ÿWPCw ¥e¶õø $Iìe(9Ç3;WåIwŸË‚èŒçéß_ ›E¨üGmì(d­û6âÒqµ*|ÜW‡‹þÈ7³²pó]öÇtÛ,´sÛFeà7»ê‡Â$yÖQ ͨn`d½`D( 0Én9å’ðûlU›Z,ø¿EFÚJ}¬D¯•êf,wå<óYú÷KiÎ]ãYh×6M½âãO3šmƒ@[¤{u‘™é9,¤ò® dUPŠîÇ$ªá.šXy¨”f…ŸvÑWޝo=±8¼H:í[˜ÁµJ[W+Z¯,¥“½Ø~ȾPŸÝíÙ²ê†r£².}/Ñ38°9q J‘¸÷Myù®ÁkPœ®4f~ü¸ Q€Ñ»É·R*oôõ]©ÃË9NðC<Šnùbf>†ŠøIí†Ü÷;¨Àvéßz`>_ëÔí¦ ºÜÿòáf”Õ aI”…4Ð~x° ½Yç ×è”ašÂO ù¥L‹@4ûYËdðNœÕ@?ÕEP™v°3€î¶!ºFiÔësC,tY„‰R’g[!W@X¬ØV D`|gZaƒ0 ÂO%ù®=W# ÂUNÍ % 04!bU 0Ï], b4 N< ^ > w@J 4Š ž 0D­ ñ mó ó   U  UiUN¾v ô‚UNvvÄô:UN.|U:€º AQ¾Æ 0DÕ 0D 0D]U:¡ D/ÛÛ B  D3''''''''''''''''''''''''''''''''''''''''''''' BZ˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(í€"  Z6Times New Roman Regular»( ¤U$¡¡Ó  Ó- ù-((2K¹$¤¤Ý ƒ¤U!ÝÓ  ÓÝ  ÝÒ°ÒÒX°ÒÔ€XxX»»ÔÑ  ÑÑÑà ` àòòÚ  Ú0Ú  Úóó - ù-¶ˆ'c eEDDb D Ó€©yË&„£‚3|x(#Ã$òòÚ  Ú0Ú  ÚóóÿU‹ÿÀÀÀ Ý ƒK¹$ÝÓ  ÓÒ°ÒÒX°ÒÔ€XxX»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú1Ú  ÚóóÝ  ÝÔ_ÔEven€though€the€record€contains€no€evidence€of€any€conversations€between€Dr.€Case€andÐ ° ÐMs.€Jennings€after€April€19,€1996,€Dr.€Case€states€in€his€brief€that€Ms.€Jennings€once€called€him€atÏhis€home€after€he€had€referred€her€to€Dr.€Stewart.€€This€information€cannot€be€considered€at€this€stageÏof€the€proceedings. KÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€XÏnX»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝÔ_ÔBased€on€the€facts€that€Dr.€Rubin€relied€upon,€we€can,€at€this€stage€of€the€litigation,€rule€outÐ ° Ðthe€possibility€that€Ms.€Jennings€is€asserting€(1)€that€Dr.€Case€is€somehow€vicariously€liable€for€Dr.ÏStewartððs€care,€(2)€that€Dr.€Case€waited€too€long€to€refer€Ms.€Jennings€to€a€specialist,€and€(3)€thatÏDr.€Case€was€somehow€negligent€by€deciding€to€refer€Ms.€Jennings€to€Dr.€Stewart. KÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X$X»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝÔ_ÔBased€on€the€facts€that€Dr.€Rubin€relied€upon,€we€can,€at€this€stage€of€the€litigation,€rule€outÐ ° Ðthe€possibility€that€Ms.€Jennings€is€asserting€(1)€that€Dr.€Case€is€somehow€vicariously€liable€for€Dr.ÏStewartððs€care,€(2)€that€Dr.€Case€waited€too€long€to€refer€Ms.€Jennings€to€a€specialist,€and€(3)€thatÏDr.€Case€was€somehow€negligent€by€deciding€to€refer€Ms.€Jennings€to€Dr.€Stewart.(í€"  Z6Times New Roman Regular lÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€XÏnX»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú4Ú  ÚóóÝ  ÝÔ_ÔExcept€for€Dr.€Rubinððs€assertions,€I€can€find€no€reported€case€confirming€that€this€is€theÐ ° Ðstandard€of€care€when€a€physician€refers€a€patient€to€a€specialist.€ êÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X$X»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝÔ_ÔThe€court€makes€only€a€passing€reference€to€the€fact€that€Drs.€Case€and€Stewart€did€notÐ ° Ðdiscuss€the€results€of€the€post„referral€nerve€conduction€study€and€no€reference€to€Dr.