ÿWPCB —ÂZ»p¿´dq›1ŒUÒ%iæK#0wÕôÍJ¥:Ó×<è$ˆO$-ëíÅœÁ6 ¹R|õã{,²YíÚ½JIoJ ÿ32`ip‡]qØO;‚µ3ÁŠ×kl¿¼½è/¤ƒ¹Äó$+l"U­â3Qé>{6·l9/‹·óÚgM®Þ-Áã€:U†œ‹Ê³Úüòðn¥Á©œ_^σüÈ5&½£eP‡`M‡(ò)¼ÞølC`A/Œ˜DŒYJÀFk¢)Oð†‹úE↠×ââYæHôN£6`@=¯þ%Ý18äÞq@/2ÿ_¨Øöhº[½]îCMb3œ´¼9Êœ_«ý¤PšR¬ïé\H?PáYCûßØ}a $¹[$³Ì9H)ã¹ó M €·¾î •h7‡Â"·PÝ£©°úÚ…C“²Ó®“.Ÿ8¯˜h¬páYîë5ÔvÖŸ=#g( ‰£2/ìi#Ûw×rêÍ¿U¦ƃMðŒÚÀì(’õT uþoüÊÆSø9ÈnÜ 7™QŠg|Ùi<#Ôé¡ÄJnÃãõëŸ_¼VÔ¹æK/›µnì‹bˆÓÈS Ü}Äßu…ãLÁ„ÉÎÁvˆEXb#Á\ 0D %a 0ˆg U"Nï 2= 2o z¡ Ò Oí ^ <wH4LÆ`Æ&ÆìƲxN‡U @‰°ÉEyÁ{< m>ÂUù^énëW×B!B! %%S&&¿y(8)8)8)U+¸k,¸#-#-#-#-bÛ-jã-uM0M0ZÂ16@/:/:/:ão;·R<R<R<R<R<R<R<R<R<R<R<R<R< = = = = = = = = = = = = = 0ë==== Bü=ü= 0¤> D3½> D-ð> 0K?? ASh?Æ»? 0¤@ 0D%A A«iA˜HP LaserJet 8000 Series PSØÚØÚÚØØÚ0(#Ã$òòÚ  Ú0Ú  Úóó»(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regular (Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú4Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔTenn.€R.€Civ.€P.€52.01€exempts€summary€judgment€orders€from€the€requirement€that€decisions€beÐ ° Ðaccompanied€by€findings€of€facts€and€conclusions€of€law. (Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú21Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔSpecifically,€he€states€that€ð ðthe€delay€in€diagnosis€of€nine€days€following€the€first€surgery€was€excessiveÐ ° Ðconsidering€the€clinical€evidence.ðð ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt EÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú22Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔThe€statements€in€these€affidavits€are,€of€course,€probative€evidence€at€the€summary€judgment€stage.€€òòSeeÐ ° ÐWagner€v.€Department€of€Agric.óó,€28€F.3d€279,€283€(3d€Cir.€1994).€€×–)â ¡B )ê:i¢Ø+00Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 53|x(ÆúI Z‹(Times New Roman  ¦Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú6Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔOnly€four€depositions€were€included€in€the€appellate€record€filed€with€this€court.€€These€included€theÐ ° Ðdepostions€of€Drs.€Perales,€Dunbar,€and€Ross,€as€well€as€the€deposition€of€Dr.€Gary€J.€Wolf,€a€Lewisburg€surgeon,€whoÐ xÈ Ðwas€Ms.€Churchððs€expert€witness. ·Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú9Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔWe€have€already€determined€that€Dr.€Wolfððs€opinion€testimony€is€not€competent€evidence€on€Ms.€ChurchððsÐ ° Ðmedical€battery€claim.€€As€best€as€we€can€determine,€Ms.€Church€attempted€to€circumvent€the€signed€consent€forms€atÐ xÈ Ðher€deposition€by€impeaching€her€own€signature.€€Litigants€cannot€create€material€factual€disputes€by€merelyÐ @ Ðcontradicting€themselves€at€the€summary€judgment€stage.€€òòSee€Reid€v.€Sears,€Roebuck€&€Co.óó,€790€F.2d€at€460;€òòPriceÐ X Ðv.€Beckeróó,€812€S.W.2d€at€598.ÿU‹ÿÀÀÀ ¸Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú23Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔDr.€Dunbarððs€argument,€viewed€as€charitably€as€we€are€procedurally€permitted,€goes€essentially€to€the€weightÐ ° Ðof€Dr.€Wolfððs€testimony€that€he€is€familiar€with€the€applicable€standard€of€care.€€Of€course,€as€we€have€already€pointedÐ xÈ Ðout,€assessing€the€weight€of€the€evidence€is€not€one€of€the€courtððs€tasks€at€the€summary€judgment€stage.€€òòSee€Ô_ÔHilliardÔ_ÔÐ @ Ðv.€Tennessee€State€Home€Health€Ô_ÔServsÔ_Ô.,€Inc.óó,€950€S.W.2d€344,€345€(Tenn.€1997).€€€ ïÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú7Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔEvidence€regarding€a€medical€battery€would€normally€come€from€the€patient,€the€physician,€anyone€elseÐ ° Ðpresent€during€the€conversations€between€the€patient€and€the€physician,€as€well€as€any€documentary€evidence€regardingÐ xÈ Ðthese€conversations.€€Dr.€Wolfððs€recitation€of€the€portions€of€Ms.€Churchððs€deposition€he€relied€on€to€form€his€opinionÐ @ Ðregarding€her€physiciansðð€conduct€is€not€a€satisfactory€substitute€for€Ms.€Churchððs€deposition.€€Dr.€Wolf€had€no€firsthandÐ X  Ðknowledge€of€the€conversations€between€Ms.€Church€and€Dr.€Perales. TÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔMs.€Churchððs€evidence€suggests€that€her€small€intestine€was€perforated€during€the€March€22,€1995€procedureÐ ° Ðwhen€Dr.€Ô_ÔPeralesÔ_Ô€separated€it€from€the€vaginal€wall. ßÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú12Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔEven€Dr.€Wolf€opined€that€Dr.€Perales€was€not€negligent€when€she€perforated€the€small€intestine. áÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔMs.€Church€also€named€ð ðJohn€Doe,€M.D.ðð€as€a€defendant,€alleging€that€he€was€ð ðan€unknown€doctor€or€nurseÐ ° Ðwho€rendered€certain€medical€care€for€and€on€behalf€of€Dolly€N.€Church€at€the€time€of€the€matters€complained€of€hereinÐ xÈ  Ðin€Davidson€County.ðð€€The€complaint€contains€no€other€mention€of€this€party. ÍÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú8Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔDr.€Wolfððs€opinion€that€Dr.€Perales€deviated€from€the€standard€of€care€by€performing€an€unauthorizedÐ °  Ðoperation€is€expressly€based€on€Ms.€Churchððs€statements€in€her€deposition€that€she€ð ðdidnððt€want€nothing€done,€as€I€say,Ð ° Ðexcept€have€my€bladder€fixed€up.ðð€€We€note€that€Ms.€Church€has€not€collaterally€attacked€the€legal€validity€of€theÐ xÈ Ðconsent€forms€she€signed.€€She€has€done€little€more€than€change€her€own€story€about€whether€she€consented.€€LitigantsÐ @ Ðcannot€create€a€genuine€issue€of€fact€by€merely€gainsaying€themselves€at€summary€judgment€stage.€€òòSee€generallyóó€òòReidÐ X Ðv.€Sears,€Roebuck€&€Co.óó,€790€F.2d€453,€460€(6th€Cir.€1986);€òòPrice€v.€Beckeróó,€812€S.W.2d€597,€598€(Tenn.€Ct.€App.Ð Ð  Ð1991). Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú10Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔThis€account€is€corroborated€by€Dr.€Peralesððs€office€notes€of€her€March€2,€1995€consultation€with€Ms.Ð ° ÐChurch. IÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú5Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔEven€though€Ms.€Churchððs€complaint€alleges€that€Dr.€Perales€performed€ð ðunnecessaryðð€procedures€on€MarchÐ ° Ð22,€1995,€the€record€contains€no€evidence€that€any€of€the€procedures€Dr.€Perales€performed€were€not€medicallyÐ xÈ Ðwarranted.€€As€we€construe€Ms.€Churchððs€allegations,€she€is€asserting€that€she€ð ðjust€wanted€.€.€.€[her]€bladder€tied€upððÐ @ Ðand€that€she€did€not€consent€to€anything€else. µÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú14Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔThis€principle€is€now€embodied€in€T.P.I.€3„Civil€6.15. Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú17Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(b).€€The€Ô_ÔaffiantÔ_Ô€need€not€practice€in€the€same€specialty€as€the€defendantÐ ° Ðphysician.€€òòSee€Walker€v.€Bellóó,€828€S.W.2d€409,€411€(Tenn.€Ct.€App.€1991);€òòGoodman€Ô_Ôv.Ô_Ô€Ô_ÔPhythyonÔ_Ôóó,€803€S.W.2d€697,Ð xÈ Ð701„02€(Tenn.€Ct.€App.€1990). Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔMs.€Church€is€not€appealing€the€summary€judgment€dismissing€her€claims€against€Drs.€McElaney€andÐ ° ÐWomack€or€Southern€Hills. ®Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú18Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(a)(1). ®Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú19Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(a)(2).- ù- `Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú11Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔDr.€Wolf€was€unable€to€give€an€expert€opinion€regarding€the€informed€consent€issue€when€he€was€deposedÐ ° Ðon€February€25,€1997,€because€he€had€never€talked€with€Ms.€Church.€€However,€by€the€time€he€executed€his€affidavitÐ xÈ Ðfiled€with€the€trial€court€on€May€12,€1997,€he€had€read€Ms.€Churchððs€deposition€and€based€his€expert€opinion€regardingÐ @ Ðthe€informed€consent€issue€based€on€Ms.€Churchððs€statements€in€her€deposition. kÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú20Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(a)(3);€òòKilpatrick€v.€Bryantóó,€868€S.W.2d€594,€602€(Tenn.€1993)€(theÐ ° Ðplaintiff€must€demonstrate€that€the€defendantððs€negligence€more€likely€than€not€caused€the€injury). PÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú15Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔAbandonment€is€essentially€a€breach€of€a€physicianððs€duty€of€continuing€treatment.€€òòSee€King€v.€Fisheróó,€918Ð ° ÐS.W.2d€108,€111€(Tex.€App.€1996).€€It€involves€the€complete€termination€of€a€physician„patient€relationship,€sòòee€Ô_ÔHartsellÔ_ÔÐ xÈ Ðv.€Ft.€Sanders€Ô_ÔRegððlÔ_Ô€Med.€Ctr.óó,€905€S.W.2d€at€949,€and€it€occurs€when€a€physician,€without€justification,€terminates€hisÐ @ Ðor€her€professional€relationship€with€a€patient€at€an€unreasonable€time€or€without€affording€the€patient€an€appropriateÐ X Ðopportunity€to€retain€a€qualified€replacement.€€òòSee€Ô_ÔTavakoliÔ_Ô„Ô_ÔNouriÔ_Ô€Ô_Ôv.Ô_Ô€Ô_ÔGuntherÔ_Ôóó,€745€A.2d€939,€941€(D.C.€2000);€òòGlennÐ Ð  Ðv.€Ô_ÔCarlstromÔ_Ôóó,€556€N.W.2d€at€803.€€€€ Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú24Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔSpecifically,€Dr.€Wolf€stated:€ð ðBut€what€we€have€here€is€a€lot€of€little€violations€that€tended€to€delay€theÐ ° Ðdiagnosis€up€until€the€point€whereby€the€29th€when,€as€I€said€before,€the€drop€dead€point€where€she€should€have€goneÐ xÈ Ðto€surgery€.€.€..ðð€€Later,€he€explained€that€ð ðPrior€to€[March€29th],€rather€than€[alarm]€bells€and€whistles€[going€off],€littleÐ @ Ðbirds€may€have€chirped€around.€€There€were€definitely€things€going€on€in€the€post„operative€course€that€should€haveÐ X Ðmade€them€[Drs.€Ô_ÔPeralesÔ_Ô€and€Dunbar]€aware.ðð€€Dr.€Wolf€also€described€these€ð ðviolationsðð€as€occurring€along€ð ða€bell„Ð Ð  Ðshaped€curveðð€and€stated€that€by€March€29,€1995,€the€physicians€were€ð ðoutside€that€curve€.€.€.€[or]€already€on€the€fringesÐ ˜è Ðprior€to€that.ðð 6Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú13Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSee€White€v.€Lawrenceóó,€975€S.W.2d€at€529;€òòBain€v.€Wellsóó,€936€S.W.2d€618,€624€(Tenn.€1997);€òòGeorge€v.Ð ° ÐAlexanderóó,€931€S.W.2d€517,€520€(Tenn.€1996). ÙÝ ƒR‘L$ÝÓ  Óà  àòòÚ  Ú25Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSouthern€Motors,€Inc.€v.€Mortonóó,€25€Tenn.€App.€204.€209,€154€S.W.2d€801,€804€(1941). ­Ý ƒR‘L$ÝÓ  Óà  àòòÚ  Ú16Ú  ÚóóÔ€ô4 ò»»ÔÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(b).