ÿWPC@ 9# .UN9 %‡ 0(w@µ4õ Æ ÆæƬÆr 0J8 D3‚ 0Tµ 0^ 0hg 0rÏ 0|A 0†½ 0C 1uÓ U,H 0dt A©Ø 0@ D+Á 0Kì B7 AOTÆ£ 0Di 0D­ D/ñ B U,=U>iB)§DCÐ AOU*býŒf‰v~ïvÓm˜HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPTÀäÌÀÀÌÀä0 (ÖÃ9 Z ‹6Times New Roman RegularX($¡¡ UD E  E  Ó€Díb¸ 3|xLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 52 ÿÿ0Indent1Ô2ÔÔ3  Ô%%%%'ÿÿdxd2" 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 $#›&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKK("ÿÿ$££Ò  ÒÒ  Ò'ÈÈÈÈdxd( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó d* ,-Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý($$””ò òÚ  Ú1Ú  Úó ó..'÷ÿ dxdüÿP Pd< Œ 9p`(Monaco< Œ 9p`(&Times New Roman% Line 7 d11117Border 1dd* $2Cþÿ << Gÿÿ< Œ 9p`(Arial óÝ ƒ!ÝÔ€ÔÔ€0ÔÝ  ÝÔ€4ÔÔ€4ÔÓ  ÓÔ YYY ÔFILEDÔ€4XÔÌÌò òMay€31,€1996ÌÌCecil€Crowson,€Jr.ÌÔ€4ôÔAppellate€Court€Clerkó ó \Ñ\R AØ'\ÑPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'@Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$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 ÒÝ ƒ!ÝÔ . ÔÔ€ÔÓ&€//X„d&ÓÑ#€//Xd#ÑÔ€0ÔÝ  ÝÑ\R AØ'\Ñ›œÑ7€†#XXdìdÈ7ÑÙ€*ÙßL€352;+'h|` Å `€€LßÌò òà@ àIN€THE€COURT€OFÏAPPEALS€OF€TENNESSEEó óÌà@ àò òWESTERN€SECTION€ATÏJACKSONÌà àà àà àòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÌÌóóÌÌROBERT€COX,€Adminstrator€ofà àà à)€Ìthe€Estate€of€Linda€Cox€Johnson,à àà à)ÌDeceased,à àà àà àà àà à)à àÌà àà àà àà àà àà à)Ìà àó óPlaintiff/Appellant,ò òà àà àà à)à àÌà àà àà àà àà àà à)à à€ó óMadison€Law€No.€C„92„245€€ò òÌvs.à àà àà àà àà àà à)à à€Ìà àà àà àà àà àà à)ÌGENERAL€CARE€CORP.€€d/b/a€HCAà à)à àó óAppeal€No.€Ìò òREGIONAL€HOSPITAL€OF€€€€€€€€à àà à)à àó ó02A01„9412„CV„00269ò òÌJACKSON,€BEVERLYANN€JETTON,à à)ÌNURSE,€SHEWANNA€MACKEY,€€€à à)ÌRECEPTIONIST,€and€JOSEPH€RAGON€)ÌM.D.,à àà àà àà àà àà à)Ìà àà àà àà àà àà à)Ìó óà àDefendants/Appellees.à àò òà à)à àÌó óòòÌóóò òÌ€€€ÌÌà@ àó óAPPEAL€FROM€THE€CIRCUIT€COURT€OF€MADISON€COUNTYÌà@ àAT€JACKSON,€TENNESSEEÌÌÌÌà@ àTHE€HONORABLE€PHIL€B.€HARRIS,€JUDGEÌòòÌÌÌFor€the€Plaintiff/Appellantóó:òòà àà àà àFor€the€Defendants/AppelleesÌóóWilliam€A.€Cohn€€€€à àà àà àà àSadia€S.€Staton€€€€€ÌCordova,€Tennesseeà àà àà àà àJackson,€TennesseeÌ€€€€€€€€€€€€€€€€€€€Ìà àà àà àà àà àà àJohn€D.€BurlesonÌà àà àà àà àà àà àJackson,€TennesseeÌò òÌÌÌà@ à€€€€€€€€AFFIRMED€ÌÌÌà àà àà àà àà àà àó óHOLLY€KIRBY€LILLARD,€JUDGEÌÌÌÌCONCUR:ÌÌòòÌóóW.€FRANK€CRAWFORD,€P.J.,€W.S.ÌÌÌALAN€E.€HIGHERS,€J.ÇØØÙ  ÙÓÓ›Ñ7€†#XXdìXXdì7ÑÑ  Ñà àThis€is€a€wrongful€death€suit€brought€by€Robert€Cox€(Cox),€œas€administrator€of€the€estate›Ïof€the€decedent,€Linda€Cox€Johnson€(Johnson),€alleging€medical€malpractice€against€General€CareÏCorporation,€d/b/a€HCA€Regional€Hospital€of€Jackson€(HCA),€and€several€of€its€emergency€roomÏpersonnel.€€The€trial€court€granted€summary€judgment€to€HCA.€€Cox€appeals€the€summaryÏjudgment€as€well€as€the€trial€courtððs€denial€of€Coxððs€motions€to€strike€the€affidavit€of€HCAððs€expertÏand€amend€the€Complaint.