€RubinððsÏopinion€that€Dr.€Case€was€negligent€for€failing€to€initiate€vascular€testing€prior€to€April€19,€1996.(í€"  Z6Times New Roman Regular lÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X$X»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú4Ú  ÚóóÝ  ÝÔ_ÔExcept€for€Dr.€Rubinððs€assertions,€I€can€find€no€reported€case€confirming€that€this€is€theÐ ° Ðstandard€of€care€when€a€physician€refers€a€patient€to€a€specialist.€ êÝ ƒK$ÝÓ  ÓÒ°ÒÒX°ÒÔ€XÏnX»»ÔÑ @ ÑÑ@Ñà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝÔ_ÔThe€court€makes€only€a€passing€reference€to€the€fact€that€Drs.€Case€and€Stewart€did€notÐ ° Ðdiscuss€the€results€of€the€post„referral€nerve€conduction€study€and€no€reference€to€Dr.€RubinððsÏopinion€that€Dr.€Case€was€negligent€for€failing€to€initiate€vascular€testing€prior€to€April€19,€1996.(í€"  Z6Times New Roman Regular úÝ ƒ"¯"ÝÝ  ÝÔ€»€© »»»ÔÔ€µê »»€©ÔÓ  Óò òÔ Ad ÔFILEDÔ€XXµêÔÐ  ÐÌAugust€18,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó,@ÓÐAZ‹"Arial Regular úÝ ƒ"¯"ÝÝ  ÝÔ€%»€© »»»ÔÔ€%µê »%»€©ÔÓ  Óò òÔ Ad ÔFILEDÔ€%XX%µêÔÐ  ÐÌAugust€12,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAhÔó ó!"#$&Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý(3¯$££Ý ƒ!ÝÝ  Ý($$””ò òÚ  Ú1Ú  Úó ó,@ÓÐAZ‹"Arial Regular(('÷ÿ dxdüÿP PdVVVV'ÿÿdxd dÝ ƒ¤U!ÝÓ  ÓÝ  ÝÔ_ÔÒX°ÒÒ°ÒññÑ„°ÑññÑTR[¤ AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÑ€ÑÑ7€ç_»»ddÈ7ÑÑ  ÑÑ  ÑÔ_ÔÔ€„s„»»Ôò òÔ_Ôñññ ñßr€ )<,(j 8` `€€@E ±` 8ttxPX°ð  rßñ ñññññßr€ )<,(j 8` `€€@E ±` 8ttxPX°ð  rßññà@¡ ¡ DàIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@ÜÜ)DàAT€NASHVILLEó óÔ€¼g\¼„„sԈРh ÐÌÌGLENDA€JENNINGS,€et€virà0 À àà0À€%À€%à)Ь ü€%€% ÐKEITH€JENNINGS,à0 h àà0Àh€%h€%àà0À€%À€%à)Р€%€% Ðà ` àà ¸ àà  àà h àà À àà  à)Ìà ` àPlaintiffs/Appellants,à0 À àà0À€%À€%à)Ðî >€%€% Ðà ` àà ¸ àà  àà h àà À àà  à)à0 p àÐT p€%p€% ÐVS.à0 ` àà0¸ ` €%` €%àà0¸ €%¸ €%àà0h€%€%àà0Àh€%h€%àà0À€%À€%à)à0p€%€%àSumner€CircuitÐj p€%p€% Ðà ` àà ¸ àà  àà h àà À àà  à)à0 p àNo.€16129„CÐ0€ p€%p€% ÐKENNETH€CASE,€M.D.;à0 À àà0À€%À€%à)ÐF– €%€% ÐSANDERS€AND€CASE€MEDICALà0  à)Ð\¬ €%€% ÐCLINIC,€P.C.;à0  àà0h€%€%àà0Àh€%h€%àà0À€%À€%à)à0p€%€%àAppeal€No.Ðr p€%p€% ÐW.€DAVID€STEWART,€M.D.;€andà0  à)à0p€%€%à01A01„9804„CV„00192ЈØp€%p€% ÐASSOCIATED€SURGEONS,à0 À àà0À€%À€%à)Оî€%€% Ðà ` àà ¸ àà  àà h àà À àà  à)Ìà ` àDefendants/Appellees.à0 À àà0À€%À€%à)ÐÊ€%€% ÐÌÔ€„s„¼¼g\ÔÌÑ€ÑÑ7€ç_¼»d»»d7ÑÑ  Ñà@ýý,Dàò òÔ‡ wô „„sÔOPINIONó óˆÐ ^® ÐÓ€Óà@‹ ‹ Dàòòò òCONCURRING€IN€PART€AND€DISSENTING€IN€PARTóóÔ#†„s„  wô3 #ÔÔ‡¼g\¼„„sÔó óˆÐ žî ÐÌà ` àI€concur€with€the€courtððs€conclusion€that€material€factual€disputes€created€byÏDr.€Rubinððs€affidavits€prevent€granting€a€summary€judgment€for€Dr.€Stewart.€ÏHowever,€I€file€this€separate€opinion€because€I€cannot€concur€with€the€courtððsÏconclusion€that€Dr.€Rubinððs€affidavits€likewise€doom€the€summary€judgment€for€Dr.