€€ (|G2‘L$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€G»»d d 8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ô4Àò»»Ô d(|3Mõ$££Ý ƒ£ª!ÝÑ€.ÑÑ8€G»»d d 8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3Mõ$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€G»»d d 8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€H,»»d dÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÔ‡»Ûž»»»ÔÑ8°ÑÔ€¼Ûž»»»ÛžÔÑ8€)üXXdê»»d 8ÑÑ  ÑÑ  Ñà@ü ü ìàÔ‡îYx۞ÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#†¼Ûž»îîYx9#ԈРÖ& Ðà@,,!ìàMarch€1998€SessionˆÐ üL ÐÔ‡XµX»¼ÛžÔÌò òÔ#†¼Ûž»XXµ##ÔÓ  ÓDOLLY€N.€CHURCH€v.€MARIA€Ô_ÔPERALESÔ_Ô,€M.D.,€òòet€alóó.Ô‡XµX»¼ÛžÔó óÐ úJ ÐÓiÓÌà@6 6 ìàò òAppeal€from€the€Circuit€Court€for€Davidson€CountyˆÐ ú J Ðà@‰ ‰ ìàNo.€96„C„1097€€€€€€Barbara€N.€Haynes,€JudgeˆÐ æ 6 ÐÌÌà@ìì*ìàßA€V) °°` d€÷E<©` A߈Ð ªú  ÐÌà@Ç Ç ìàNo.€M1997„00227„Ô_ÔCOAÔ_Ô„R3„CV€„€Filed€August€22,€2000ˆÐ ¥õ  ÐÌßA€V) °°` dE<|` AßÐ }Í  Ðó óÌÌThis€appeal€involves€a€dispute€between€an€elderly€patient€and€her€physicians€regarding€theirÐ d´ Ðtreatment€of€a€severe€post„operative€infection€caused€by€a€bowel€perforation€that€occurred€duringÐ P  Ðgynecological€surgery.€€The€patient€filed€suit€in€the€Circuit€Court€for€Davidson€County€against€fiveÐ <Œ Ðphysicians€and€a€hospital€alleging€medical€battery€and€malpractice.€€The€trial€court€granted€aÐ (x Ðsummary€judgment€to€the€physicians€and€the€hospital€and€dismissed€the€patientððs€case.€€On€thisÐ d Ðappeal,€the€patient€takes€issue€with€the€summary€judgment€granted€to€her€gynecologist,€a€consultingÐ P Ðgeneral€surgeon,€and€the€gynecologist€attending€her€following€surgery€in€her€gynecologistððs€absence.€Ð ì< ÐWe€have€determined€that€the€trial€court€properly€dismissed€the€patientððs€medical€battery€andÐ Ø( Ðinformed€consent€claims€against€her€gynecologist.€€However,€we€have€also€determined€that€the€threeÐ Ä Ðphysicians€have€not€demonstrated€that€they€are€entitled€to€a€judgment€as€matter€of€law€on€theÐ ° Ðpatientððs€medical€malpractice€claim€based€on€the€delay€in€diagnosing€and€treating€the€bowelÐ œì Ðperforation.Ð ˆØ ÐÌò òÓ  Óà@@,,ìàTenn.€R.€App.€P.€3€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Affirmed€in€Part;€à@@ˆˆìàà@ @ àÐ `° ÐVacated€in€Part;€and€Remandedó óÐ L œ ÐÓ4 ÓÌòòÔ#†¼Ûž»àXµÉ#ÔÔ‡XµX.¼ÛžÔWilliam€C.€Koch,€Jr.,€óóJ.,€delivered€the€opinion€of€the€court,€in€which€òòHenry€F.€Todd,€Ô_ÔP.J.Ô_Ô,€M.S.,óóÐ $"t! Ðand€òòBen€H.€Ô_ÔCantrellÔ_Ô€J.óó,€joined.Ð #`" ÐÌBarbara€G.€Medley,€Ô_ÔLewisburgÔ_Ô,€Tennessee,€for€the€appellant,€Dolly€N.€Church.Ð è$8 $ ÐÌNoel€F.€Ô_ÔStahlÔ_Ô,€Nashville,€Tennessee,€for€the€appellee,€Maria€Ô_ÔPeralesÔ_Ô.Ð À&"& ÐÌDixie€W.€Cooper€and€Shirley€A.€Irwin,€Nashville,€Tennessee,€for€the€appellee,€Laura€Dunbar.Ð ˜(è#( ÐÌEd€R.€Davies€and€E.€Reynolds€Davies,€Jr.,€Nashville,€Tennessee,€for€the€appellee,€Stephen€J.€Ross.Ð p*À%* ÐÌÌÌà@66'ìàò òOPINIONó óÔ#†¼Ûž»XXµF #ԈР .p).ý ЇÔ€XµX»¼ÛžÔà  àDolly€N.€Church,€a€Ô_ÔLewisburgÔ_Ô€resident€in€her€mid„seventies,€had€experienced€problems€with€Ð ° Ðurinary€incontinence€and€vaginal€prolapse€for€several€years.€€She€had€a€partial€hysterectomy€in€1990Ð œì Ðto€address€the€prolapse€problem,€but€the€procedure€was€not€successful.€€In€December€1993,€sheÐ ˆØ Ðconsulted€Dr.€Maria€Ô_ÔPeralesÔ_Ô,€a€Nashville€gynecologist,€about€these€conditions.€Dr.€Ô_ÔPeralesÔ_Ô€examinedÐ tÄ ÐMs.€Church,€and,€in€addition€to€a€grade€three€vaginal€prolapse,€she€discovered€a€large€Ô_ÔcystoceleÔ_ÔÐ `° Ðprotruding€out€of€Ms.€Churchððs€vaginal€wall€as€well€as€a€Ô_ÔrectoceleÔ_Ô€in€the€posterior€vaginal€wall.€€Dr.Ð L œ ÐÔ_ÔPeralesÔ_Ô€advised€Ms.€Church€that€her€treatment€options€included€surgery€or€a€more€conservative,€non„Ð 8 ˆ Ðsurgical€management€of€her€condition.€€Ms.€Church€opted€for€the€non„surgical€option.€€However,€inÐ $ t ÐNovember€1994,€Ms.€Church€returned€to€Dr.€Ô_ÔPeralesÔ_Ô€to€request€surgery.Ð  ` ÐÌà  àDr.€Ô_ÔPeralesÔ_Ô€had€been€inclined€initially€to€perform€the€procedures€Ô_ÔlaparoscopicallyÔ_Ô.€€However,Ð è 8  Ðduring€her€pre„surgical€consultation€with€Ms.€Church€and€Ms.€Churchððs€daughter€on€March€2,€1995,Ð Ô$  Ðshe€discovered€extensive€Ô_ÔhypermobilityÔ_Ô€of€Ms.€Churchððs€urethra€along€with€the€other€conditions€sheÐ À  Ðhad€already€observed.€€In€addition,€Ms.€Church€disclosed€for€the€first€time€that€she€did€not€wish€toÐ ¬ü  Ðreceive€any€blood€or€blood€products€during€surgery€because€she€was€a€Jehovahððs€Witness.€€In€viewÐ ˜è  Ðof€Ms.€Churchððs€religious€beliefs€and€the€danger€of€blood€vessel€compromise€during€Ô_ÔlaparoscopicÔ_ÔÐ „Ô  Ðsurgery,€Dr.€Ô_ÔPeralesÔ_Ô€decided€to€perform€a€more€traditional€exploratory€laparotomy.€€While€explainingÐ pÀ Ðthe€proposed€procedure€to€Ms.€Church,€Dr.€Ô_ÔPeralesÔ_Ô€discussed€the€possible€removal€of€Ms.€ChurchððsÐ \¬ Ðfallopian€tubes€and€ovaries,€as€well€as€the€potential€risks€and€complications€of€the€surgery,€includingÐ H˜ Ðinfection€and€bleeding.€Following€this€discussion,€Ms.€Church€consented€to€the€surgery.Ð 4„ ÐÌà  àMs.€Church€was€admitted€to€Southern€Hills€Medical€Center€in€Nashville€on€March€8,€1995Ð  \ Ðfor€her€surgery.€€However,€the€surgery€was€postponed€because€of€an€unexpected€complication€thatÐ øH Ðcould€have€interfered€with€her€anesthesia.€€She€was€re„admitted€to€Southern€Hills€on€March€22,€1995.€Ð ä4 ÐBefore€the€surgery,€she€executed€a€consent€form€acknowledging€that€the€operationððs€risks€had€beenÐ Ð  Ðdisclosed€to€her€and€specifically€authorizing€Dr.€Ô_ÔPeralesÔ_Ô,€and€any€surgeons€she€might€associate,€toÐ ¼  Ðperform€the€exploratory€laparotomy,€a€bilateral€Ô_ÔsalpingoÔ_Ô€Ô_ÔoophorectomyÔ_Ô€(removal€of€her€ovaries€andÐ ¨ø Ðfallopian€tubes),€a€bladder€suspension,€and€anterior€and€posterior€vaginal€repair.€€She€also€authorizedÐ ”ä ÐDr.€Ô_ÔPeralesÔ_Ô€ð ðto€do€whatever€.€.€.€she€deems€advisableðð€if€she€or€the€other€physicians€encounteredÐ €Ð Ðð ðunforseen€conditions€.€.€.€in€the€course€of€the€operation€calling€.€.€.€for€procedures€in€addition€to€orÐ l¼ Ðdifferent€from€[the€ones€specifically€listed].ððÐ X ¨ ÐÌà  àUnforeseen€complications€did€arise€during€Ms.€Churchððs€surgery.€€While€performing€theÐ 0"€  Ðvaginal€vault€suspension,€Dr.€Ô_ÔPeralesÔ_Ô€discovered€that€a€portion€of€Ms.€Churchððs€bowel€was€adheringÐ #l! Ðto€the€vaginal€wall.€€Correcting€this€condition€required€Dr.€Ô_ÔPeralesÔ_Ô€to€cut€a€small€loop€of€the€bowelÐ $X" Ðaway€from€the€upper€portion€of€the€vaginal€wall.€€Dr.€Ô_ÔPeralesÔ_Ô€also€discovered€a€suspicious€mass€thatÐ ô$D # Ðhad€involved€the€left€ovary€and€accordingly€removed€Ms.€Churchððs€ovaries,€uterine€tubes,€and€relatedÐ à%0!$ Ðligaments.€After€removing€the€left€ovary,€Dr.€Ô_ÔPeralesÔ_Ô€noted€hardening€and€hypertrophy€in€a€portionÐ Ì&"% Ðof€Ms.€Churchððs€sigmoid€colon.€€Suspecting€malignancy,€Dr.€Ô_ÔPeralesÔ_Ô€summoned€Dr.€Laura€Dunbar,Ð ¸'#& Ða€general€surgeon,€to€the€operating€room€for€a€consultation.€€Dr.€Dunbar€performed€a€limited€rigidÐ ¤(ô#' ÐÔ_ÔsigmoidoscopyÔ_Ô€but€was€unable€to€examine€the€abnormal€bowel€section€itself€because€Ms.€ChurchÐ )à$( Ðhad€not€been€prepped€for€a€bowel€procedure.€€Following€these€procedures,€Ms.€Churchððs€incision€wasÐ |*Ì%) Ðclosed,€and€she€was€transferred€to€the€recovery€room.Ð h+¸&* ÐÐ T,¤'+ Ðà  àMs.€Churchððs€post„operative€recovery€did€not€go€well.€€She€experienced€Ô_ÔpreternatualÔ_ÔÐ ° Ðabdominal€pain€and€nausea;€her€urinary€output€decreased;€and€she€developed€a€persistent€fever.€€Dr.Ð œì ÐÔ_ÔPeralesÔ_Ô€performed€ultrasound€and€blood€tests€to€determine€the€cause€of€Ms.€Churchððs€difficulties.€Ð ˆØ ÐOn€March€24,€1995,€Dr.€Ô_ÔPeralesÔ_Ô€consulted€with€Dr.€Dunbar,€and€the€two€physicians€decided€to€giveÐ tÄ ÐMs.€Church€additional€fluids€and€to€continue€to€monitor€her€kidney€function.€€Three€days€later,€onÐ `° ÐMarch€27,€1995,€after€Ms.€Church€did€not€improve,€Dr.€Ô_ÔPeralesÔ_Ô€consulted€Dr.€Clara€Womack,€aÐ L œ ÐÔ_ÔnephrologistÔ_Ô.€€Dr.€Womack€examined€Ms.€Church,€ordered€a€CT€scan€to€verify€that€she€had€bothÐ 8 ˆ Ðkidneys,€and€then€recommended€continuing€the€regimen€of€managing€Ms.€Churchððs€fluid€intake.Ð $ t ÐÌà  àMs.€Churchððs€condition€continued€to€worsen,€and€she€began€to€experience€shortness€ofÐ ü L  Ðbreath.€€On€March€29,€1995,€seven€days€after€surgery,€Dr.€Ô_ÔPeralesÔ_Ô€brought€in€Dr.€Mary€Ô_ÔMcElaneyÔ_ÔÐ è 8  Ðwho€concluded€that€Ms.€Church€was€ð ðin€mild€distressðð€and€was€suffering€from€low€oxygen€in€herÐ Ô$  Ðblood.€€An€X„ray€was€taken€to€rule€out€the€possibility€of€a€blood€clot.€€Dr.€Ô_ÔPeralesÔ_Ô€left€Nashville€onÐ À  ÐMarch€29,€1995,€to€attend€a€conference€in€Arizona,€leaving€her€patients,€including€Ms.€Church,€inÐ ¬ü  Ðthe€care€of€Dr.€Steven€Ross,€a€gynecologist.€€Ð ˜è  ÐÌà  àMs.€Churchððs€condition€continued€to€deteriorate,€and€on€March€29,€1995,€Dr.€Ô_ÔMcElaneyÔ_ÔÐ pÀ Ðapproved€transferring€her€to€the€Southern€Hills€intensive€care€unit€where€she€was€promptly€placedÐ \¬ Ðon€life€support.€€Dr.€Ô_ÔMcElaneyÔ_Ô€advised€Ms.€Churchððs€family€that€her€condition€was€serious.€€Dr.€RossÐ H˜ Ðexamined€Ms.€Church€in€the€intensive€care€unit€and€ordered€additional€tests,€including€a€second€CTÐ 4„ Ðscan€on€March€29,€1995€which€confirmed€the€presence€of€free€air€in€Ms.€Churchððs€abdomen.€€ByÐ  p ÐMarch€30,€1995,€with€Ms.€Churchððs€blood€pressure€dropping€and€her€abdomen€palpably€tight,€Dr.Ð  \ ÐÔ_ÔMcElaneyÔ_Ô€began€to€suspect€sepsis€(blood€poisoning).€€Dr.€Dunbar€suspected€acute€pancreatitis.Ð øH ÐÌà  àOn€March€31,€1995,€Ms.€Church€was€returned€to€surgery€for€a€second€exploratory€laparotomyÐ Ð  Ðperformed€by€Drs.€Dunbar€and€Ross.€€The€operation€revealed€that€Ms.€Church€had€a€perforated€bowelÐ ¼  Ðthat€had€caused€a€severe€infection€in€her€abdominal€cavity.Ô_Ô׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×Ô_Ô€€The€physicians€repaired€the€perforationÐ ¨ø Ðand€drained€what€Dr.€Dunbar€characterized€as€ð ða€large€amountðð€of€pus€from€Ms.€Churchððs€abdomen.€Ð ”ä ÐFollowing€this€procedure,€Ms.€Church€was€returned€to€intensive€care€where€she€remained€in€seriousÐ €Ð Ðcondition€for€weeks.€€She€was€connected€to€a€ventilator€and€required€pulmonary€artery€catheterÐ l¼ Ðmonitoring,€as€well€as€total€Ô_ÔparenteralÔ_Ô€administration€of€food€and€water.€€Ms.€Church€was€notÐ X ¨ Ðremoved€from€life€support€until€May€26,€1995.€€Thereafter,€on€June€22,€1995,€three€months€after€herÐ D!” Ðadmission€to€Southern€Hills,€Ms.€Church€was€transferred€to€a€nursing€home€in€Ô_ÔLewisburgÔ_Ô.Ð 0"€  ÐÌà  àOn€March€21,€1996,€Ms.€Church€filed€suit€in€the€Circuit€Court€for€Davidson€County€againstÐ $X" ÐDrs.