€€Cox€also€appeals€the€alleged€denial€of€a€motion€to€consolidate€the€caseÏat€bar€with€a€related€suit;€however,€œthe›€record€is€silent€as€to€what,€if€any,€action€the€trial€court€tookÏregarding€this€motion.€€We€affirm€the€trial€courtððs€denial€of€Coxððs€motion€to€strike€the€affidavit€ofÏHCAððs€expert€and€the€entry€of€summary€judgment€in€favor€of€HCA.€œ€€We€find€no€error€regardingÏamendment€of€the€Complaint,€and€the€consolidation€issue€is€pretermitted€by€our€affirmance€of€theÏtrial€courtððs€entry€of€summary€judgment.›Ìà àOn€August€27,€1991,€Johnson€visited€Dr.€Bob€Souder€(Souder)€for€diagnosis€andÏtreatment€of€an€illness.€€At€Souderððs€direction,€Johnson€went€to€HCA€the€next€day€for€someÏoutpatient€tests.€€Over€the€next€two€days,€Johnson€felt€progressively€worse,€and€on€the€morning€ofÏSaturday,€August€31,€1991,€relatives€took€Johnson€to€the€HCA€emergency€room.€€The€partiesÏdispute€the€time€at€which€Johnson€arrived€at€the€emergency€room.€€The€parties€also€dispute€the€timeÏJohnson€was€first€examined€by€a€physician.€€At€some€point€after€she€arrived€at€HCAððs€emergencyÏroom,€she€was€moved€to€HCAððs€intensive€care€unit,€where€she€died.€€Coxððs€Complaint,€filed€onÏAugust€21,€1992,€alleges€that€HCA€and€its€staff€were€negligent€in€not€treating€Johnson€promptlyÏupon€her€arrival€at€the€emergency€room.€€Cox€had€also€filed€a€separate€lawsuit€against€Souder€inÏanother€court.Ìà àHCA€filed€a€motion€with€the€trial€court€for€summary€judgment.€€In€support€of€its€motion,ÏHCA€submitted€the€affidavit€of€a€medical€expert,€Dr.€Richard€Stein.€€Cox€moved€the€court€to€strikeÏSteinððs€affidavit€and,€in€opposition€to€the€motion€for€summary€judgment,€offered€the€affidavit€ofÏhis€own€expert,€Dr.€Philip€Leavy.€€Cox€also€moved€the€court€to€allow€him€to€amend€his€ComplaintÏto€identify€the€laboratory€which€ran€some€tests€on€the€decedent€œat›€HCAððs€laboratory.€€€œIn€addition,ÏCox›€œmoved›€for€joinder€of€the€separate€suit€against€Souder€to€the€case€at€bar.€€The€trial€court€deniedÍCoxððs€motion€to€strike€Steinððs€affidavit,€granted€HCAððs€motion€for€summary€judgment,€and€deniedÏCoxððs€motion€to€amend€the€Complaint.€€The€record€is€silent€as€to€whether€the€trial€court€took€anyÏaction€regarding€the€motion€to€join€the€instant€case€with€the€separate€lawsuit€against€Souder.€€Ìà àIn€this€appeal,€Cox€asserts€that€his€motion€to€strike€Dr.€Steinððs€affidavit€should€have€beenÏœgranted›€and€that€the€trial€court€erred€in€granting€HCAððs€motion€for€summary€judgment.€€Cox€alsoÏargues€that€his€motion€to€amend€his€Complaint€should€have€been€heard€prior€to€the€motion€forÏsummary€judgment€and€asserts€that,€had€it€been€heard€first,€the€amended€Complaint€would€haveÏsurvived€HCAððs€motion€for€summary€judgment.€€Cox€œcontends›€that€the€trial€court€denied€hisÏmotion€for€joinder€and€seeks€to€appeal€that€denial,€but€does€not€cite€any€portion€of€the€record€whichÏcontains€the€trial€courtððs€denial€of€the€joinder€motion.Ìà àWe€first€consider€the€denial€of€appellantððs€motion€to€strike€the€affidavit€of€Dr.