ÏCase.€€Notwithstanding€Dr.€Rubinððs€rather€expansive€and€largely€unsubstantiatedÏnotions€about€the€standard€of€care€of€referring€physicians,€the€court€has€overlookedÏan€ineluctable€ingredient€to€malpractice€liability.€€A€negligent€act€or€omission€by€aÏphysician€does€not€give€rise€to€liability€unless€it€caused€the€patient€to€suffer€injuriesÏthat€he€or€she€would€not€otherwise€have€suffered.ÌÌà@ùù.Dàò òI.ó óˆÐ i0¹+- ÐÌà ` àDr.€Kenneth€Case€saw€Ms.€Jennings€on€three€occasions€between€April€5€andÏApril€19,€1996€for€complaints€of€left€arm€pain€from€her€elbow€to€her€hand.€€He€firstÏdiagnosed€her€condition€as€tendinitis€and€repetitive€use€syndrome.€€When€Dr.€CaseÏexamined€Ms.€Jennings€on€April€19,€1996€and€discovered€that€she€had€developed€blueÏnail€beds,€he€suspected€that€she€might€be€suffering€from€thoracic€outlet€syndrome€andÏreferred€her€to€Dr.€W.€David€Stewart,€a€vascular€surgeon.€€Dr.€Caseððs€staff€obtainedÐ Ð; 7;w Ðan€appointment€for€Ms.€Jennings€for€April€23,€1996€and€passed€along€to€Dr.€StewartÏthat€Dr.€Case€suspected€that€Ms.€Jennings€might€have€thoracic€outlet€syndrome.€€AsÏfar€as€the€record€shows,€Dr.€Case€never€saw€Ms.€Jennings€again€and€never€conferredÏfurther€with€Dr.€Stewart€about€her€case.׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€The€record€likewise€contains€no€evidenceÐ “ ã Ðthat€either€Ms.€Jennings€or€Dr.€Case€anticipated€that€they€would€have€a€continuingÏphysician„patient€relationship€following€the€referral€to€Dr.€Stewart.ÌÌà ` àDr.€Stewart€examined€Ms.€Jennings€for€the€first€and€only€time€on€April€23,Ï1996.€€He€was€fully€aware€that€Dr.€Case€suspected€thoracic€outlet€syndrome.€€BasedÏon€the€medical€history€that€Ms.€Jennings€provided€and€his€own€examination,€Dr.ÏStewart€ordered€nerve€conduction€studies€to€rule€out€the€possibility€of€carpal€tunnelÏsyndrome.€€He€also€arranged€for€a€follow„up€visit€with€Ms.€Jennings€for€May€6,€1996.€ÏDr.€Stewart€received€the€results€of€the€nerve€conduction€studies€on€April€29,€1996.€ÏThese€results€were€negative€for€carpal€tunnel€syndrome.€€Dr.€Stewart€never€discussedÏthe€results€of€these€studies€with€Dr.€Case€and€never€even€discussed€them€with€Ms.ÏJennings€because€she€did€not€keep€her€May€6,€1996€appointment.ÌÌà ` àInstead€of€keeping€her€May€6,€1996€appointment€with€Dr.€Stewart,€Ms.ÏJennings€made€a€May€7,€1996€appointment€with€Dr.€Verne€Allen,€a€neurosurgeonÏwho€had€treated€her€previously.€€Dr.€Allen€ordered€an€arteriogram€and€referred€Ms.ÏJennings€to€Dr.€Lawrence€Pass,€another€vascular€surgeon.€€Dr.€Pass€admitted€Ms.ÏJennings€to€the€hospital€on€May€9,€1996.€€She€underwent€a€series€of€vascular€surgeriesÏbeginning€on€May€13,€1996,€and€her€left€forearm€was€amputated€on€May€17,€1996.€ÏIn€the€process,€she€also€experienced€adult€respiratory€distress€syndrome€(ð ðARDSðð)Ïwhich€diminished€her€lung€capacity.