€Ô_ÔPeralesÔ_Ô,€Dunbar,€Ross,€Ô_ÔMcElaneyÔ_Ô,€and€Womack€and€Ô_ÔHCAÔ_Ô€Health€Services€of€Tennessee,€Inc.,Ð ô$D # Ðd/b/a€Southern€Hills€Medical€Center,׃ ×Ý ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€alleging€medical€battery€and€medical€malpractice.€€AllÐ à%0!$ ÐÔ_Ôdefendants€filed€answers€denying€liability.€€In€August€1996,€the€trial€court€granted€summaryÐ ° Ðjudgment€to€HCA€and€Doctors€Womack€and€McElaney.€€Subsequently€Drs.€Perales,€Dunbar,€andÐ œì ÐRoss€moved€for€summary€judgment.€€In€May€1997,€the€trial€court€granted€those€defendants€summaryÐ ˆØ Ðjudgment.€€Completely€out€of€court€on€her€lawsuit€at€that€point,€Ms.€Church€appealed€from€theÐ tÄ Ðsummary€judgment€granted€to€Drs.€Perales,€Ross,€and€Dunbar.׃( ×Ý ƒ#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×Ð `° ÐÌà@¬¬)ìàò òI.ó óˆÐ 8 ˆ ÐÌà  àSummary€judgments€enable€courts€to€conclude€cases€that€can€and€should€be€resolved€onÐ  ` Ðdispositive€legal€issues.€€òòSeeóó€òòByrd€v.€Hallóó,€847€S.W.2d€208,€210€(Tenn.€1993);€òòAirport€Props.€Ltd.Ð ü L  Ðv.€Gulf€Coast€Dev.,€Inc.óó,€900€S.W.2d€695,€697€(Tenn.€Ct.€App.€1995).€€They€are€appropriate€onlyÐ è 8  Ðwhen€the€facts€material€to€the€dispositive€legal€issues€are€undisputed.€€Accordingly,€they€should€notÐ Ô$  Ðbe€used€to€resolve€factual€disputes€or€to€determine€the€factual€inferences€that€should€be€drawn€fromÐ À  Ðthe€evidence€when€those€inferences€are€in€dispute.€€òòSeeóó€òòBellamy€v.€Federal€Express€Corp.óó,€749Ð ¬ü  ÐS.W.2d€31,€33€(Tenn.€1988).Ð ˜è  ÐÌà  àMedical€malpractice€cases€may€be€adjudicated€by€summary€judgment€in€properÐ pÀ Ðcircumstances.€€òòSeeóó,€òòe.g.óó,€òòDonnelly€v.€Walteróó,€959€S.W.2d€166,€168€(Tenn.€Ct.€App.€1997);€òòEstateÐ \¬ Ðof€Henderson€v.€Mireóó,€955€S.W.2d€56,€59„60€(Tenn.€Ct.€App.€1997).€€In€order€to€be€entitled€to€aÐ H˜ Ðsummary€judgment,€the€moving€party€must€demonstrate€that€no€genuine€issues€of€material€fact€existÐ 4„ Ðand€that€he€or€she€is€entitled€to€judgment€as€a€matter€of€law.€€òòSeeóó€Tenn.€R.€Civ.€P.€56.04;€òòByrd€v.Ð  p ÐHallóó,€847€S.W.2d€at€210;€òòPlanet€Rock,€Inc.€v.€Regis€Ins.€Co.óó,€6€S.W.3d€484,€490€(Tenn.€Ct.€App.Ð  \ Ð1999).€€A€summary€judgment€should€be€denied,€however,€when€a€genuine€dispute€exists€with€regardÐ øH Ðto€any€material€fact,€òòsee,€e.g.,€Seavers€v.€Methodist€Med.€Ctr.óó,€9€S.W.3d€86,€97€(Tenn.€1999)Ð ä4 Ð(reversing€a€summary€judgment€in€a€medical€malpractice€action€because€of€the€existence€of€a€genuineÐ Ð  Ðissue€of€material€fact),€€or€when€the€controlling€law€does€not€clearly€entitle€the€moving€side€to€eitherÐ ¼  Ðescape€or€impose€liability.€€òòSeeóó€òòHogins€v.€Rossóó,€988€S.W.2d€685,€689€(Tenn.€Ct.€App.€1998)Ð ¨ø Ð(reversing€a€summary€judgment€where€the€law€did€not€support€the€moving€party).€€òòóóÐ ”ä ÐÌà  àOur€task€on€appeal€is€to€review€the€record€to€determine€whether€the€requirements€for€grantingÐ l¼ Ðsummary€judgment€have€been€met.€€òòSee€Hunter€v.€Brownóó,€955€S.W.2d€49,€50„51€(Tenn.€1997);Ð X ¨ ÐòòAghili€v.€Saadatnejadióó,€958€S.W.2d€784,€787€(Tenn.€Ct.€App.€1997).€€Summary€judgments€do€notÐ D!” Ðenjoy€a€presumption€of€correctness€on€appeal.€€òòSee€Nelson€v.€Martinóó,€958€S.W.2d€643,€646€(Tenn.Ð 0"€  Ð1997);€òòCity€of€Tullahoma€v.€Bedford€Countyóó,€938€S.W.2d€408,€412€(Tenn.€1997).€€€€òòóóAccordingly,Ð #l! Ðwhen€we€review€a€summary€judgment,€we€view€all€the€evidence€in€the€light€most€favorable€to€theÐ $X" Ðnon„movant,€and€we€resolve€all€factual€inferences€in€the€non„movantððs€favor.€€òòSee€Luther€v.Ð ô$D # ÐComptonóó,€5€S.W.3d€635,€639€(Tenn.€1999);€òòMuhlheim€v.€Knox€County€Bd.€of€Educ.óó,€2€S.W.3d€927,Ð à%0!$ Ð929€(Tenn.€1999).€€A€summary€judgment€will€be€upheld€only€when€the€undisputed€facts€reasonablyÐ Ì&"% Ðsupport€one€conclusion€ð!ð€that€the€moving€party€is€entitled€to€a€judgment€as€a€matter€of€law.€€òòSeeÐ ° ÐWhite€v.€Lawrenceóó,€975€S.W.2d€525,€529„30€(Tenn.€1998);€òòMcCall€v.€Wilderóó,€913€S.W.2d€150,€153Ð œì Ð(Tenn.€1995)òòóó.€€€Ð ˆØ ÐÌà  àThe€record€before€us€does€not€reveal€the€basis€for€the€trial€courtððs€decision€to€grant€theÐ `° Ðsummary€judgment€motions€filed€by€Drs.€Perales,€Dunbar,€and€Ross.€€The€order€dismissing€theÐ L œ Ðclaims€against€these€physicians€simply€states€that€their€motions€ð ðwere€well„taken€and€should€beÐ 8 ˆ Ðgranted.ðð€€This€order,€while€technically€consistent€with€Tenn.€R.€Civ.€P.€52.01,׃×Ý ƒ#ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€provides€littleÐ $ t Ðpractical€assistance€to€the€parties€or€the€court€on€this€appeal.€€In€complicated€cases€involving€multipleÐ  ` Ðparties,€multiple€claims,€and€multiple€defenses,€a€reviewing€court€may€find€itself€at€a€loss€to€decipherÐ ü L  Ðthe€actual€basis€for€the€trial€courtððs€decision.€€When€this€occurs,€we€have€little€choice€other€than€toÐ è 8  Ðð ðperform€the€equivalent€of€an€archeological€dig€and€endeavor€to€reconstruct€the€probable€basis€forÐ Ô$  Ðthe€[trial]€courtððs€decision.ðð€òòCamilo„Robles€v.€Hoyosóó,€151€F.3d€1,€8€(1st€Cir.€1998).€€Accordingly,Ð À  Ðtrial€courts€can€assist€appellate€review€in€complicated€cases€by€disclosing€clearly€and€briefly€theÐ ¬ü  Ðfactual€and€legal€basis€for€their€decisions.€€òòSeeóó€òòThomas€v.€N.A.€Chase€Manhattan€Bankóó,€994€F.2dÐ ˜è  Ð236,€241€n.6€(5th€Cir.€1993);€òòUnited€States€v.€Woodsóó,€885€F.2d€352,€353„54€(6th€Cir.€1989);€òòLandauÐ „Ô  Ðv.€J.D.€Barter€Const.€Co.,€Inc.óó,€657€F.2d€158,€162€(7th€Cir.€1981);€òòVan€Bourg,€Allen,€Weinbert€&Ð pÀ ÐRoger€v.€NLRBóó,€656€F.2d€1356,€1357€(9th€Cir.€1981).Ð \¬ ÐÌà  àApart€from€the€straightforward€cases€involving€a€single€issue€such€as€the€application€of€theÐ 4„ Ðstatute€of€limitations,€medical€malpractice€cases€customarily€involve€issues€and€questions€that€wouldÐ  p Ðbe€greatly€illumined€by€the€trial€courtððs€explanation€of€its€decision.€€The€evidentiary€standardsÐ  \ Ðuniquely€applicable€to€medical€malpractice€cases€ordinarily€give€rise€to€subtle€and€complexÐ øH Ðevidentiary€questions€for€which€some€elucidation€of€the€exact€reasons€for€ending€a€case€summarilyÐ ä4 Ðwill€almost€always€be€helpful.€€In€this€case,€we€are€left€to€soldier€on€without€guidance€from€the€trialÐ Ð  Ðcourt.Ð ¼  ÐÌà@……)ìàò òII.ó óˆÐ ”ä Ðà@ìàòòò òThe€Claims€Against€Dr.€Peralesó óóóˆÐ €Ð ÐÌà  àWe€turn€first€to€the€summary€judgment€dismissing€Ms.€Churchððs€claims€against€Dr.€Perales.€Ð X ¨ ÐMs.€Churchððs€complaint€alleges€three€causes€of€action€against€Dr.€Perales.€€First,€Ms.€Church€allegesÐ D!” Ðthat€Dr.€Perales€committed€medical€battery€by€performing€surgery€that€she€had€not€authorized.€Ð 0"€  ÐSecond,€she€alleges€that€Dr.€Perales€did€not€properly€obtain€her€informed€consent€to€all€theÐ #l! Ðprocedures€that€were€performed€on€March€22,€1995.€€Third,€she€alleges€that€Dr.€Perales€negligentlyÐ $X" Ðmanaged€her€post„operative€recovery€by€failing€to€diagnose€and€treat€her€bowel€perforation€in€aÐ ô$D # Ðtimely€manner.€€We€have€determined€that€the€trial€court€properly€granted€the€summary€judgment€withÐ à%0!$ Ðregard€to€Ms.€Churchððs€medical€battery€and€informed€consent€claims.€€However,€we€have€alsoÐ Ì&"% Ðdetermined€that€material€factual€disputes€preclude€the€summary€dismissal€of€Ms.€ChurchððsÐ ¸'#& Ðmalpractice€claim€based€on€Dr.€Peralesððs€management€of€Ms.€Churchððs€post„operative€care.Ð ¤(ô#' ÐÐ )à$( Ðà@‹‹)ìàò òA.ó óˆÐ ° Ðà@I I ìàòòò òThe€Medical€Battery€and€Informed€Consent€Claimsó óóóˆÐ œì ÐÌà  àMs.€Churchððs€complaint€alleges€that€Dr.€Perales€ð ðfell€below€the€acceptable€standard€ofÐ tÄ Ðmedical€care€in€this€.€.€.€communityðð€by€ð ðperforming€unnecessary€abdominal€exploration€after€beingÐ `° Ðevaluated€and€admitted€for€only€urinary€incontinence€and€vaginal€prolapseðð€and€by€ð ðfailing€to€obtainÐ L œ Ðher€informed€consent€to€the€procedure€and€treatment.ðð€€We€have€determined€that€these€allegationsÐ 8 ˆ Ðembody€two€related,€yet€separate,€claims.€€The€first€claim€is€for€medical€battery;€the€second€claimÐ $ t Ðis€for€failing€to€obtain€informed€consent.׃#×Ý ƒ#ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€€Dr.€Perales€has€demonstrated€that€she€is€entitled€to€aÐ  ` Ðjudgment€dismissing€these€claims€as€a€matter€of€law.Ð ü L  ÐÌà@¡¡)ìàò ò1.ó óˆÐ Ô$  Ðà@““ìàòòò òA€Patientððs€Bodily€Integrityó óóóˆÐ À  ÐÌà  àAll€competent€adults€have€a€fundamental€right€to€bodily€integrity.€€òòSee€Washington€v.Ð ˜è  ÐGlucksbergóó,€521€U.S.€702,€720,€117€S.€Ct.€2258,€2267€(1997);€òòHezeau€v.€Pendleton€Methodist€Mem.Ð „Ô  ÐHosp.óó,€715€So.€2d€756,€760€(La.€Ct.€App.€1998);€òòMahan€v.€Bethesda€Hosp.,€Inc.óó,€617€N.E.2d€714,Ð pÀ Ð718€(Ohio€Ct.€App.€1992);€òòShellenbarger€v.€Brigmanóó,€3€P.3d€211,€216€(Wash.€Ct.€App.€2000).€ThisÐ \¬ Ðright€is€rooted€in€the€Anglo„American€tradition€of€personal€autonomy€and€the€right€of€self„Ð H˜ Ðdetermination.€€òòSee€Thor€v.€Superior€Courtóó,€855€P.2d€375,€380€(Cal.€1993);òò€In€re€Gardneróó,€534€A.2dÐ 4„ Ð947,€950€(Me.€1987);€òòBrophy€v.€New€England€Sinai€Hosp.,€Inc.óó,€497€N.E.2d€626,€633€(Mass.€1986).Ð  p ÐIncluded€in€this€right€is€the€right€of€competent€adult€patients€to€accept€or€reject€medical€treatment.€Ð  \ ÐòòSee€Cruzan€v.€Director,€Missouri€Depððt€of€Healthóó,€497€U.S.€261,€278„79,€110€S.€Ct.€2841,€2851„52Ð øH Ð(1990).Ð ä4 ÐÌà  àBased€on€their€recognition€of€a€patientððs€bodily€integrity,€the€courts€have€recognized€thatÐ ¼  Ðpatients€may€recover€damages€from€physicians€who€perform€non„emergency€medical€proceduresÐ ¨ø Ðwithout€their€consent.€€There€are€four€premises€underlying€these€claims.€€The€first€is€that€the€decisionÐ ”ä Ðto€undergo€a€medical€procedure€rests€with€the€patient€who,€if€competent,€retains€the€right€to€exerciseÐ €Ð Ðcontrol€over€his€or€her€own€body.€€The€second€is€that€a€physician€has€no€right€to€subject€a€competentÐ l¼ Ðpatient€to€a€medical€procedure€without€the€patientððs€consent.€€The€third€is€that€a€patient€willÐ X ¨ Ðordinarily€be€unable€to€make€an€intelligent€decision€whether€to€consent€to€a€procedure€without€a€clearÐ D!” Ðand€adequate€explanation€by€the€physician€of€the€nature,€benefits,€and€risks€of€the€contemplatedÐ 0"€  Ðprocedure€and€of€the€other€treatment€alternatives€available€to€the€patient.€€Following€up€on€the€thirdÐ #l! Ðpremise,€the€fourth€is€that€physicians€have€a€duty,€before€performing€a€procedure,€to€provide€anÐ $X" Ðadequate€explanation€and€to€obtain€the€patientððs€consent.€€òòSee€Dingle€v.€Belinóó,€749€A.2d€157,€165Ð ô$D # Ð(Md.€2000).Ð à%0!$ Ðâ âÐ Ì&"% Ðà  àThe€Tennessee€Supreme€Court€has€recognized€that,€depending€on€the€circumstances,€twoÐ ° Ðâ âcauses€of€action€may€arise€when€a€physician€performs€a€procedure€without€the€patientððs€consent.