€Richard€SteinÏsubmitted€by€HCA€in€support€of€its€motion€for€summary€judgment.€€Steinððs€affidavit€states€hisÏœopinion€that,›€to€a€reasonable€degree€of€medical€certainty,€€even€if€Johnson€had€received€appropriateÏtreatment€promptly€at€the€time€Cox€maintains€that€she€arrived€at€HCAððs€emergency€room,€thisÏwould€not€have€prevented€her€death.€€The€admissibility€of€expert€testimony€is€a€matter€œwithin›€theÏsound€discretion€of€the€trial€court€and€will€only€be€overturned€on€appeal€when€the€court€hasÏarbitrarily€exercised€or€abused€that€discretion.€€ò òòòState€v.€Ballardó óóó,€855€S.W.2d€557,€562€(Tenn.Ï1993);€òòò òAustin€v.€City€of€Memphisó óóó,€684€S.W.2d€624,€634€(Tenn.€App.€œ1984).›€€Cox€arguesÏthat€Steinððs€affidavit€consisted€of€baseless€conjecture€and€speculation.€€However,€Steinððs€affidavitÏstates€that€his€opinion€is€based€on€Johnsonððs€hospital€records,€the€autopsy€report,€informationÏreasonably€relied€on€by€other€physicians€in€the€field€of€hematology,€and€his€own€research€andÏexperiences€in€treating€patients€with€similar€symptoms.€€The€trial€court€did€not€abuse€its€discretionÏin€denying€the€motion€to€strike,€and€its€denial€is€affirmed.€Ìà àWe€next€consider€the€entry€of€summary€judgment€in€favor€of€HCA.€€A€trial€court€shouldÏgrant€a€motion€for€summary€judgment€when€the€movant€demonstrates€that€there€are€no€genuineÏissues€of€material€fact€and€that€the€moving€party€is€entitled€to€a€judgment€as€a€matter€of€law.€ÍœTenn.R.Civ.P.›€56.03.€€The€party€moving€for€summary€judgment€bears€the€burden€ofÏdemonstrating€that€no€genuine€issue€of€material€fact€exists.€€ò òòòByrd€v.€Halló óóó,€847€S.W.2d€208,€210Ï(Tenn.€1993).€€On€a€motion€for€summary€judgment,€the€court€must€take€the€strongest€legitimateÏview€of€the€evidence€in€favor€of€the€nonmoving€party,€allow€all€reasonable€inferences€in€favor€ofÏthat€œparty,›€and€discard€all€countervailing€evidence.€€ò òòòId.óóó ó€at€210„11.€€€In€ò òòòByrdó óóó,€the€court€stated:ÌÓÓà8 àOnce€it€is€shown€by€the€moving€party€that€there€is€no€genuine€issue€of€material€fact,Ïthe€nonmoving€party€must€then€demonstrate,€by€affidavits€or€discovery€materials,Ïthat€there€is€a€genuine,€material€fact€dispute€to€warrant€a€trial.€€In€this€regard,€RuleÏ56.05€provides€that€œthe›€nonmoving€party€cannot€simply€rely€upon€his€pleadings€butÏmust€set€forth€òòò òspecific€factsó óóó€showing€that€there€is€a€genuine€issue€of€material€factÏfor€trial.€€ð ðIf€he€does€not€so€respond,€summary€judgment€.€.€.€shall€be€enteredÏagainst€him.ððÌÌÓÓò òòòœId.ó óó󛀜€at€211€(citations›€omitted).€€Summary€judgment€is€only€appropriate€when€the€case€can€œbe›Ïdecided€on€the€legal€issues€alone.€€ò òòòId.ó óóó€at€210.€€Since€only€questions€of€law€are€involved,€there€isÏno€presumption€of€correctness€regarding€a€trial€courtððs€grant€of€summary€judgment.€€ò òòòJohnson€v.ÏEMPE,€Inc.ó óóó,€837€S.W.2d€œ62,€68›€(Tenn.€App.€1992).€€Review€of€the€order€granting€summaryÏjudgment€is,€therefore,€ò òòòde€novo.€€ó óóóÌà àIn€order€to€carry€his€burden€in€a€medical€malpractice€action,€a€plaintiff€must€prove€theÏfollowing:ÌÓÓœà8 à›à à(1)€The€recognized€standard€of€acceptable€professional€œpractice›€in€œtheÏprofession›€and€the€speciality€thereof,€if€any,€that€œthe›€defendant€practices€in€theÏcommunity€in€which€he€practices€œor›€in€a€similar€community€at€the€time€the€allegedÏinjury€or€œwrongful›€action€occurred;ÌÌœà8 à›à à(2)€That€the€defendant€acted€with€less€than€or€failed€to€œact›€with€ordinary€andÏœreasonable›€care€in€accordance€with€such€œstandard;›€and€ÌÌœà8 àà à(3)›€As€a€proximate€result€of€the€defendantððs€negligent€œact€or›€omission,€theÏœplaintiff€suffered›€injuries€which€would€not€œotherwise›€have€occurred.ÌÌÓÓT.C.A.€œðð€29„26„115(a)(1)„(3)€(1980);›€ò òòòHurst€v.€Doughertyó óóó,€800€œS.W.2d›€183,€185€(Tenn.€App.Ï1990).€€To€prove€negligence,€a€plaintiff€must€establish€each€element:€€duty,€breach€of€duty,Ïcausation,€proximate€cause,€and€damages.€€ò òòòKilpatrick€v.€Bryantó óóó,€868€S.W.2d€594,€598€(Tenn.Ï1993).€€In€medical€malpractice€actions,€negligence€and€causation€are€usually€established€by€medicalÍexpert€testimony.€€T.C.A.€œðð€29„26„115(b)€(1980);›€ò òòòStokes€v.€Leungó óóó,€651€S.W.2d€704,€706Ï(Tenn.€App.€1982).€€The€Tennessee€Supreme€Court€has€stated€that€ð ð[c]ausation€in€fact€is€a€matterÏof€probability,€not€possibility,€and€in€a€medical€malpractice€case,€such€must€be€œshown›€to€aÏreasonable€degree€of€medical€certainty.ðð€€ò òòòKilpatrickó óóó,€868€S.W.2d€at€602€(citing€ò òòòWhite€v.ÏMethodist€Hosp.€Southó óóó,€844€S.W.2d€642,€œ648„49›€(Tenn.€App.€œ1992)).›€€Thus,€in€order€toÏestablish€causation,€the€medical€expert€testimony€must€show€to€a€reasonable€degree€of€medicalÏcertainty€that€the€tortious€conduct€of€the€defendant€caused€the€injury€to€the€œpatient.›Ìà àHCA€presented€competent€expert€testimony€to€show€lack€of€proximate€œcause;›€that€is,€evenÏif€HCA€œhad€been›€negligent€in€not€treating€Johnson€promptly,€prompt€treatment€would€not€haveÏprevented€her€death.€€Steinððs€affidavit€stated€that€it€was€his€opinion,€within€a€reasonable€degree€ofÏmedical€certainty,€that€Johnsonððs€life€could€not€have€been€saved€even€if€Johnson€had€immediatelyÑ€6ÑÇreceived€prompt€treatment€at€the€time€the€plaintiff€asserts€she€arrived€at€HCAððs€emergency€room.€€ItÏthen€became€Coxððs€burden€to€go€beyond€the€pleadings€to€establish€that€there€was€indeed€a€genuineÏissue€of€material€fact€on€the€issue€of€proximate€cause.€Ìà àCox€offered€affidavit€testimony€of€his€own€expert,€Dr.€Philip€Leavy,€to€rebut€the€SteinÏaffidavit€submitted€by€HCA.€€On€the€issue€of€proximate€cause,€Leavyððs€affidavit€states€as€follows:ÌÓÓà8 àœà àIt›€appears€to€me€upon€the€facts€presented€to€me€and€upon€the€medicalÏrecords€presented€to€me,€that€there€is€a€òòò òpossibilityó óóó€that€the€decedentððs€death€couldÏhave€been€prevented€by€prompt€and€proper€medical€attention€from€the€DefendantÏHCA€Regional€Medical€Center.€€Under€no€circumstances€was€death€automatic.Ìà à(Emphasis€œadded.)