ÌÌà àà àThe›€ð ðadmissionðð€relied€upon€by€the€plaintiff€is€of€noÏavail€to€him.€€There€is€no€expert€testimony€before€us€that€the€useÏof€œthe€ð ðtool,ðð€otherwise›€œunidentified,€employed€by€Dr.€Bauguss›Íœconstitutes€a›€deviation€from€the€ð ðrecognized€standard€ofÏacceptable€professional€practice.ðð€€We€cannot€œfind€a€deviationÏbased€on€Bryantððs›€affidavit,œ× ƒ> ××  ×›€and€the€subject€is€not€addressed€inÏDr.€œAltshuler›ððs€affidavit.ÌÌÓ  ÓIVÌÌÓ  Óà àà àœThe›€affidavits€œsubmitted€by€the€plaintiff€are›€alsoÏdeficient€on€the€required€element€of€proximate€cause.€€Dr.ÏAltshulerððs€affidavit€is€entirely€silent€on€this€issue.€€TheÏmalpractice€œstatutes€are›€clear€that€a€plaintiff€must€provideÏcompetent€expert€medical€testimony€proving€that€ð ð[a]s€a€proximateÏresult€of€the€defendantððs€negligent€act€or€omission,€the€plaintiffÏsuffered€injuries€which€would€not€otherwise€have€occurred.ðð€ÏT.C.A.€ðð€29„26„115(a)(3).€€œGenerally€speaking,€applicable›ÏTennessee€caselaw€œrequires›€expert€testimony€on€the€issue€ofÏproximate€cause.€€ò òòòBowman,€ó óóó547€S.W.2d€at€530„31€(ð ðIt€is€theÏestablished€law€in€Tennessee€that€malpractice€actions€involvingÏissues€œof€.›€.€œ.€proximate›€cause€require€expert€testimony.€.€.ðð);Íœò òòòDolan,›€ó óóó648€S.W.2d€œat›€654€œ(ð ðIn›€medical€malpractice€cases€causationÏis€generally€a€matter€requiring€expert€testimony.ðð).ÌÌà àà àOnce€a€defendant€has€filed€a€properly€supported€motionÏfor€summary€judgment,€the€failure€of€the€plaintiff€to€raise€anÏissue€of€material€fact€regarding€the€proximate€cause€of€theÏplaintiffððs€injuries€renders€his€or€her€case€ripe€for€summaryÏjudgment.€€The€ò òòòDolan€ó óóócourt€stated€the€following€on€this€point:ÌÓÓÌÌà8 àà8 àThe€rule€requires,€in€the€final€analysis,€thatÏplaintiffs€in€malpractice€actions€must€comeÏforward.€.€.with€expert€opinion€on€the€issuesÏof€negligence€and€proximate€cause€to€make€outÏa€genuine€issue€of€material€fact,€or€face€theÏlikelihood€of€summary€judgment€in€favor€of€theÏdefendants.€.€.Our€examination€of€the€recordÏreveals€no€expert€testimony€establishing€aÏcausal€connection€between€the€allegedÏnegligence€of€the€treating€physician€and€theÏultimate€cause€of€death.€ÌÌÌÌÓÓò òòòDolan,€ó óóó648€S.W.2d€at€œ653„54.›€€The€ò òòòDolan€óóó ócourt€affirmed€a€grant€ofÏsummary€judgment€to€the€defendant.€€òòId.€€See€also€ò òHall€v.€Ramos,Ïœó óóóNo.›€œ01A01„9007„00261,›€œ1991€WL€27372€(Tenn.App.,›€M.S.,€filed€MarchÏ6,€1991,€Cantrell,€J.)€(affirming€summary€judgment€becauseÍplaintiffs€failed€ð ðto€come€forward€with€proof€showing€a€genuineÏissue€on€the€question€of€causation.ðð).ÌÌà àà àSince€Bryantððs€proof€has€failed€to€create€a€genuineÏissue€of€fact€on€causation,€this€is€another€reason€why€we€mustÏaffirm€the€trial€courtððs€grant€of€summary€judgment€as€to€theÏplaintiffððs€cause€of€action€for€malpractice.