ÌÌà ` àñ ñòòóóñ ñMs.€Jenningsððs€medical€malpractice€claims€are€stated€in€the€most€general€terms.€ÏHer€complaint€alleges€only€that€ð ðthe€defendants€each€violated€the€standard€ofÏreasonable€professional€medical€care€for€physicians€in€their€respective€specialty€areasÏin€their€substandard€treatment.ðð€€Later,€in€the€memorandum€in€opposition€to€theÐ í3=/: Ðmotions€for€summary€judgment,€her€lawyer€stated€that€ð ð[t]he€òògravamenóó€of€herÐ ° Ðcomplaint€is€that€both€defendants€violated€the€standard€of€care€in€the€treatment€of€her,Ïfailing€timely€and€correctly€to€diagnose€an€upper€extremity€vascular€occlusion.ðð€ÏThus,€giving€Ms.€Jennings€every€benefit€of€the€doubt,€she€sued€Dr.€Case€and€Dr.ÏStewart€for€negligence€in€diagnosing€and€treating€her€condition.ÌÌò òó óÔ#†„B„»¼{>ë #ÔÔ‡¼{>»„„BÔà ` àThe€generality€of€Ms.€Jenningsððs€claims€requires€some€judicial€guessworkÐ ,|  Ðconcerning€the€specific€acts€of€negligence€on€which€Ms.€Jennings€bases€herññeññÏmalpractice€claims€against€Dr.€Case.€€However,€because€Ms.€Jennings€must€eitherÏsupport€her€allegations€with€expert€evidence€or€risk€their€dismissal,€òòseeóó€Tenn.€CodeÐ h ÐAnn.€ðð€29„26„115(b)€(1980);€òòMoon€v.€St.€Thomas€Hosp.óó,€983€S.W.2d€225,€229€(Tenn.Ð ¼  Ð1998),€her€claims€must€be€limited€to€the€factual€bases€of€Dr.€Rubinððs€expert€opinions.€ÏAs€I€read€Dr.€Rubinððs€affidavits,€his€opinion€that€Dr.€Case€was€negligent€rests€on€theÏfollowing€three€acts€or€omissions:€first,€Dr.€Caseððs€failure€to€provide€Dr.€Stewart€withÏcopies€of€his€treatment€records;€second,€Dr.€Caseððs€failure€to€discuss€with€Dr.€StewartÏthe€results€of€the€nerve€conduction€studies€that€Dr.€Stewart€ordered;€and€third,€Dr.ÏCaseððs€failure€to€initiate€vascular€testing€prior€to€April€19,€1996.ññ׃×ññññ׃×ññÝ ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×Ð ” ä" ÐÌÔ#†„B„»¼{>_#ÔÔ‡¼{>»„„BÔà ` àThe€courtððs€decision€regarding€Dr.€Case,€as€I€understand€it,€appears€to€ññbeññññtheññÐ Ü#,& Ðlimited€to€Dr.€Rubinððs€opinion€that€Dr.€Case€was€negligent€because€he€failed€toÏprovide€Dr.€Stewart€with€his€treatment€records.ññ׃P×ññññ׃P×ññÝ ƒ#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€Accordingly,€I€assume€that€the€courtÐ $'t"* Ðhas€decided€that€Msññ.ññññ,ññ€Jennings€cannot€get€to€the€jury€on€the€other€two€factual€bases€forÏDr.€Rubinððs€opinion.€€If€my€assumption€is€correct,€I€am€in€complete€agreement€withÏthe€result€the€court€has€reached€on€these€claims.€€However,€I€would€reach€the€resultÏusing€a€different€approach€applicable€to€all€three€factual€predicates€for€Dr.€RubinððsÏopinion.€€I€would€find€that€no€reasonable€fact„finder€could€conclude,€based€on€theÏundisputed€facts,€that€neither€Dr.€Caseððs€failure€to€send€his€treatment€records€to€Dr.Ð ü0L,6 ÐStewart,€nor€his€failure€to€discuss€the€results€of€the€nerve€conduction€study€with€Dr.