›€€ÌÌÓÓThus,€Leavyððs€affidavit€states€only€that€there€œis›€ð ða€possibilityðð€that€Johnsonððs€death€could€haveÏbeen€prevented€had€HCA€acted€properly.€€€In€essence,€based€on€Leavyððs€affidavit,€Cox€soughtÏrecovery€for€Johnsonððs€ð ðlost€chance€of€survival,ðð€discussed€by€the€Tennessee€Supreme€Court€inÏò òòòKilpatrickó óóó,€ò òòòsupraóóó ó.€€Inò òòò€Kilpatrickó óóó,€the€Court€declined€to€relax€the€œtraditional›€causation€standard,Ïstating€that€a€œð ð€ððdoctorððs›€testimony€that€a€certain€thing€is€possible€is€no€evidence€at€œall.ðð€ðð›€Ïò òòòKilpatrickó óóó,€868€S.W.2d€at€602€(quoting€ò òòòLindsey€v.€Miami€œDev.›€Corp.ó óóó,€689€S.W.2d€856,Ï861„62€(Tenn.€œ1985)).›€€Proof€of€causation€equating€to€a€ð ðpossibilityðð€is€not€sufficient,€as€a€matterÏof€law,€to€establish€by€a€preponderance€of€the€evidence€in€a€medical€malpractice€case€that€theÏdefendantððs€tortious€conduct€caused€the€plaintiffððs€injury.€€Leavyððs€affidavit€was€insufficient€toÏrebut€the€affidavit€submitted€by€HCA;€thus,€the€trial€courtððs€entry€of€summary€judgment€in€favor€ofÏHCA€must€be€affirmed.€Ìà àCox€next€asserts€error€in€the€trial€courtððs€denial€of€the€motion€to€amend.€€Coxððs€ComplaintÏstates€that€ð ðBob€T.€Souder,€M.D.€ran€medical€laboratory€tests,ò òòò€the€œresult›€of€which€heÏrequested€from€a€laboratoryó óóóðð€(emphasis€added).€€Cox€later€moved€the€trial€court€to€add€theÏfollowing€sentence€to€the€Complaint:€ð ðThe€laboratory€which€ran€the€medical€tests€was€theÏlaboratory€of€the€Defendant€HCA€Regional€Hospital.ðð€€€However,€neither€the€Complaint€œnor›€theÏproposed€amendment€allege€negligence€in€relation€to€the€tests€conducted€on€August€28,€1991.€ÏSince€the€œamended›€œcomplaint›€would€not€have€stated€a€claim€for€negligence€with€regard€to€theÍAugust€28,€œ1991›€laboratory€tests,€it€would€not€have€survived€HCAððs€motion€for€summaryÏjudgment.€€Any€error€by€the€trial€court€on€the€motion€to€amend€would€be€harmless€error.€€ÏLikewise,€hearing€the€motion€to€amend€after€the€granting€of€summary€judgment€did€not€change€theÏresult€in€this€case.€€The€trial€courtððs€actions€regarding€the€motion€to€amend€are€affirmed.€Ìà àFinally,€Cox€argues€that€the€trial€court€erred€in€failing€to€grant€his€motion€to€join€the€instantÏlawsuit€with€the€œseparate›€lawsuit€against€Dr.€Souder.€€We€decline€to€consider€this€issue€because€(1)Ïthere€is€nothing€in€the€record€establishing€the€trial€courtððs€ruling€on€the€œmotion›€and€(2)€the€issue€isÏpretermitted€by€our€affirmance€of€the€trial€courtððs€grant€of€summary€judgment€in€favor€of€HCA.€€€€Ìà àThe€judgment€of€the€trial€court€is€affirmed.€€œCosts€on€appeal€are€taxed€to€the€Appellant,€forÏwhich€execution€may€issue€if€necessary.€€›€œÌÓÓÌÌà àà àà àà àà àà àòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ìà àà àà àà àà àà àóóò òHOLLY€KIRBY€LILLARD,€J.ÌÌÌÌCONCUR:ÌÌòòÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÌóóW.€FRANK€CRAWFORD,€P.J.,€W.S.ÌÌòòÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÌALAN€E.€HIGHERS,€J.ó óÌ›