€ÌœÇ›Ó  ÓVÌÌÓ  Óà àà àFinally,€we€turn€to€Bryantððs€œother€claim„„that›€Dr.ÏBauguss€performed€œsurgery›€œon›€him€without€his€informed€consent.€ÏBryantððs€affidavit€contains€the€following€statement:ÌÓÓÌÌà8 àà8 àIn€my€Complaint€I€allege€that€Dr.€BaugussÏfailed€to€provide€me€with€the€proper€informedÏconsent.€€This€Complaint€was€not€addressed€inÏhis€Affidavit.€€Standing€alone,€that€ComplaintÏin€and€of€itself€is€enough€to€justify€theÏdenial€of€Summary€Judgment€on€the€behalf€ofÏthe€Defendant.€€It€is€my€testimony€that€Dr.ÏBauguss€failed€to€inform€me€of€the€possibleÏconflicts€œ[sic]€or›€of€the€possibleÏcomplications€œand€problems€which›€could€occurÏas€a€result€of€the€surgery.ÌÌÌÌÓÓBryantððs€statement€that€the€informed€consent€claim€ð ðwas€notÏaddressed€in€[Dr.€Baugussðð]€Affidavitðð€œoverlooks›€the€followingÏstatement€in€that€affidavit:ÌÓÓÌÌà8 àà8 àIt€is€further€my€opinion€within€a€reasonableÏdental€certainty€that€the€rare€potential€forÏnerve€injury€in€this€procedure€does€notÏrequire€description€of€this€complication€inÏobtaining€informed€consent.€ÌÌÌÌÓÓBryantððs€expert,€Dr.€Altshuler,€œdid€not€address€whether€Dr.ÏBauguss€should€have€advised€the€plaintiff€that€numbness€of€theÏface€might€result€from€the€surgery.€€Even€if€he€had,€his€failureÏto€indicate€that€he€was€aware€of€the€relevant€standard€ofÏacceptable€professional€practice€would€have€rendered€his€testimonyÏinadmissible€and€hence€not€subject€to€consideration€in€this€case.›€€ÌÌà àà àThe€malpractice€œstatutes›€again€œprovide›€guidance€for€theÏdetermination€of€this€issue.€€œT.C.A.€ðð€29„26„118€states€asÏfollows:›ÌÓÓÌÌà8 àà8 àœIn›€a€malpractice€action,€the€plaintiff€shallÏprove€by€evidence€as€required€by€ðð€29„26„115(b)€that€the€defendant€did€not€supplyÏappropriate€information€to€the€patient€inÏobtaining€his€informed€consent€(to€theÏprocedure€out€of€which€plaintiffððs€claimÏallegedly€arose)€in€accordance€with€theÏrecognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€the€specialty,Ïif€any,€that€the€defendant€practices€in€theÏcommunity€in€which€he€practices€and€in€similarÏcommunities.€€ÌÌÌÌÓÓœThus,›€by€its€clear€œterms,›€the€statute€requires€expert€testimony€onÍthe€œrelevant€standard›€of€care€in€providing€ð ðappropriateÏinformationðð€œfor›€informed€consent.€€œIn€ò òòòGerman€v.€Nichopoulos,›€œó óóó577ÏS.W.2d€197€(Tenn.App.€1978),òò›€óóthe€court€stated€the€following€onÏinformed€consent:ÌÓÓÌÌà8 àà8 àLiability€predicated€on€the€doctrine€ofÏinformed€consent.€.€.is€predicated€uponÏnegligence€of€the€physician€in€the€failure€toÏreasonably€advise€the€patient€regarding€theÏtreatment€recommended.€€The€necessary€resultÏof€that€failure€is€that€any€consent€given€byÏthe€patient€for€that€treatment€is€said€to€beÏwithout€an€informed€or€knowledgeable€consent.Ï.€.€œ.€However,›€in€order€to€recover€under€thisÏtheory€in€a€medical€malpractice€case,€thereÏmust€be€some€medical€testimony€as€to€the€usualÏand€customary€advice€given€to€patients€toÏprocure€consent€in€similar€situations.€€ÌÌ€€à àà àà à*à àà à*à àà à*à àà à*ÌÌà8 àà8 àThere€œis€simply›€œno›€competent€proof€thatÏpresents€any€jury€issue.€€Counsel€insists€thatÏsimply€because€plaintiff€testified€that€no€oneÏtold€her€of€any€possible€risks€prior€toÏreceiving€the€injection,€a€Prima€facie€caseÏbased€on€lack€of€informed€consent€was€madeÏout.€€We€disagree€and€hold,€as€did€the€œMiddle›ÏSection€of€this€Court€in€an€unreported€case,Ïthat,€in€matters€of€informed€consent€theÏplaintiff€has€the€burden€of€proving€by€expertÏmedical€evidence,€(a)€what€a€reasonableÏmedical€practitioner€of€the€same€or€similarÏcommunities€under€the€same€or€similarÏcircumstances€would€have€disclosed€to€theÍpatient€about€attendant€risks€incident€to€aÏproposed€diagnosis€or€treatment€and€(b)€thatÏthe€defendant€departed€from€the€norm.ÌÌÌÌòòÓÓò òGerman,€ó óóó577€S.W.2d€at€202,€204;€ò òòòCardwell,ó óóó€724€S.W.2d€at€750.€€TheÏreason€for€the€rule€requiring€expert€testimony€is€obvious:€courts,Ïlacking€the€benefit€of€medical€training,€have€no€way€of€œknowing›Ïwhat€information€customarily€should€be€transmitted€to€a€patient€inÏorder€to€allow€him€or€her€to€make€an€informed€decision€about€aÏmedical€procedure.€€Dr.€Bauguss€has€sworn€that€œthe€condition€ofÏwhich€Bryant€complains€is€so€ð ðrareðð›€as€not€to€require€œdisclosureÏfor€informed€consent.›€€Bryant€did€not€controvert€this€assertionÏthrough€expert€testimony,€as€required€by€the€statute€and€relevantÏœcaselaw.ÌÌà àà àBryant€points€out€that€Dr.€Baugussðð€affidavit€fails€toÏstate€that€he€advised€Bryant€of€òòanyóó€risks€associated€with€theÏsurgery.€€He€seems€to€argue€that€this€failure€in€some€way€rendersÏthe€defendantððs€motion€as€to€the€informed€consent€issueÏinadequate.€€The€answer€to€this€contention€is€that€failure€toÏinform€a€patient€of€a€risk€that€does€not€ripen€into€a€condition€asÍa€result€of€the€surgery€is€immaterial€as€to€whether€informedÏconsent€was€given.€€In€such€a€situation,€no€injury€equals€no€causeÏof€action.€€The€critical€question€is€what,€if€anything,€wasÏrequired€to€be€said,€and€what€was€said,€about€the€condition€thatÏòòdidóó€result€from€the€surgery.ÌÌà àà àSummary›€judgment€against€œthe€plaintiff›€on€the€informedÏconsent€issue€was€proper.€€ÌÌà àà àFor€the€aforementioned€reasons,€the€judgment€of€theÏtrial€court€is€affirmed€and€this€case€is€remanded€for€collectionÏof€costs€assessed€below,€pursuant€to€applicable€law.€€Costs€onÏappeal€are€taxed€and€assessed€to€appellant.€ÌÌÌÓÓà àà àà àà àà àà àà à_____________________________Ìà àà àà àà àà àà àà àCharles€D.€Susano,€Jr.,€J.ÌÌCONCUR:ÌÌÌÌ____________________________ÌHouston€M.€œGoddard›,€œP.J.›ÌÌÌÌÌœ____________________________›ÌœHerschel›€P.€Franks,€J.