€€TheÐ œì Ðfirst€cause€of€action€is€one€for€medical€battery;€the€second€is€one€for€failing€to€obtain€the€patientððsÐ ˆØ Ðinformed€consent.€€òòSee€Blanchard€v.€Kellumóó,€975€S.W.2d€522,€524€(Tenn.€1998).€€While€these€causesÐ tÄ Ðof€action€share€a€common€ancestry,€the€differences€between€them€are€more€than€academic.Ð `° ÐÌà  àA€medical€battery€occurs€when€a€physician€performs€an€unauthorized€procedure.€€Typically,Ð 8 ˆ Ða€medical€battery€involves€a€physician€performing€a€procedure€that€the€patient€did€not€know€theÐ $ t Ðphysician€was€going€to€perform€or€a€physician€performing€a€procedure€on€a€part€of€the€body€otherÐ  ` Ðthan€the€one€described€to€the€patient.€€òòSee€Ashe€v.€Radiation€Oncology€Assocs.óó,€9€S.W.3d€119,€121Ð ü L  Ð(Tenn.€1999).€€The€controlling€factual€issues€in€these€cases€are€whether€the€patient€knew€theÐ è 8  Ðphysician€was€going€to€perform€the€procedure€and€whether€the€patient€authorized€the€physician€toÐ Ô$  Ðperform€it.€€According€to€the€Tennessee€Supreme€Court,€if€the€answer€to€either€of€these€questionsÐ À  Ðis€no,€a€medical€battery€has€been€committed.€€òòSee€Blanchard€v.€Kellumóó,€975€S.W.2d€at€524.€€BecauseÐ ¬ü  Ðthe€answers€to€these€questions€focus€on€the€patientððs€knowledge€and€awareness,€patients€pursuingÐ ˜è  Ða€medical€battery€claim€need€not€present€expert€evidence€to€support€their€claim.€€òòSee€Blanchard€v.Ð „Ô  ÐKellumóó,€975€S.W.2d€at€524.€Ð pÀ ÐÌà  àIn€contrast,€a€lack€of€informed€consent€violation€occurs€when€the€patient€is€aware€that€aÐ H˜ Ðprocedure€is€going€to€be€performed€but€is€unaware€of€the€potential€risks€associated€with€theÐ 4„ Ðprocedure.€€òòSee€Ashe€v.€Radiation€Oncology€Assocs.óó,€9€S.W.3d€at€121;€òòBlanchard€v.€Kellumóó,€975Ð  p ÐS.W.2d€at€524.€€The€tort€does€not€relate€to€the€manner€in€which€the€procedure€was€performed,€butÐ  \ Ðrather€to€the€manner€in€which€the€physician€obtained€the€patientððs€consent€to€perform€the€procedure.€Ð øH ÐòòSee€German€v.€Nichopoulosóó,€577€S.W.2d€197,€202€(Tenn.€Ct.€App.€1978),€òòrevððd€on€other€groundsóó,Ð ä4 ÐòòSeavers€v.€Methodist€Med.€Ctr.óó,€9€S.W.3d€86€(Tenn.€1999).€€These€claims€are€part€of€the€medicalÐ Ð  Ðmalpractice€statutes.€€òòSeeóó€Tenn.€Code€Ann.€ðð€29„26„118€(1980).€€Accordingly,€patients€seekingÐ ¼  Ðdamages€for€lack€of€informed€consent€must€prove€that€the€physicianððs€conduct€fell€below€theÐ ¨ø Ðapplicable€standard€of€care€and€that€reasonably€prudent€persons€in€the€patientððs€position€would€notÐ ”ä Ðhave€consented€to€the€procedure€if€they€had€been€suitably€informed€of€the€risks,€benefits,€andÐ €Ð Ðalternatives.€€òòSee€Ashe€v.€Radiation€Oncology€Assocs.óó,€9€S.W.3d€at€122„23.€€Ð l¼ ÐÌà  àThe€inquiry€in€lack€of€informed€consent€cases€is€whether€the€physician€provided€the€patientÐ D!” Ðsufficient€information€to€enable€the€patient€to€make€an€intelligent€and€informed€decision€either€toÐ 0"€  Ðrefuse€or€consent€to€the€procedure.€€òòSee€Shadrick€v.€Cokeróó,€963€S.W.2d€726,€732€(Tenn.€1998).€€ToÐ #l! Ðprove€that€the€information€was€insufficient,€a€patient€must€present€evidence€that€his€or€her€physicianÐ $X" Ðfailed€to€disclose€information€about€the€risks€of€the€proposed€procedure€that€a€reasonable€physicianÐ ô$D # Ðwould€have€disclosed€under€similar€circumstances.€€òòSee€Ashe€v.€Radiation€Oncology€Assocs.óó,€9Ð à%0!$ ÐS.W.3d€at€121.€€This€evidence€must€take€the€form€of€expert€testimony€because€it€is€clearly€beyondÐ Ì&"% Ðthe€common€knowledge€of€laypersons.€€òòSee€Bryant€v.€HCA€Health€Servs.€of€Tenn.,€Inc.óó,€15€S.W.3dÐ ¸'#& Ð804,€808„09€(Tenn.€2000);€òòBlanchard€v.€Kellumóó,€975€S.W.2d€at€524;€òòHarris€v.€Buckspanóó,€984Ð ¤(ô#' ÐS.W.2d€944,€948€(Tenn.€Ct.€App.€1998).Ð )à$( ÐÌà@¡¡)ìàò ò2.ó óˆÐ h+¸&* Ðà@<<ìàòòò òThe€Flawed€Appellate€Recordó óóóˆÐ T,¤'+ Їà  àBefore€we€address€the€substance€of€Ms.€Churchððs€medical€battery€and€lack€of€informedÐ ° Ðconsent€claims,€we€must€turn€our€attention€to€a€flaw€in€the€appellate€record€that€materially€affectsÐ œì Ðthe€scope€of€our€review.€€The€partiesðð€briefs€contain€numerous€references€to€Ms.€Churchððs€depositionÐ ˆØ Ðtestimony.€€While€the€record€indicates€that€Ms.€Churchððs€lawyer€may€have€filed€Ms.€ChurchððsÐ tÄ Ðdeposition€in€the€trial€court€as€part€of€her€response€to€Dr.€Peralesððs€summary€judgment€motion,€theÐ `° Ðdeposition€was€never€made€part€of€the€record€on€appeal.׃×Ý ƒ#ÃÝòòÚ  Ú6Ú  ÚóóÝ  Ý×  ×€€This€is€a€material€omission€because€theÐ L œ Ðrecord€contains€no€other€direct€evidence€of€Ms.€Churchððs€version€of€her€pre„operative€conversationsÐ 8 ˆ Ðwith€Dr.€Perales.Ð $ t ÐÌà  àWhen€this€court€noted€the€absence€of€Ms.€Churchððs€deposition€during€oral€argument,€Dr.Ð ü L  ÐPeralesððs€lawyer€endeavored€to€assume€responsibility€for€the€oversight.€€However,€Ms.€Church€wasÐ è 8  Ðresponsible€for€ensuring€that€all€parts€of€the€trial€court€record€germane€to€the€issues€she€intended€toÐ Ô$  Ðraise€on€appeal€were€included€in€the€appellate€record.€€òòSeeóó€Tenn.€R.€App.€P.€24(a),€(e);€òòState€v.€Banesóó,Ð À  Ð874€S.W.2d€73,€82€(Tenn.€Crim.€App.€1993).€€There€was€ample€opportunity€to€discover€that€Ms.Ð ¬ü  ÐChurchððs€deposition€was€not€in€the€record€because€the€appellate€record€had€been€on€file€with€thisÐ ˜è  Ðcourt€and€available€to€the€parties€for€six€months€prior€to€oral€argument,€and€Ms.€Churchððs€lawyerÐ „Ô  Ðactually€had€the€record€in€her€possession€for€two€weeks€prior€to€oral€argument.€€Ð pÀ ÐÌà  àOnce€the€fact€that€Ms.€Churchððs€deposition€was€not€included€in€the€record€was€brought€to€herÐ H˜ Ðattention,€Ms.€Churchððs€lawyer€could€have€supplemented€the€record€pursuant€to€Tenn.€R.€App.€P.Ð 4„ Ð24(e).€€She€did€not€do€so,€and€as€a€result,€the€record€contains€no€testimony€by€Ms.€Church€regardingÐ  p Ðher€pre„operative€conversations€with€Dr.€Perales.€€We€cannot€take€judicial€knowledge€of€herÐ  \ Ðtestimony,€even€if€parts€of€it€are€cited€in€the€briefs,€because€it€is€outside€the€record.€€òòSeeóó€òòRichmondÐ øH Ðv.€Richmondóó,€690€S.W.2d€534,€535€(Tenn.€Ct.€App.€1985).€€Thus,€in€accordance€with€Tenn.€R.€App.Ð ä4 ÐP.€36(a),€Ms.€Church€must€bear€the€consequences€of€absence€of€her€deposition€from€the€record.Ð Ð  ÐÌà@¡¡)ìàò ò3.ó óˆÐ ¨ø Ðà@³³ìàòòò òThe€Medical€Battery€Claimó óóóˆÐ ”ä ÐÌà  àWe€need€not€tarry€long€with€Ms.€Churchððs€medical€battery€claim€because€she€concedes€in€herÐ l¼ Ðbrief€that€she€has€failed€ð ðto€establish€that€Doctor€Perales€was€negligent€by€performing€unnecessaryÐ X ¨ Ðabdominal€exploration.ðð€€We€agree.€€Without€Ms.€Churchððs€deposition,€the€record€contains€no€otherÐ D!” Ðcompetent€evidence€to€contradict€Dr.€Peralesððs€testimony€in€her€affidavit€and€deposition€that€she€fullyÐ 0"€  Ðexplained€all€anticipated€procedures,€including€the€exploratory€laparotomy€and€the€salpingoÐ #l! Ðoophorectomy,€to€Ms.€Church€and€that€Ms.€Church€consented€to€them.׃è×Ý ƒ#ÃÝòòÚ  Ú7Ú  ÚóóÝ  Ý×  ×€€Without€this€evidence,€Ms.Ð $X" ÐChurch€cannot€demonstrate€the€existence€of€a€material€factual€dispute€regarding€her€medical€batteryÐ ° Ðclaim.€Ð œì ÐÌà  àMs.€Churchððs€medical€battery€claim€would€have€been€doomed€even€without€the€oversightÐ tÄ Ðregarding€her€deposition.€€To€support€her€summary€judgment€motion,€Dr.€Perales€produced€writtenÐ `° Ðconsent€forms€signed€by€Ms.€Church€consenting€to€the€exploratory€laparotomy€and€the€salpingoÐ L œ Ðoophorectomy.€€Based€on€these€forms,€the€only€conclusion€that€reasonable€persons€could€haveÐ 8 ˆ Ðreached€was€that€Ms.€Church€consented€to€these€procedures.€€Ð $ t ÐÌà  àA€patientððs€consent€may€be€express€or€implied.€€Express€consent€is€permission€given€directlyÐ ü L  Ðeither€by€voice€or€in€writing.€€A€party€seeking€to€prove€express€consent€may€do€so€by€introducing€theÐ è 8  Ðwriting€memorializing€the€consent.€€òòSeeóó,€òòe.g.óó,€òòIn€re€Swine€Flu€Immunization€Prods.€Litig.óó,€533€F.Ð Ô$  ÐSupp.€567,€574„76€(D.€Colo.€1980).€€When€a€patient€has€signed€a€written€consent€form€expresslyÐ À  Ðcovering€a€particular€procedure,€the€terms€of€the€consent€form€will€ordinarily€control€the€questionÐ ¬ü  Ðof€whether€the€patient€consented€to€the€procedure.€€òòSee€Hudson€v.€Parvinóó,€582€So.€2d€403,€411€(Miss.Ð ˜è  Ð1991)€(holding€that€the€language€of€an€executed€consent€form€took€precedence€over€the€alleged€priorÐ „Ô  Ðconversations€between€the€patient€and€the€physician).€€When€a€written€consent€form€exists,€the€courtsÐ pÀ Ðlook€to€ð ðthe€metes€and€bounds€of€the€agreement€entered€into€between€[the€patient]€and€[the€surgeon]Ð \¬ Ðand€the€parameters€of€the€authorization€given.ðð€€€òòSamoilov€v.€Razóó,€536€A.2d€275,€279€(N.J.€Super.Ð H˜ ÐCt.€App.€Div.€1987).Ð 4„ ÐÌà  àAs€a€general€matter,€the€law€presumes€that€persons€who€sign€documents,€having€been€givenÐ  \ Ðan€opportunity€to€read€them,€are€bound€by€their€signatures.€€òòSee€Solomon€v.€First€Tenn.€Bankóó,€774Ð øH ÐS.W.2d€935,€943€(Tenn.€Ct.€App.€1989).€€This€rule€applies€in€medical€battery€and€informed€consentÐ ä4 Ðcases.€€Thus,€the€law€presumes€that€patients€ordinarily€read€and€take€whatever€other€measures€areÐ Ð  Ðnecessary€to€understand€the€nature,€terms,€and€general€meaning€of€consent€forms€involving€medicalÐ ¼  Ðtreatment.€€òòSee€Karp€v.€Cooleyóó,€349€F.€Supp.€827,€835€(S.D.€Tex.€1972);€òòGrannum€v.€Berardóó,€422Ð ¨ø ÐP.2d€812,€815€(Wash.€1967).€€This€presumption€has€been€codified€in€many€states.€€òòSee,€e.g.,€ParikhÐ ”ä Ðv.€Cunninghamóó,€493€So.€2d€999,€1001€(Fla.€1986);€òòCardio€TVP€Surgical€Assocs.€v.€Gillisóó,€528€S.E.2dÐ €Ð Ð785,€787€(Ga.€2000);€òòShahinaw€v.€Brownóó,€963€P.2d€1184,€1188€(Idaho€1998);€òòEarl€v.€Ratliffóó,€998Ð l¼ ÐS.W.2d€882,€891€(Tex.€1999).€€Thus,€the€existence€of€a€signed€consent€form€gives€rise€to€aÐ X ¨ Ðpresumption€of€consent€in€the€absence€of€proof€of€misrepresentation,€inadequate€disclosure,€forgery,Ð D!” Ðor€lack€of€capacity.€€€Ð 0"€  ÐÌà  àWhere€a€physician€performs€a€procedure€contracted€for€by€the€patient,€that€treatment,€whileÐ $X" Ðit€may€or€may€not€be€malpractice,€is€not€battery.€€òòSeeóó€òòHartsell€v.€Fort€Sanders€Regððl€Med.€Ctr.óó,€905Ð ô$D # ÐS.W.2d€944,€947€(Tenn.€Ct.€App.€1995).€€If€an€executed€consent€form€expressly€covers€the€surgeryÐ à%0!$ Ðperformed€on€the€patient,€and€no€evidence€competently€undermines€the€validity€of€that€consent,׃ ×Ý ƒ#ÃÝòòÚ  Ú8Ú  ÚóóÝ  Ý×  ×€theÐ Ì&"% Ðsurgery€is€not€a€battery,€and€the€physician€is€entitled€to€judgment€as€a€matter€of€law€on€any€claim€ofÐ ° Ðbattery.€€òòSeeóó€òòBlincoe€v.€Luessenhopóó,€669€F.€Supp.€513,€517„18€(D.D.C.€1987);€òòAdames€Mendez€v.Ð œì ÐUnited€Statesóó,€652€F.€Supp.€356,€359€(D.P.R.€1987)€(granting€partial€summary€judgment);€òòIpcock€v.Ð ˆØ ÐGilmoreóó,€354€S.E.2d€315,€318€(N.C.€Ct.€App.€1987).Ð tÄ ÐÌà  àThe€undisputed€evidence€shows€that€Ms.€Church€read€the€consent€forms.€€In€addition€toÐ L œ Ðsigning€them,€she€placed€her€initials€near€the€filled„in€blank€spaces€on€the€form,€and€she€marked€outÐ 8 ˆ Ðthe€provision€authorizing€blood€transfusions,€wrote€in€ð ðNo€Blood,ðð€and€then€signed€her€notation.€Ð $ t ÐMs.€Church€does€not€take€issue€with€the€consent€forms€or€with€the€circumstances€under€which€sheÐ  ` Ðsigned€them.€€There€is€no€other€competent€evidence€in€the€record€to€prevent€the€application€of€theÐ ü L  Ðpresumption€that€she€consented€to€the€procedures€described€on€the€forms.׃×Ý ƒ#ÃÝòòÚ  Ú9Ú  ÚóóÝ  Ý×  ×€€Thus,€Dr.€Perales€isÐ è 8  Ðentitled€to€a€summary€judgment€on€Ms.€Churchððs€medical€battery€claim€based€on€the€consent€formsÐ Ô$  Ðalone.€€Ð À  ÐÌà@¡¡)ìàò ò4.ó óˆÐ ˜è  Ðà@ù ù ìàòòò òThe€Lack€of€Informed€Consent€Claimó óóóˆÐ „Ô  ÐÌà  àMs.€Churchððs€lack€of€informed€consent€claim€must€suffer€the€same€fate€as€her€medical€batteryÐ \¬ Ðclaim.€€Without€Ms.€Churchððs€deposition,€the€only€competent€evidence€of€the€discussions€betweenÐ H˜ ÐMs.€Church€and€Dr.€Perales€regarding€the€proposed€surgery€is€Dr.€Peralesððs€affidavit€and€deposition.€Ð 4„ ÐIn€her€September€18,€1996€deposition,€Dr.€Perales€described€her€March€2,€1995€discussion€with€Ms.Ð  p ÐChurch€regarding€the€exploratory€laparotomy€as€follows:Ð  \ ÐÌà8  àà8` Ð Ð à[I]n€her€particular€case€because€of€her€being€a€Jehovahððs€Witness,€IÐ ä4 Ðdid€not€want€to€take€that€risk€of€any€bleeding€happening€and€not€beingÐ Ð  Ðable€to€give€her€any€blood€by€the€time€I€noticed€that€she€had€had€someÐ ¼  Ðbleeding.€€Thus€I€mentioned€to€her€and€her€daughter€„€„€Katie€SpaffordÐ ¨ø Ðwas€present€in€the€presurgical€consultation€„€„€I€mentioned€to€her€andÐ ”ä Ðâ âher€daughter€that€I€would€prefer€to€do€the€procedure€through€anÐ €Ð Ðexploratory€laparotomy€where€there€would€be€an€incision€in€theÐ ° Ðabdomen€and€do€the€repairs€through€the€abdomen.׃!×Ý ƒ#ÃÝòòÚ  Ú10Ú  ÚóóÝ  Ý×  ×Ðœì` x` x Ðâ âÌIn€an€affidavit€filed€with€the€trial€court€on€March€27,€1997,€Dr.€Perales€elaborated€on€her€discussionÐ tÄ Ðregarding€the€removal€of€Ms.€Churchððs€ovaries€and€fallopian€tubes:Ð `° ÐÌà8  àà8` Ð Ð àIn€view€of€Mrs.€Churchððs€religious€beliefs€and€the€danger€of€bloodÐ 8 ˆ Ðvessel€compromise€during€a€laparoscopic€approach,€I€decided€toÐ $ t Ðperform€the€surgical€procedures€utilizing€an€exploratory€laparotomyÐ  ` Ðapproach.€€The€surgical€procedure€was€described€to€Mrs.€Church,Ð ü L  Ðincluding€the€possible€removal€of€Mrs.€Churchððs€fallopian€tubes€andÐ è 8  Ðovaries.€€The€potential€risks€and€complications€of€the€procedureÐ Ô$  Ðincluding€infection€and€bleeding€were€discussed€with€Mrs.€ChurchÐ À  Ðand€she€agreed€to€proceed€with€surgery.Ьü ` x` x ÐÌIn€both€her€deposition€and€affidavit,€Dr.€Perales€states€unequivocally€that€Ms.€Church€consented€toÐ „Ô  Ðthese€procedures€after€they€were€explained€to€her.€€To€corroborate€her€account,€Dr.€Perales€points€toÐ pÀ Ðthe€hospitalððs€surgical€consent€forms€Ms.€Church€signed€both€on€March€8,€1995,€and€March€22,Ð \¬ Ð1995,€in€which€she€consented€to€an€exploratory€laparotomy,€a€bilateral€salpingo€oophorectomy,€aÐ H˜ Ðbladder€suspension,€and€an€anterior€and€posterior€repair.€€Ð 4„ ÐÌà  àDr.€Wolfððs€deposition€does€not€provide€the€evidence€needed€to€create€a€genuine€issue€ofÐ  \ Ðmaterial€fact€regarding€Ms.€Churchððs€discussions€with€Dr.€Perales.€Dr.€Wolf€was€clearly€permittedÐ øH Ðto€base€his€expert€opinions€regarding€the€standard€of€care€and€causation€on€evidence€outside€theÐ ä4 Ðrecord.€òòSeeóó€Tenn.€R.€Civ.€P.€56.06.€€Thus,€he€could€form€expert€opinions€based€on€informationÐ Ð  Ðgleaned€from€reading€Ms.€Churchððs€deposition,€whether€the€deposition€was€part€of€the€record€or€not.€Ð ¼  ÐHowever,€Dr.€Wolfððs€recitation€of€the€portions€of€Ms.€Churchððs€deposition€on€which€he€relied€is€notÐ ¨ø Ðevidence€that€the€conversations€occurred€as€Ms.€Church€described€them.׃/ ×Ý ƒ#ÃÝòòÚ  Ú11Ú  ÚóóÝ  Ý×  ×€€The€only€competentÐ ”ä Ðevidence€of€these€conversations€would€be€the€testimony€of€Ms.€Church,€Ms.€Spafford,€Dr.€Perales,Ð €Ð Ðand€anyone€else€present€during€the€March€2,€1995€pre„surgical€consultation€or€any€documentÐ l¼ Ðmemorializing€these€conversations€that€would€be€admissible€as€an€exception€to€the€hearsay€rule.Ð X ¨ ÐÌà  àBased€on€the€undisputed€evidence€in€the€record€before€us,€we€have€concluded€that€the€onlyÐ 0"€  Ðconclusion€that€a€reasonable€person€could€reach€is€that€Dr.€Peralesððs€explanation€of€the€nature€of€theÐ #l! Ðâ âprocedures€she€intended€to€perform€as€well€as€the€risks€and€benefits€of€these€procedures€compliedÐ $X" Ðwith€the€standard€of€care€applicable€to€Dr.€Perales.€€Accordingly,€the€trial€court€properly€granted€theÐ ° Ðsummary€judgment€dismissing€Ms.€Churchððs€lack€of€informed€consent€claim.Ð œì Ðâ âÌà@)ìàò òB.ó óˆÐ tÄ Ðà@––ìàòòò òThe€Delay€in€Post„Operative€Diagnosis€and€Treatment€Claimó óóóˆÐ `° ÐÌà  àMs.€Church€does€not€claim€that€Dr.€Perales€performed€any€of€the€March€22,€1995€surgicalÐ 8 ˆ Ðprocedures€negligently€or€that€the€perforation€of€her€small€intestine€at€its€antimesenteric€border€wasÐ $ t Ðcaused€by€Dr.€Peralesððs€negligence.׃×Ý ƒ#ÃÝòòÚ  Ú12Ú  ÚóóÝ  Ý×  ×€€However,€she€asserts€that€Dr.€Perales€was€negligent€in€failingÐ  ` Ðto€diagnose€and€treat€the€effects€of€the€perforation€of€her€small€intestine€during€the€course€of€herÐ ü L  Ðpost„operative€recovery.€€This€contention€is€the€heart€of€Ms.€Churchððs€medical€malpractice€claimÐ è 8  Ðagainst€Dr.€Perales.€€For€her€part,€Dr.€Perales€gives€two€responses€to€this€claim.€First,€she€asserts€thatÐ Ô$  Ðshe€owed€no€duty€to€Ms.€Church€when€this€negligence€occurred.€€Second,€she€asserts€that€Ms.Ð À  ÐChurchððs€expert€opinion€on€causation€is€ð ðpurely€speculative.ðð€€We€disagree€with€both€of€Dr.Ð ¬ü  ÐPeralesððs€arguments€and€find€that€the€trial€court€should€not€have€summarily€dismissed€Ms.€ChurchððsÐ ˜è  Ðmalpractice€claim€against€Dr.€Perales€for€negligently€failing€to€diagnose€and€treat€her€perforatedÐ „Ô  Ðintestine.Ð pÀ ÐÌà@¡¡)ìàò ò1.ó óˆÐ H˜ Ðà@¬ ¬ ìàòòò òDr.€Peralesððs€Duty€to€Ms.€Churchó óóóˆÐ 4„ ÐÌà  àThe€existence€of€a€duty€owed€by€the€defendant€to€the€plaintiff€is€a€necessary€ingredient€ofÐ  \ Ðevery€negligence€claim,€including€medical€malpractice€claims.׃4X×Ý ƒ#ÃÝòòÚ  Ú13Ú  ÚóóÝ  Ý×  ×€€Accordingly,€we€turn€first€to€Dr.Ð øH ÐPeralesððs€assertion€that€she€owed€no€duty€to€Ms.€Church€after€March€29,€1995,€because€she€had€leftÐ ä4 ÐNashville€to€attend€a€medical€seminar€and€had€turned€over€Ms.€Churchððs€care€to€Dr.€Ross.€€If€Dr.Ð Ð  ÐPerales€is€correct,€she€is€entitled€to€a€dismissal€of€Ms.€Churchððs€malpractice€claim€as€a€matter€of€law.€Ð ¼  ÐDetermining€whether€Dr.€Perales€owed€a€duty€to€Ms.€Church€is€a€question€of€law.€€òòSee€Staples€v.Ð ¨ø ÐCBL€&€Assocs.óó,€15€S.W.3d€83,€89€(Tenn.€2000);€òòRice€v.€Sabiróó,€979€S.W.2d€305,€308€(Tenn.€1998);Ð ”ä ÐòòJackson€v.€Bradley,óó€987€S.W.2d€852,€854€(Tenn.€Ct.€App.€1998).Ð €Ð ÐÌà  àThe€existence€of€a€physicianððs€duty€arises€out€of€the€professional€relationship€between€theÐ X ¨ Ðphysician€and€his€or€her€patient.€€The€relationship€is€generally€characterized€as€a€contractual€one€inÐ D!” Ðwhich€the€patient€knowingly€and€voluntarily€seeks€the€professional€assistance€of€the€physician,€andÐ 0"€  Ðthe€physician€knowingly€agrees€to€treat€the€patient.€€òòSee€Jennings€v.€Caseóó,€10€S.W.3d€625,€628Ð #l! Ð(Tenn.€Ct.€App.€1999);€òòOsborne€v.€Frazoróó,€58€Tenn.€App.€15,€20,€425€S.W.2d€768,€771€(1968).€€TheÐ $X" Ðphysician€also€agrees€to€use€his€or€her€best€judgment€and€skill€in€providing€treatment.€€òòSee€Truan€v.Ð ô$D # ÐSmithóó,€578€S.W.2d€73,€75„76€(Tenn.€1979);òò€Redwood€v.€Raskindóó,€49€Tenn.€App.€69,€75,€350€S.W.2dÐ à%0!$ Ð414,€416„17€(1961).Ð Ì&"% ÐÐ ¸'#& Ðà  àOnce€a€physician€accepts€a€patient,€he€or€she€has€a€duty€to€continue€providing€treatment€asÐ ° Ðlong€as€it€is€medically€necessary.€€òòSee€Hongsathavij€v.€Queen€of€Angels/Hollywood€PresbyterianÐ œì ÐMed.€Ctr.óó,€73€Cal.€Rptr.€2d€695,€704€(Ct.€App.€1998);€òòEstate€of€Katsetos€v.€Nolanóó,€368€A.2d€172,€182Ð ˆØ Ð(Conn.€1976);€òòSurgical€Consultants,€P.C.€v.€Ballóó,€447€N.W.2d€676,€682€(Iowa€Ct.€App.€1989);€Ð tÄ ÐòòMcLaughlin€v.€Hellbuschóó,€591€N.W.2d€569,€573€(Neb.€1999);€òòJackson€v.€Oklahoma€Memððl€Hosp.óó,Ð `° Ð909€P.2d€765,€774€(Okla.€1995).òòóó€Accordingly,€the€Tennessee€Supreme€Court€has€held€that€Ð L œ ÐÌà8  àà8` Ð Ð àa€physician€who€undertakes€the€treatment€of€a€case€may€not€abandonÐ $ t Ðhis€[or€her]€patient€until€in€his€[or€her]€judgment€the€facts€justify€theÐ  ` Ðcessation€of€attention,€unless€he€[or€she]€give€to€the€patient€due€noticeÐ ü L  Ðthat€he€[or€she]€intends€to€quit€the€case€and€affords€the€patientÐ è 8  Ðopportunity€to€procure€other€medical€attendance.ÐÔ$ ` x` x ÐÌòòBurnett€v.€Laymanóó,€133€Tenn.€323,€329„30,€181€S.W.€157,€158€(1915).׃$×Ý ƒ#ÃÝòòÚ  Ú14Ú  ÚóóÝ  Ý×  ×€€The€law€imposes€this€dutyÐ ¬ü  Ðon€treating€physicians€in€recognition€of€their€responsibility€to€avoid€a€lapse€in€necessary€treatmentÐ ˜è  Ðto€their€patients.€€òòSee€Rosen€v.€Greifenbergeróó,€513€S.E.2d€861,€865€(Va.€1999).€€€Ð „Ô  ÐÌà  àA€physicianððs€duty€to€attend€a€patient€continues€as€long€as€required€unless€the€physician„Ð \¬ Ðpatient€relationship€is€ended€by€(1)€mutual€consent,€(2)€the€physicianððs€withdrawal€after€reasonableÐ H˜ Ðnotice,€(3)€the€dismissal€of€the€physician€by€the€patient,€or€(4)€the€cessation€of€the€medical€necessityÐ 4„ Ðthat€gave€rise€to€the€relationship€in€the€first€place.€€òòSee€Glenn€v.€Carlstromóó,€556€N.W.2d€800,€802Ð  p Ð(Iowa€1996);€òòWeiss€v.€Rojanasathitóó,€975€S.W.2d€113,€119„20€(Mo.€1998).€€While€the€physician„Ð  \ Ðpatient€relationship€exists,€the€physician€has€a€duty€to€continue€providing€care.€€Thus,€in€the€absenceÐ øH Ðof€an€emergency€or€other€special€circumstances,€where€a€physician€knows€or€should€know€that€aÐ ä4 Ðcondition€exists€that€requires€further€medical€attention€to€prevent€injurious€consequences,€theÐ Ð  Ðphysician€must€render€such€attention,€or€must€see€to€it€that€some€other€competent€person€does€so,Ð ¼  Ðuntil€the€condition€is€resolved€or€until€the€physician„patient€relationship€is€properly€terminated.€€òòSeeÐ ¨ø ÐPritchard€v.€Nealóó,€229€S.E.2d€18,€20€(Ga.€Ct.€App.€1976);€òòReynolds€v.€Dennisonóó,€981€S.W.2d€641,Ð ”ä Ð642€(Mo.€Ct.€App.€1998);€òòJackson€v.€Oklahoma€Memððl€Hosp.óó,€909€P.2d€at€774.Ð €Ð ÐÌà  àIt€is€neither€realistic€nor€fair€to€expect€that€physicians€will€be€able€to€provide€continuous€careÐ X ¨ Ðto€each€of€their€patients€twenty„four€hours€a€day,€seven€days€a€week,€and€three€hundred€and€sixty„fiveÐ D!” Ðdays€a€year.€€The€medical€profession€recognizes€that€it€is€appropriate€for€physicians€to€arrange€forÐ 0"€  Ðother€physicians€to€cover€for€them€when€they€will€be€temporarily€unavailable.€€Accordingly,€theÐ #l! Ðcourts€have€held€that€when€a€physician€is€temporarily€unable€to€attend€a€patient€personally,€he€or€sheÐ $X" Ðmay€make€arrangements€for€a€competent€person€to€attend€the€patient€in€the€physicianððs€absence.€€òòSeeÐ ô$D # ÐKenney€v.€Piedmont€Hosp.óó,€222€S.E.2d€162,€166€(Ga.€Ct.€App.€1975);€òòManno€v.€McIntoshóó,€519Ð à%0!$ ÐN.W.2d€815,€821„22€(Iowa€Ct.€App.€1994);€òòTripp€v.€Pateóó,€271€S.E.2d€407,€410„11€(N.C.€Ct.€App.Ð Ì&"% Ð1980);€òòJohnson€v.€Wardóó,€344€S.E.2d€166,€170€(S.C.€Ct.€App.€1986)€òòoverruled€on€other€groundsóó,Ð ¸'#& Ðâ âòòSpahn€v.€Town€of€Port€Royalóó,€499€S.E.2d€205,€207€(S.C.€1998);€òòMcCay€v.€Mitchellóó,€62€Tenn.€App.Ð ¤(ô#' Ð424,€432,€463€S.W.2d€710,€714„15€(1970);€òòLee€v.€Dewbreóó,€362€S.W.2d€900,€903€(Tex.€Civ.€App.Ð ° Ð1962).Ð œì Ðâ âÌà  àEven€though€Ms.€Church€had€initially€seen€Dr.€Perales€in€December€1993,€she€and€Dr.Ð tÄ ÐPerales€entered€into€a€physician„patient€relationship€regarding€her€gynecological€surgery€inÐ `° ÐNovember€1994€when€they€agreed€to€proceed€with€the€surgical€option€to€correct€Ms.€ChurchððsÐ L œ Ðurinary€incontinence€and€vaginal€prolapse.€€By€agreeing€to€perform€these€surgical€procedures,€Dr.Ð 8 ˆ ÐPerales,€as€a€matter€of€law,€undertook€not€only€to€perform€the€procedures€themselves€in€aÐ $ t Ðprofessionally€appropriate€manner€but€also€to€provide€Ms.€Church€with€the€required€post„operativeÐ  ` Ðtreatment.€€òòSee€Swaw€v.€Klompienóó,€522€N.E.2d€1267,€1272€(Ill.€App.€Ct.€1988);€òòStarnes€v.€Tayloróó,Ð ü L  Ð158€S.E.2d€339,€345€(N.C.€1968).€€Ð è 8  ÐÌà  àDr.€Peralesððs€duty€to€Ms.€Church€did€not€end€with€the€completion€of€the€surgical€proceduresÐ À  Ðon€March€22,€1995.€€Ms.€Churchððs€medical€problems€had€not€been€finally€resolved,€and€Dr.€PeralesÐ ¬ü  Ðhad€a€continuing€obligation€to€provide€Ms.€Church€with€post„operative€treatment.€€In€fact,€Ms.Ð ˜è  ÐChurchððs€medical€condition€deteriorated€alarmingly€following€surgery.€€Dr.€Perales€knew€that€Ms.Ð „Ô  ÐChurchððs€condition€was€critical€and€that€Ms.€Church€required€continuing€medical€attention€to€preventÐ pÀ Ðfurther€injurious€consequences.€€In€order€to€assure€that€there€would€be€no€lapse€in€Ms.€Churchððs€care,Ð \¬ ÐDr.€Perales€arranged€for€Drs.€Ross€and€Dunbar€to€cover€for€her€while€she€was€attending€an€out„of„Ð H˜ Ðstate€medical€seminar.€€€Ð 4„ ÐÌà  àDr.€Perales€did€not€intend€to€terminate€her€professional€relationship€with€Ms.€Church€whenÐ  \ Ðshe€left€Nashville€to€attend€the€medical€seminar.€€Had€she€done€so,€she€would€have€exposed€herselfÐ øH Ðto€liability€for€abandonment.׃2×Ý ƒ#ÃÝòòÚ  Ú15Ú  ÚóóÝ  Ý×  ×€€Dr.€Perales€remained€Ms.€Churchððs€physician.€€Accordingly,€her€duty€Ð ä4 Ðto€provide€continuing€treatment€to€Ms.€Church€did€not€end€on€March€29,€1995,€simply€because€sheÐ Ð  Ðleft€Nashville€to€attend€a€conference.Ð ¼  ÐÌà  àWe€likewise€decline€to€find€that€Dr.€Peralesððs€duty€to€Ms.€Church€ended€simply€because€she€Ð ”ä Ðarranged€for€Drs.€Ross€and€Dunbar€to€cover€for€her€in€her€absence.€€The€undisputed€evidence€in€thisÐ €Ð Ðrecord€does€not€conclusively€establish€the€nature€of€the€legal€relationship€between€Dr.€Perales€andÐ l¼ ÐDrs.€Ross€and€Dunbar€regarding€Ms.€Churchððs€care€during€Dr.€Peralesððs€temporary€absence.€€If€Drs.Ð X ¨ ÐRoss€and€Dunbar€were€acting€as€Dr.€Peralesððs€ð ðagentsðð€or€if€the€three€physicians€were€otherwiseÐ D!” Ðacting€in€concert€to€provide€Ms.€Church€care,€then€Dr.€Perales€would€share€the€responsibility,€if€any,€Ð 0"€  Ðfor€the€delays€in€diagnosing€and€treating€Ms.€Churchððs€bowel€perforation€and€intra„abdominalÐ #l! Ðprocess€occurring€on€and€after€March€29,€1995.Ð $X" ÐÌà@¡¡)ìàò ò2.ó óˆÐ à%0!$ Ðà@* * ìàòòò òMs.€Churchððs€Evidence€of€Causationó óóóˆÐ ° ÐÌà  àDr.€Perales€also€asserts€that€she€is€entitled€to€a€summary€judgment€because€Ms.€Church€has€Ð ˆØ Ðfailed€to€come€forward€with€the€evidence€required€by€Tenn.€Code€Ann.€ðð€29„26„115(a)(3)€that€herÐ tÄ Ðconduct€proximately€caused€Ms.€Church€to€suffer€injuries€that€would€not€otherwise€have€occurred.€Ð `° ÐThis€argument€tests€the€quality€of€the€evidence€Ms.€Church€used€to€oppose€Dr.€Peralesððs€€summaryÐ L œ Ðjudgment€motion.€€Specifically,€it€challenges€the€adequacy€of€Dr.€Wolfððs€expert€opinions.Ð 8 ˆ ÐÌà  àAll€affidavits€used€either€to€support€or€to€oppose€a€motion€for€summary€judgment€must€meetÐ  ` Ðthe€requirements€Tenn.€R.€Civ.€P.€56.06€that€(1)€the€affidavit€must€be€made€on€the€affiantððs€personalÐ ü L  Ðknowledge,€(2)€the€affiantððs€statements€must€otherwise€be€admissible€in€evidence,€and€(3)€the€affiantÐ è 8  Ðis€competent€to€testify€regarding€the€substance€of€the€affidavit.€€In€addition€to€these€requirements,Ð Ô$  Ðexpert€affivadits€must€demonstrate€that€the€affiant€is€qualified€to€render€an€expert€opinion€[Tenn.€R.Ð À  ÐEvid.€104(a)]€and€that€the€affiantððs€statements€or€opinions€will€substantially€assist€the€trier€of€factÐ ¬ü  Ð[Tenn.€R.€Evid.€702].€€òòSee€Knight€v.€Hospital€Corp.€of€Am.óó,€No.€01A01„9509„CV„00408,€1997€WLÐ ˜è  Ð5161,€at€*5„6€(Tenn.€Ct.€App.€Jan.€8,€1997)€(No€Tenn.€R.€App.€P.€11€application€filed).€€If€theÐ „Ô  Ðaffidavit€is€introduced€in€opposition€to€a€motion€for€summary€judgment,€it€must€also€create€someÐ pÀ Ðgenuine€dispute€regarding€one€or€more€facts€that€are€legally€material€to€the€outcome€of€the€case.€€òòSeeÐ \¬ ÐRutherford€v.€Polar€Tank€Trailer,€Inc.óó,€978€S.W.2d€102,€103„04€(Tenn.€Ct.€App.€1998).€€€Ð H˜ ÐÌà  àIn€medical€malpractice€cases,€Tenn.€Code€Ann.€ðð€29„26„115€imposes€five€other€substantiveÐ  p Ðrequirements€on€expert€affidavits.€€The€affiant€must€demonstrate€that€he€or€she€meets€the€geographicÐ  \ Ðand€durational€residence€and€practice€requirements.׃8×Ý ƒ#ÃÝòòÚ  Ú16Ú  ÚóóÝ  Ý×  ×€€Second,€the€affiant€must€demonstrate€that€heÐ øH Ðor€she€practices€in€a€profession€or€specialty€that€makes€the€affiantððs€opinion€relevant€to€the€issues€inÐ ä4 Ðthe€case.׃%X×Ý ƒ#ÃÝòòÚ  Ú17Ú  ÚóóÝ  Ý×  ×€€Third,€the€affiant€must€demonstrate€that€familiarity€with€the€recognized€standard€ofÐ Ð  Ðprofessional€practice€in€the€community€where€the€defendant€practices€or€in€similar€communities.׃)x×Ý ƒ#ÃÝòòÚ  Ú18Ú  ÚóóÝ  Ý×  ׀Р¼  ÐFourth,€the€affiant€must€give€an€opinion€concerning€whether€the€defendant€physician€met€or€failedÐ ¨ø Ðto€meet€the€relevant€standard€of€professional€practice.׃*×Ý ƒ#ÃÝòòÚ  Ú19Ú  ÚóóÝ  Ý×  ×€€Finally,€the€affiant€must€opine€whether€theÐ ”ä Ðdefendant€physicianððs€negligence€more€likely€than€not€caused€the€patient€injuries€that€he€or€sheÐ €Ð Ðwould€not€otherwise€have€suffered.׃0˜×Ý ƒ#ÃÝòòÚ  Ú20Ú  ÚóóÝ  Ý×  ×Ð l¼ Ðâ âÐ X ¨ Ðà  àThis€court€has€admonished€lawyers€to€couch€their€medical€expertsðð€conclusions€in€theÐ ° Ðâ âlanguage€of€Tenn.€Code€Ann.€ðð€29„26„115€to€avoid€summary€judgment€problems.€€òòSeeóó€òòGambill€v.Ð œì ÐMiddle€Tenn.€Med.€Ctr.óó,€751€S.W.2d€145,€148€(Tenn.€Ct.€App.€1988);€òòsee€also€Mullins€v.€Jonasóó,€No.Ð ˆØ Ð02A01„9306„CV„00132,€1994€WL€424141,€at€*3€(Aug.€15,€1994)€(No€Tenn.€R.€App.€P.€11Ð tÄ Ðapplication€filed);€òòKeith€v.€Hensonóó,€No.€01A01„9311„CV„00507,€1994€WL€176925,€at€*3€(May€11,Ð `° Ð1994)€òòperm.€app.€deniedóó€(Tenn.€Sept.€12,€1994).€€However,€we€recognize€that€a€mere€ritualisticÐ L œ Ðincantation€of€statutory€buzz€words€evidences€very€little.€€Accordingly,€when€an€expertððs€opinion€isÐ 8 ˆ Ðchallenged,€we€will€determine€whether€the€opinion€is€based€on€trustworthy€facts€or€data€sufficientÐ $ t Ðto€provide€some€basis€for€the€opinion.€€òòSee€generallyóó€òòMcDaniel€v.€CSX€Transp.,€Inc.óó,€955€S.W.2dÐ  ` Ð257,€265€(Tenn.€1997).€€We€neither€assay€the€expertððs€credibility€nor€determine€the€evidentiaryÐ ü L  Ðweight€that€should€be€given€to€the€expertsðð€opinion.€€Rather,€we€merely€look€to€see€if€the€challengedÐ è 8  Ðopinion€has€some€legally„acceptable€basis€from€which€its€conclusions€could€be€rationally€drawn.€€òòSeeóóÐ Ô$  ÐòòDevore€v.€Deloitte€&€Toucheóó,€No.€01A01„9602„CH„00073,€1998€WL€68985,€at€*9„10€(Tenn.€Ct.Ð À  ÐApp.€Feb.€20,€1998)€(No€Tenn.€R.€App.€P.€11€application€filed)€(affirming€summary€judgment€whereÐ ¬ü  Ðproffered€expert€testimony€lacked€a€trustworthy€basis).€€Expert€opinions€having€no€basis€can€properlyÐ ˜è  Ðbe€disregarded€because€they€cannot€materially€assist€the€trier€of€fact.€Nor€can€they€create€genuineÐ „Ô  Ðdisputes€of€material€fact€at€summary€judgment€stage.Ð pÀ ÐÌà  àWe€have€concluded€that€Dr.€Wolfððs€affidavits€and€deposition€meet€all€the€technicalÐ H˜ Ðrequirements€of€Tenn.€R.€Civ.€P.€56.06€and€Tenn.€Code€Ann.€ðð€29„26„115.€€Accordingly,€the€soleÐ 4„ Ðissue€to€be€decided€is€whether€Dr.€Wolfððs€testimony€fails€to€create€a€material€factual€disputeÐ  p Ðregarding€whether€Dr.€Peralesððs€post„operative€care€of€Ms.€Church€more€likely€than€not€caused€Ms.Ð  \ ÐChurch€to€suffer€injuries€that€would€not€otherwise€have€occurred.Ð øH ÐÌà  àDr.€Wolfððs€opinions€are€based€on€his€personal€review€of€Ms.€Churchððs€hospital€records€andÐ Ð  Ðthe€files€and€depositions€of€Drs.€Perales,€Ross,€and€Dunbar.€€As€an€experienced€general€surgeon€withÐ ¼  Ðover€twenty„five€years€in€practice,€Dr.€Wolf€states€that€the€available€records€reveal€that€Ms.€ChurchÐ ¨ø Ðð ðdid€not€have€a€normal€usual€or€even€acceptable€postoperative€course.ðð€€He€points€out€repeatedly€thatÐ ”ä ÐMs.€Church€went€ð ðprogressively€downhillðð€following€surgery.€€While€he€concedes€that€diagnosingÐ €Ð Ðan€intra„abdominal€process€can€be€difficult,€he€concludes,€based€on€Ms.€Churchððs€symptoms€andÐ l¼ Ðcomplaints€and€on€the€CT€scan€results€obtained€on€March€29,€1995,€that€her€physicians€actedÐ X ¨ Ðnegligently€by€delaying€their€decision€to€perform€another€exploratory€laparotomy€until€March€31,Ð D!” Ð1995.׃×Ý ƒ#ÃÝòòÚ  Ú21Ú  ÚóóÝ  Ý×  ×Ð 0"€  ÐÌà  àDuring€the€post„operative€delay€in€diagnosing€and€treating€her€perforated€bowel,€Ms.€ChurchÐ $X" Ðsuffered€abdominal€pain,€nausea,€fever,€and€life„threatening€shortness€of€breath.€€Ultimately,€herÐ ô$D # Ðcondition€deteriorated€to€the€point€where€she€required€artificial€life„support€and€became€too€weakÐ à%0!$ Ðfor€surgery.€€These€undisputed€facts€provide€an€adequate€basis€for€Dr.