ÏStewart,€nor€his€failure€to€initiate€vascular€testing€before€April€19,€1996€were€a€cause„¼in„fact€of€Ms.€Jenningsððs€later€medical€complications.ÌÌà@ËË.Dàò òII.ó óˆÐ @  ÐÌà ` à€I€do€not€base€my€conclusions€in€this€case€on€any€disagreement€with€Dr.ÏRubinððs€rather€broad€assertion€that€the€applicable€standard€of€care€requires€referringÏphysicians€to€communicate€the€details€of€their€clinical€notes€to€the€specialist€to€whomÏthey€refer€a€patient.ññ׃×ññññ׃×ññÝ ƒ#ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€€For€the€purpose€of€this€appeal,€we€may€assume€that€Dr.€RubinÐ tÄ Ðis€correct€and€that€referring€physicians€have€a€duty€to€communicate€their€treatmentÏand€findings€to€the€specialist€who€will€be€taking€over€the€patientððs€treatment.€€WeÏmay€further€assume€that€telling€Dr.€Stewartððs€staff€that€Dr.€Case€suspected€thoracicÏoutlet€syndrome€did€not€comply€with€Dr.€Rubinððs€view€of€the€standard€of€care.€€MyÏconclusion€is€based€on€Ms.€Jenningsððs€failure€to€demonstrate€that€she€will€be€able€toÏprove€at€trial€that€Dr.€Caseððs€failure€to€provide€his€clinical€notes€to€Dr.€Stewart€causedÏher€later€medical€problems.ÌÌà ` àCause„in„fact€is€a€necessary€ingredient€of€every€negligence€case.€€òòSee€White€v.Ð 8"ˆ$ ÐLawrenceóó,€975€S.W.2d€525,€529€(Tenn.€1998);òò€Kilpatrick€v.€Bryantóó,€868€S.W.2d€594,Ð Ü#,& Ð597„98€(Tenn.€1993).€€€òòóóIt€has€been€written€into€the€medical€malpractice€statute.€€AÐ €%Ð ( Ðplaintiff€seeking€damages€in€a€medical€malpractice€case€must€prove€that€ð ð[a]s€aÏproximate€result€of€the€defendantððs€negligent€act€or€omission,€the€plaintiff€sufferedÏinjuries€that€would€not€otherwise€have€been€suffered.ðð€€Tenn.€Code€Ann.€ðð€29„26„115Ï(1980).€€Thus,€proof€that€a€physician€breached€the€standard€of€care€is€not€enough€toÏtake€a€medical€malpractice€case€to€the€jury.€€Along€with€evidence€of€a€breach€of€theÏstandard€of€care,€the€plaintiff€must€also€produce€evidence€from€which€the€fact„finderÏmay€reasonably€conclude€that€the€breach€of€the€standard€of€care€caused€injuries€thatÏthe€patient€would€not€otherwise€have€suffered.€€òòSee€German€v.€Nichopoulosóó,€577Ð  2ð-8 ÐS.W.2d€197,€201€(Tenn.€Ct.€App.€1978)€(holding€that€a€recovery€for€negligenceÏrequires€proof€of€a€negligent€act€that€causes€a€loss).€Ð è581< Їà ` àApplying€these€principles€to€this€case,€Ms.€Jennings€can€recover€damages€fromÏDr.€Case€only€if€she€proves€that€Dr.€Caseððs€failure€to€communicate€the€results€of€hisÏexamination€to€Dr.€€Stewart€caused€the€later€amputation€of€her€arm€and€the€ARDS€sheÏlater€experienced.€€There€is€simply€no€evidence€in€this€record€upon€which€aÏreasonable€fact„finder€could€reach€this€conclusion.€€If€anything,€the€evidence€isÏinsurmountably€to€the€contrary.ÌÌà ` àMs.€Jenningsððs€lawyer€questioned€Dr.€Stewart€in€great€detail€about€the€effectