WPC  # VUNa % 0Nb 0 w@ 4$ 8 m: Q ` h p 0J 0T@ 0^ 0h 0rZ 0| 0H 0 1u^ 0dU>7B)u BDC AMU*K/u D3v~vU 0@( AOh 0D} D/ BHP LaserJet 4Si/4SiMX PS 600dpiPSCRIPT0nLH'"  Z 6Times New Roman Regular(&y$   - -((2H>$ y!     XXX   `   0   )*+D,-e.//0e1Ӏ;D U3|x; frakes v. cardiology consultants - concurring opinioni (Cantrell)   ' IB011C20IB011C2 .   2 0Indent123  2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23   ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X<  9p`(&Times New Roman% Line 7 d d$$$$7Border 1dd-&C << G<  9p`(Arial % !  #d###   ((   YYY FILED(XAugust29,1997CecilW.CrowsonAppellateCourtClerk  %%%%'dxdPtPtHH(FG(HH(d'hStyl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   h HD: Geneva  h HD: Geneva ("$    -C<< CLevel 1Level 2Level 3Level 4Level 5($$   1  ' dxdP Pd ! . ##         X \RA'\\RA'\7ud d7    #ԛ @ INTHECOURTOFAPPEALSOFTENNESSEE@ MIDDLESECTIONATNASHVILLE #JANICEM.FRAKES,   )survivingspousesof   )GARYD.FRAKES,   )      ) Plaintiff/Appellant,  )      ) DavidsonCircuit      ) No.94C2155VS.      )      ) AppealNo.      ) 01A019702CV00069̜R')&A1-j|l`  `@RߛCARDIOLOGYCONSULTANTS, )P.C.,and     )HARRYL.PAGE,JR.,M.D.,  )      ) Defendants/Appellees.  )#@ CONCURRINGOPINION # Thiscasepresentsthiscourtsfirstoccasiontoconfrontquestionsconcerningtheuseofclinicalpracticeguidelinesinamedicalmalpracticecase.WhileIconcurwiththecourtsconclusionthatthetrialcourtdidnotcommitreversibleerrorbyadmittingthe ExerciseTestParametersAssociatedWithPoorPrognosisand/orIncreasedSeverityofCADguidelinesintoevidence,wemustatsomepointaddresstheproceduralandsubstantiveaspectsofusingguidelinessuchasthese. Clinicalpracticeguidelineshaveemergedwithinthepastfewyearsasoneofthemedicalprofessionsresponsestotheperceivedshortcomingsinmedicalpractice.ClarkC._Havighurst_,PracticeGuidelinesasLegalStandardsGoverningPhysicianLiability,54Law&Contemp._Probs_.87,88(1991)( _Havighurst_).Theyconsistofsystematicallydevelopedstatementsdesignedtoassistthepractitionerandpatientinmakingdecisionsaboutappropriatehealthcareinspecificclinicalcircumstances.Ratherthanbeingameresamplingofprofessionalopinion,theseguidelinesprovideconsensusstandardsofconductthatarebothclearerandmorerationalthanthosecurrentlyusedtoidentifyprofessionalnegligence. Legislaturesandcourtshaveyettodeterminehow_triers_Ԅoffactshouldusepracticeguidelines.Theycanbeextremelyhelpfulincasescallingintoquestionwhetheraphysicianchosethewrongcourseofdiagnosisortreatmentorshouldhavegonefurtherinattemptingtounderstandorcorrectthesituation.See_Havighurst_,supra,54Law&Contemp._Probs_.at95.However,theyshouldnotnecessarilybeviewedasconclusiveevidenceofthestandardofcare.Proofofcompliancewithpracticeguidelinesshouldnotnecessarilyestablishduecare;justasproofofnoncomplianceshouldnotestablishnegligenceperse. Clinicalpracticeguidelinescanmateriallyassistthe_triers_Ԅoffactinmedicalmalpracticecases.Properlyauthenticatedclinicalpracticeguidelinesarerelevanttothequestionoftheproperstandardofcareandshouldbeadmittedassubstantiveevidenceifintroducedthroughawitnesswhocanlayaproperfoundation.TheyshouldnotbeequatedwithlearnedtreatisesthatcanonlybeusedforimpeachmentunderTenn.R._Evid_.618.      _____________________________      WILLIAMC.KOCH,JR.,JUDGE