€Wolfððs€opinion€that€ð ðDollyÐ Ì&"% ÐChurch€suffered€injuries€which€would€not€have€otherwise€occurred,ðð€and€Dr.€Wolfððs€opinion€isÐ ¸'#& Ðsufficient€to€create€a€material€factual€issue€that€renders€a€summary€judgment€inappropriate.Ð ¤(ô#' ÐÐ )à$( Ðà  àWe€respectfully€disagree€with€the€trial€courtððs€conclusion€that€Dr.€Perales€is€entitled€to€aÐ ° Ðsummary€judgment€dismissing€Ms.€Churchððs€medical€malpractice€claims€against€her.€€Accordingly,Ð œì Ðwe€vacate€the€portion€of€the€summary€judgment€dismissing€Ms.€Churchððs€malpractice€claims€againstÐ ˆØ ÐDr.€Perales€based€on€her€alleged€negligent€delay€in€diagnosing€and€treating€Ms.€Churchððs€perforatedÐ tÄ Ðbowel.Ð `° ÐÌà@^^(ìàò òIII.ó óˆÐ 8 ˆ Ðà@È È ìàòòò òThe€Malpractice€Claim€Against€Dr.€Dunbaró óóóˆÐ $ t ÐÌà  àMs.€Church€also€insists€that€the€trial€court€erred€by€granting€the€summary€judgmentÐ ü L  Ðdismissing€her€medical€malpractice€claims€against€Dr.€Dunbar.€€In€response,€Dr.€Dunbar€asserts€thatÐ è 8  Ðthe€shortcomings€in€Dr.€Wolfððs€testimony€provide€three€independent€reasons€supporting€the€trialÐ Ô$  Ðcourtððs€decision.€€Our€review€of€the€challenged€evidence€leads€us€to€reject€each€of€these€arguments.Ð À  ÐÌà@‹‹)ìàò òA.ó óˆÐ ˜è  Ðà@QQ ìàòòò òDr.€Wolfððs€Familiarity€With€the€Applicable€Standard€of€Careó óóóˆÐ „Ô  ÐÌà  àDr.€Dunbar€first€argues€that€Dr.€Wolfððs€testimony€should€be€disregarded€for€summaryÐ \¬ Ðjudgment€purposes€because€he€failed€to€demonstrate€that€he€is€familiar€with€the€applicable€standardÐ H˜ Ðof€care€as€required€by€Tenn.€Code€Ann.€ðð€29„26„115(a)(1).€€She€makes€this€argument€despite€Dr.Ð 4„ ÐWolfððs€assertion€in€his€November€15,€1996€affidavit€that€he€isÐ  p ÐÌà8  àà8` Ð Ð àfamiliar€with€the€recognized€standard€of€acceptable€professionalÐ øH Ðpractice€in€the€medical€community€of€Nashville,€Davidson€County,Ð ä4 ÐTennessee,€and€similar€communities,€for€the€surgical€management,Ð Ð  Ðcare€and€treatment€of€patients€such€as€Dolly€Church,€as€thoseÐ ¼  Ðstandards€exist€now€and€as€they€existed€in€March€of€1995.Шø` x` x ÐÌDr.€Wolf€repeated€this€assertion€in€his€May€10,€1997€affidavit,€and€added€that€he€isÐ €Ð ÐÌà8  àà8` Ð Ð àfamiliar€with€the€above€referenced€standard€of€acceptable€professionalÐ X ¨ Ðpractice€with€regard€to€the€post„surgical€management€care€andÐ D!” Ðtreatment€of€patients,€such€as€Dolly€Church,€regardless€of€whatÐ 0"€  Ðspecialty€the€physician€may€be€practicing.Ð#l!` x` x ÐÌThese€statements,€taken€in€conjunction€with€the€undisputed€evidence€regarding€Dr.€WolfððsÐ ô$D # Ðprofessional€training,€background,€and€experience,€are€adequate€to€stake€out€a€prima€facie€claim€ofÐ à%0!$ ÐDr.€Wolfððs€compliance€with€the€requirements€in€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)€for€renderingÐ Ì&"% Ðan€expert€opinion.Ð ¸'#& ÐÌà  àDr.€Dunbar€attempts€to€undermine€these€statements€using€several€of€Dr.€Wolfððs€statementsÐ )à$( Ðduring€his€February€25,€1997€deposition.€Dr.€Dunbarððs€lawyer€questioned€Dr.€Wolf€at€some€lengthÐ |*Ì%) Ðregarding€his€practice€of€referring€certain€patients€to€a€general€surgeon€at€St.€Thomas€Hospital€inÐ h+¸&* ÐNashville.€€Dr.€Wolf€explained€that€he€made€these€referrals,€not€because€he€could€not€treat€theirÐ T,¤'+ Ðproblems€that€fell€within€his€domain€of€general€surgery,€but€because€many€of€these€patients€hadÐ ° Ðmultiple€problems€and€the€other€necessary€specialists€were€not€ð ðgenuinely€availableðð€in€MarshallÐ œì ÐCounty.€€The€following€exchange€occurred€during€this€questioning:Ð ˆØ ÐÌà8  àà8` Ð Ð àà ¸ àQ.à  àDo€you€have€a€full„time€nephrologist€on€staff€atÐ `° ÐMarshall€County€Medical€Center?ÐL œ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.à  àDr.€Sue€Ellen€Lee,€whose€office€is€in€Columbia,€is€onÐ $ t Ðactive€staff€at€Marshall€Medical€Center.€€She€runs€the€dialysis€centerÐ  ` Ðhere€in€Lewisburg.€€And€she€is€available.Ðü L ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àà  àAgain,€availability€within€the€bylaws€as€opposed€toÐ Ô$  Ðgenuine€availability€is€a€different€story.€€I€am€within€20€minutes€ofÐ À  ÐMaury€Regional,€and€I€am€therefore€on€active€staff€and€available.€Ð ¬ü  ÐHowever,€if€I€had€a€patient€like€Mrs.€Church€in€the€ICU€at€MauryÐ ˜è  ÐRegional,€I€would€not€be€comfortable€leaving€the€premises€to€see€myÐ „Ô  Ðpatients€in€my€office€here.€€And€therefore€some€sacrifices€have€to€beÐ pÀ Ðmade.€€If€you€cannot€provide€the€capable€care,€then€the€patient€has€toÐ \¬ Ðbe€transferred€to€a€facility€where€they€can€be€[capably€cared€for].ÐH˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.à  àAre€you€saying€that€a€patient€like€Dolly€Church€wouldÐ  p Ðhave€to€be€transferred€from€Marshall€County€Medical€Center€toÐ  \ ÐMaury€Regional?ÐøH` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.à  àUltimate€„€„€reviewing€the€chart,€ultimately€she€couldÐ Ð  Ðhave€undergone€the€same€surgery,€et€cetera.€€But,€yes,€by€the€27th€orÐ ¼  Ðso€she€would€have€been€put€in€an€ambulance€and€shipped€up€to€St.Ð ¨ø ÐThomas€for€further€follow„up,€yes.Дä` x` x ÐÌBased€on€this€exchange,€Dr.€Dunbar,€who€like€Dr.€Wolf€is€a€board€certified€general€surgeon,€assertsÐ l¼ Ðthat€Dr.€Wolf€lacks€the€necessary€knowledge€and€experience€to€render€an€expert€opinion€regardingÐ X ¨ Ðwhat€the€standard€of€care€required€Dr.€Dunbar€to€do€to€treat€Ms.€Church€between€March€29€andÐ D!” ÐMarch€31,€1995.€€Ð 0"€  ÐÌà  àThe€logic€of€Dr.€Dunbarððs€argument€escapes€us.€€If€Dr.€Dunbar€is€arguing€that€there€is€noÐ $X" Ðevidence€in€the€record€that€Dr.€Wolf€has€demonstrated€that€he€meets€Tenn.€Code€Ann.€ðð€29„26„Ð ô$D # Ð115(a)(1)ððs€requirements,€she€has€overlooked€Dr.€Wolfððs€two€affidavits€in€which€he€states€quiteÐ à%0!$ Ðclearly€that€he€is€familiar€with€the€applicable€standard€of€care.׃ ×Ý ƒ#ÃÝòòÚ  Ú22Ú  ÚóóÝ  Ý×  ×€€If€Dr.€Dunbar€is€arguing€that€Dr.Ð Ì&"% ÐWolf€conceded€that€he€does€not€possess€the€knowledge€necessary€to€formulate€an€opinion€regardingÐ ¸'#& Ðthe€standard€of€care€in€Nashville,€she€has€either€misunderstood€what€Dr.€Wolf€said€in€his€depositionÐ ¤(ô#' Ðor€has€chosen€to€take€Dr.€Wolfððs€statements€out€of€context.Ð )à$( Їà  àPrior€to€the€exchange€on€which€Dr.€Dunbar€bases€her€argument,€the€following€exchangeÐ ° Ðbetween€Dr.€Dunbarððs€lawyer€and€Mr.€Wolf€occurred:Ð œì ÐÌà8  àà8` Ð Ð àà ¸ àQ.à  àIs€the€reason€youððre€referring€them€to€Dr.€Eskin,€theÐ tÄ Ðgeneral€surgeon,€is€because€they€have€problems€within€the€specialtyÐ `° Ðof€general€surgery?ÐL œ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.à  àNo.€€Most€of€the€time€the€reason€is€because€theyððve€gotÐ $ t Ðother€medical€problems.€Marshall€Medical€Center€does€not€have€aÐ  ` Ðpulmonologist.€€We€do€not€have€full„time€cardiologists.€€We€have€aÐ ü L  Ðnephrologist€that€comes€periodically€for€dialysis.€€While€it€can€beÐ è 8  Ðdone,€it€is€a€difficult€thing€to€get€done.€€As€far€as€in€the€field€„€„€in€myÐ Ô$  Ðfield€of€general€surgery€.€.€.€I€feel€that€the€OR€and€the€OR€staff€isÐ À  Ðcapable€of€doing€anything€that€I€am€capable€of€doing;€however,€manyÐ ¬ü  Ðof€them€[the€patients€being€referred€to€St.€Thomas]€have€multipleÐ ˜è  Ðmedical€problems€that€the€internists€do€not€feel€comfortableÐ „Ô  Ðmanaging.€€And,€honestly,€I€do€not€feel€comfortable€managing€if€theyÐ pÀ Ðdo€not€want€to€help€me€with€it.Ð\¬` x` x ÐÌDr.€Wolfððs€answer€clearly€demonstrates€that€the€reason€why€he€refers€some€general€surgery€patientsÐ 4„ Ðto€St.€Thomas€is€not€because€he€does€not€know€how€to€treat€them,€but€rather€because€these€patientsÐ  p Ðhave€other€medical€problems€for€which€other€specialists€are€not,€as€a€practical€matter,€available.€€Dr.Ð  \ ÐWolfððs€candid€acknowledgment€of€the€practical€limitations€on€a€rural€practice€of€medicine€does€notÐ øH Ðundermine€his€assertion€that€his€training,€experience,€and€background€have€equipped€him€with€theÐ ä4 Ðknowledge€of€the€acceptable€standard€of€professional€practice€for€general€surgeons€working€inÐ Ð  ÐNashville€or€similar€communities€with€regard€to€the€care€and€treatment€of€patients€like€DollyÐ ¼  ÐChurch.׃×Ý ƒ#ÃÝòòÚ  Ú23Ú  ÚóóÝ  Ý×  ׀Р¨ø ÐÌà@)ìàò òB.ó óˆÐ €Ð Ðà@¬ ¬ ìàòòò òMs.€Churchððs€Causation€Evidenceó óóóˆÐ l¼ ÐÌà  àDr.€Dunbar,€like€Dr.€Perales,€challenges€the€adequacy€of€the€evidence€in€Dr.€Wolfððs€affidavitÐ D!” Ðand€deposition€on€the€issue€of€causation.€€We€have€already€pointed€out€at€some€length€the€injuriesÐ 0"€  ÐDr.€Wolf€opines€Ms.€Church€suffered€because€of€the€delay€in€diagnosing€and€treating€her€perforatedÐ #l! Ðbowel.€€Dr.€Wolf€stated€that€Ms.€Church€experienced€further€sickness,€unnecessary€pain,€and€aÐ $X" Ðsignificantly€extended€recuperative€period€as€a€result€of€these€delays.€€At€the€conclusion€of€one€ofÐ ô$D # Ðhis€affidavits,€Dr.€Wolf€stated€that€ð ð[a]ll€of€the€opinions€I€have€expressed€herein€are€based€upon€aÐ à%0!$ Ðreasonable€degree€of€medical€certainly.ðð€€That€assertion€is€sufficient€to€create€a€genuine,€materialÐ Ì&"% Ðfactual€dispute€sufficient€to€prevent€the€granting€of€a€summary€judgment,Ð ¸'#& Їà@‹‹)ìàò òòòC.ó óóóˆÐ ° Ðà@è è ìàò òòòDr.€Wolfððs€Contradictory€Testimonyóóó óˆÐ œì ÐÌà  àAs€a€final€matter,€Dr.€Dunbar€asserts€that€Dr.€Wolfððs€testimony€should€be€disregardedÐ tÄ Ðbecause€€it€is€irreconcilably€contradictory.€€While€a€number€of€Dr.€Wolfððs€answers€in€his€FebruaryÐ `° Ð25,€1997€deposition€are€not€free€from€ambiguity,€we€do€not€find€that€they€flatly€contradict€the€laterÐ L œ Ðstatements€in€his€May€10,€1997€affidavit.Ð 8 ˆ ÐÌà  àTennessee€follows€the€rule€that€contradictory€statements€by€the€same€witness€regarding€aÐ  ` Ðsingle€fact€cancel€each€other€out.€€òòSee€State€v.€Matthewsóó,€888€S.W.2d€446,€449€(Tenn.€Crim.€App.Ð ü L  Ð1993);€òòGambill€v.€Middle€Tenn.€Med.€Ctr.óó,€751€S.W.2d€at€149„50.€€The€Tennessee€Supreme€CourtÐ è 8  Ðhas€characterized€mutually€contradictory€statements€by€the€same€witness€as€ð ðno€evidenceðð€of€the€factÐ Ô$  Ðsought€to€be€proved.€€òòSee€Johnston€v.€Cincinnati€N.O.€&€T.P.€Ry.óó,€146€Tenn.€135,€160,€240€S.W.€429,Ð À  Ð436€(1922).€€However,€in€order€to€be€disregarded€under€the€so„called€cancellation€rule,€the€allegedlyÐ ¬ü  Ðcontradictory€statements€must€be€unexplained€and€neither€statement€can€be€corroborated€by€otherÐ ˜è  Ðcompetent€evidence.€€òòSee€State€v.€Matthewsóó,€888€S.W.2d€at€450;€òòGambill€v.€Middle€Tenn.€Med.€Ctr.óó,Ð „Ô  Ð751€S.W.2d€at€151.€€When€the€cancellation€rule€is€invoked€at€the€summary€judgment€stage€toÐ pÀ Ðchallenge€evidence€opposing€the€motion,€the€courts€must€view€the€challenged€evidence€in€the€lightÐ \¬ Ðmost€favorable€to€the€opponent€of€the€motion.€€Ð H˜ ÐÌà  àThe€dispute€on€which€Dr.€Dunbar€relies€involves€Dr.€Wolfððs€opinion€concerning€when€Ms.Ð  p ÐChurchððs€physicians€violated€the€applicable€standard€of€care.€€Dr.€Wolf€stated€in€his€May€10,€1997Ð  \ Ðaffidavit€that€Drs.€Perales,€Dunbar,€and€Ross€ð ðdeviated€from€the€recognized€and€acceptable€standardÐ øH Ðof€medical€care€.€.€.€in€that€they€failed€to€timely€diagnose€the€perforation€of€the€small€bowel.ðð€He€alsoÐ ä4 Ðstated€that€ð ðthe€delay€in€diagnosis€of€nine€days€following€the€first€surgery€was€excessive€consideringÐ Ð  Ðthe€clinical€evidence€strongly€suggestive€of€an€intra„abdominal€process€as€the€source€of€the€patientððsÐ ¼  Ðproblems.ðð€€However,€as€a€result€of€skillful€cross„examination€during€his€February€25,€1997Ð ¨ø Ðdeposition,€Dr.€Wolf€stated€that€applicable€standard€of€care€was€not€violated€until€March€29,€1995,€Ð ”ä Ðseven€days€after€Ms.€Churchððs€first€surgery.€€We€do€not€believe€that€these€statements€areÐ €Ð Ðirreconcilably€inconsistent€in€light€of€the€fact€that€Ms.€Churchððs€malpractice€claim€is€for€delay€inÐ l¼ Ðdiagnosis€and€treatment.Ð X ¨ ÐÌà  àDr.€Wolfððs€testimony€regarding€when€the€physiciansðð€delay€in€diagnosing€and€treating€Ms.Ð 0"€  ÐChurch€became€negligent€is€certainly€not€linear.€€He€resisted€the€lawyersðð€efforts€to€pin€him€downÐ #l! Ðon€a€precise€date€when€the€failure€to€diagnose€and€treat€became€negligent.€€Eventually,€he€stated€thatÐ $X" Ðthe€delay€became€negligent€on€March€29,€1995,€after€the€return€of€the€results€of€the€second€CT€scan.€Ð ô$D # ÐAt€that€time,€he€opined,€the€standard€of€care€required€Ms.€Churchððs€physicians€to€begin€preparingÐ à%0!$ ÐMs.€Church€for€another€exploratory€laparotomy€in€order€to€either€rule€out€or€address€the€existenceÐ Ì&"% Ðof€an€intra„abdominal€process.€€He€also€opined€that€this€surgery€should€have€been€performed€on€theÐ ¸'#& Ðevening€of€March€29,€1995,€or,€at€the€latest,€on€the€morning€of€March€30,€1995.€€Accordingly,€heÐ ¤(ô#' Ðfaulted€the€physicians€for€waiting€until€March€31,€1995€to€decide€to€perform€another€exploratoryÐ )à$( Ðlaparotomy€on€Ms.€Church.Ð |*Ì%) Ðâ âÐ h+¸&* Ðà  àThe€testimony€relied€on€by€Dr.€Dunbar€to€create€an€irreconcilable€conflict€for€the€most€partÐ ° Ðâ âinvolves€Ms.€Churchððs€treatment€between€March€22€and€March€29,€1995.€€The€point€that€Dr.€WolfÐ œì Ðwas€tying€to€make€was€that€Ms.€Churchððs€symptoms€and€the€results€of€her€tests€did€not€rule€out€theÐ ˆØ Ðpossibility€that€her€condition€was€due€to€an€intra„abdominal€process.€€While€Dr.€Wolf€questionedÐ tÄ Ðwhy€the€medical€records€did€not€indicate€that€the€physicians€were€actively€considering€the€possibilityÐ `° Ðof€an€intra„abdominal€process,€he€stated€that€he€could€not€fault€the€treatment€path€the€physicians€wereÐ L œ Ðfollowing€prior€to€March€29,€1995.׃3×Ý ƒ#ÃÝòòÚ  Ú24Ú  ÚóóÝ  Ý×  ×€€Viewing€the€whole€of€Dr.€Wolfððs€testimony€in€its€mostÐ 8 ˆ Ðfavorable€light,€it€seems€that€the€point€he€was€trying€to€make€was€that€the€physicians€attending€Ms.Ð $ t ÐChurch€should€have€decided€to€perform€another€exploratory€laparotomy€by€no€later€than€March€29,Ð  ` Ð1995.€€As€Dr.€Wolf€put€it:Ð ü L  ÐÌà8  àà8` Ð Ð àWhat€I€am€saying€is€that€up€until€[March]€29th€Dolly€Church€did€notÐ Ô$  Ðhave€a€normal,€usual€or€even€acceptable€post„operative€course.€€ManyÐ À  Ðflags€were€raised€questioning€it;€however,€the€culmination€is€with€allÐ ¬ü  Ðthese€flags€being€raised€by€the€29th,€the€fact€that€she€was€no€longerÐ ˜è  Ðexplored,€yes,€I€feel€thereððs€a€violation.Ð„Ô ` x` x ÐÌà  àA€number€of€Dr.€Wolfððs€opinions€lack€precision,€and€this€lack€of€precision€may€eventuallyÐ \¬ Ðundermine€the€weight€of€Dr.€Wolfððs€testimony€in€the€eyes€of€a€jury.€€However,€it€is€not€our€task€toÐ H˜ Ðweigh€the€evidence€at€this€stage€of€the€proceeding,€and€we€do€not€find€Dr.€Wolfððs€testimony€to€beÐ 4„ Ðso€ð ðvery€flat€and€unexplainedðð׃7×Ý ƒ#ÃÝòòÚ  Ú25Ú  ÚóóÝ  Ý×  ×€as€to€require€us€to€disregard€it€completely.€€Thus,€to€the€extent€thatÐ  p Ðit€found€Dr.€Wolfððs€testimony€to€be€irreconcilable€and€ð ðuntrustworthy,ðð€as€Dr.€Dunbar€suggests,€theÐ  \ Ðtrial€court€erred€by€disregarding€Dr.€Wolfððs€opinions.Ð øH ÐÌà@dd)ìàò òIV.ó óˆÐ Ð  Ðà@O O ìàòòò òThe€Malpractice€Claim€Against€Dr.€Rossó óóóˆÐ ¼  ÐÌà  àMs.€Church€also€challenges€the€trial€courtððs€decision€to€summarily€dismiss€her€malpracticeÐ ”ä Ðclaim€against€Dr.€Ross,€the€gynecologist€who€was€covering€for€Dr.€Perales€after€March€29,€1995.€Ð €Ð ÐDr.€Ross€contends€that€he€is€entitled€to€a€summary€judgment€because€Ms.€Churchððs€evidence€doesÐ l¼ Ðnot€establish,€as€Tenn.€Code€Ann.€ðð€29„26„115(a)(3)€requires,€that€she€suffered€an€injury€at€his€handsÐ X ¨ Ðthat€would€not€otherwise€have€occurred.€€We€disagree.Ð D!” ÐÌà  àInjury€is€any€wrong€or€damage€done€to€another.€€òòSeeóó€òòVance€v.€Schulderóó,€547€S.W.2d€927,€932Ð #l! Ð(Tenn.€1977).€€Legally€speaking,€to€injure€another€person€signifies€an€act€or€omission€against€Ô_ÔthatÐ $X" Ðpersonððs€rights€that€results€in€some€damage.€€òòSeeóó€òòBarnes€v.€Kyleóó,€202€Tenn.€529,€536,€306€S.W.2dÐ ° Ð1,€4€(1957).€€Any€want€of€skillful€care€or€diligence€on€a€physicianððs€part€that€sets€back€a€patientððsÐ œì Ðrecovery,€prolongs€the€patientððs€illness,€increases€the€plaintiffððs€suffering,€or,€in€short,€makes€theÐ ˆØ Ðpatientððs€condition€worse€than€if€due€skill,€care,€and€diligence€had€been€used,€constitutes€injury€forÐ tÄ Ðthe€purpose€of€a€medical€malpractice€claim.€€òòSeeóó€òòÔ_ÔBorylaÔ_Ô€v.€Ô_ÔPashÔ_Ôóó,€960€P.2d€123,€129€(Colo.€1998)òò;Ð `° ÐRogers€v.€Ô_ÔKeeÔ_Ôóó,€137€N.W.260,€265€(Mich.€1912);€òòÔ_ÔBechardÔ_Ô€v.€Ô_ÔEisingerÔ_Ôóó,€481€Ô_ÔN.Y.S.Ô_Ô€2d€906,€908€(App.Ð L œ ÐDiv.€1984);€òòÔ_ÔTomcikÔ_Ô€v.€Ohio€Ô_ÔDepððtÔ_Ô€of€Rehabilitation€&€Correctionóó,€598€N.E.2d€900,€902€(Ohio€Ct.Ð 8 ˆ ÐCl.€1991).€Ð $ t ÐÌà  àDr.€Ross€supports€his€argument€by€pointing€to€Dr.€Wolfððs€answer€to€one€question€in€hisÐ ü L  ÐFebruary€25,€1997€deposition.€€At€one€point€during€the€questioning€by€Dr.€Rossððs€lawyer,€theÐ è 8  Ðfollowing€exchange€occurred:Ð Ô$  ÐÌà8  àà8` Ð Ð àQ.à ¸ àDoctor€[Wolf],€what€injury€to€Mrs.€Church€did€the€one„dayÐ ¬ü  Ðdelay,€from€the€time€Dr.€Ross€became€involved€in€the€case€until€sheÐ ˜è  Ðwas€actually€taken€to€surgery€on€March€31st,€cause€Mrs.€Church€thatÐ „Ô  Ðshe€would€not€have€otherwise€suffered?ÐpÀ` x` x ÐÌà8  àà8` Ð Ð àA.à0¸ ` x` xàThere€is€no€way€of€knowing.ÐH˜¸ x¸ x ÐÌBased€on€that€answer,€Dr.€Ross,€citing€the€well„established€tenet€that€a€verdict€cannot€be€based€onÐ  p Ðmere€speculation,€conjecture,€and€guesswork,€òòseeóó€òòÔ_ÔSadekÔ_Ô€v.€Nashville€Recycling€Co.óó,€751€S.W.2d€428,Ð  \ Ð431€(Tenn.€Ct.€App.€1988),€argues€that€any€attribution€to€him€of€any€of€Ms.€Churchððs€injuriesÐ øH Ðrequires€engaging€in€impermissible€speculation.€Ð ä4 ÐÌà  àDr.€Rossððs€argument€overlooks€Dr.€Wolfððs€May€12,€1997€affidavit€in€which€Dr.€Wolf€statesÐ ¼  Ðthat€the€deviations€from€the€acceptable€standard€of€care€by€Ms.€Churchððs€physicians€during€her€post„Ð ¨ø Ðoperative€care€ð ðcaused€Dolly€Church€to€get€sicker€.€.€..ðð€€Dr.€Wolfððs€use€of€the€term€ð ðsickerðð€was€all„Ð ”ä Ðencompassing.€€Elsewhere€in€his€affidavit,€Dr.€Wolf€details€what€ð ðsickerðð€entailed€ð!ð€weight€gain,€aÐ €Ð Ðstretched„out€abdomen,€abdominal€pain,€elevated€white€corpuscle€blood€count,€fever,€bodilyÐ l¼ Ðweakness,€body€system€poisoning,€and€compromise€of€body€functions.€€He€also€opined€that€the€delayÐ X ¨ Ðin€diagnosing€and€treating€Ms.€Churchððs€perforated€bowel€caused€her€to€suffer€and€prolonged€herÐ D!” Ðrecovery€process.€€All€of€these€diminutions€in€Ms.€Churchððs€well„being€fit€the€legal€concept€of€injuryÐ 0"€  Ðto€the€extent€that€she€suffered€them€due€to€the€wrongful€acts€of€her€physicians.Ð #l! ÐÌà  àDr.€Wolf€explicitly€states€in€his€May€12,€1997€affidavit€that€part€of€the€worsening€of€Ms.Ð ô$D # ÐChurchððs€condition€occurred€between€March€29,€1995,€and€March€31,€1995,€after€Dr.€Ross€hadÐ à%0!$ Ðstarted€to€cover€for€Dr.€Ô_ÔPeralesÔ_Ô.€€Viewing€the€evidence€most€favorably€to€Ms.€Church,€she€hasÐ Ì&"% Ðdemonstrated€the€existence€of€a€triable€issue€of€fact€on€whether€she€suffered€injury€during€the€timeÐ ¸'#& Ðthat€Dr.€Ross€was€attending€her.€€Ð ¤(ô#' ÐÌà  àIt€does€not€matter€that€Ms.€Churchððs€evidence€does€not€establish€the€full€extent€of€the€injuriesÐ |*Ì%) Ðshe€may€have€suffered€under€Dr.€Rossððs€care.€€The€extent€of€injury€is€not€a€proper€inquiry€at€theÐ h+¸&* Ðsummary€judgment€stage.€€The€law€prohibits€damages€as€too€speculative€only€when€the€existence€ofÐ T,¤'+ Ðdamage€is€uncertain,€not€when€merely€the€amount€of€damage€is€uncertain.€€òòSeeóó€òòÔ_ÔOverstreetÔ_Ô€v.Ð ° ÐÔ_ÔShoneyÔ_Ôððs,€Inc.óó,€4€S.W.3d€694,€703€(Tenn.€Ct.€App.€1999).€€Analogously,€the€plaintiff€facing€aÐ œì Ðsummary€judgment€in€a€medical€malpractice€case€must€demonstrate€only€that€he€or€she€has€beenÐ ˆØ Ðinjured.€€The€question€of€how€much€the€plaintiff€has€been€injured€should€be€left€for€the€trier€of€fact.€Ð tÄ ÐIn€this€case€Ms.€Churchððs€evidence€created€an€issue€of€fact€concerning€whether€Dr.€Ross€injured€her.€Ð `° ÐWith€that€material€fact€in€dispute,€the€trial€court€should€have€declined€to€award€Dr.€Ross€a€summaryÐ L œ Ðjudgment.Ð 8 ˆ ÐÌà@‹‹)ìàòòò òV.ó óóóˆÐ  ` ÐÌà  àOur€opinion€in€this€case€should€not€be€construed€as€fixing€liability€on€Drs.€Ô_ÔPeralesÔ_Ô,€Dunbar,Ð è 8  Ðand€Ross€or€even€as€intimating€that€Ms.€Church€has€a€strong€case.€€We€have€decided€only€that€theÐ Ô$  Ðtrial€court€should€not€have€granted€the€summary€judgment€to€dispose€of€Ms.€Churchððs€medicalÐ À  Ðmalpractice€claims€against€Drs.€Ô_ÔPeralesÔ_Ô,€Dunbar,€and€Ross€based€on€their€alleged€delay€in€diagnosingÐ ¬ü  Ðand€treating€her€perforated€bowel€and€the€intra„abdominal€process€it€caused.€€Accordingly,€we€affirmÐ ˜è  Ðthe€summary€judgment€dismissing€Ms.€Churchððs€medical€battery€and€informed€consent€claimsÐ „Ô  Ðagainst€Dr.€Ô_ÔPeralesÔ_Ô€and€vacate€the€summary€judgments€dismissing€Ms.€Churchððs€medical€malpracticeÐ pÀ Ðclaims€against€Drs.€Ô_ÔPeralesÔ_Ô,€Dunbar,€and€Ross.€€We€remand€the€case€to€the€trial€court€for€furtherÐ \¬ Ðproceedings€consistent€with€this€opinion€and€tax€the€costs€of€this€appeal€jointly€and€severally€toÐ H˜ ÐMaria€Ô_ÔPeralesÔ_Ô,€Laura€Dunbar,€and€Stephen€J.€Ross€for€which€execution,€if€necessary,€may€issue.Ð 4„ ÐÌÌà  àà ` àà ¸ àà  àà h àà À àà  à__________________________________Ð øH Ðà  àà ` àà ¸ àà  àà h àà À àà  àWILLIAM€C.€KOCH,€JR.,€JUDGE€Ô#†X)üXXXµ‹#ÔÐ ä4 ÐÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àà  àà x à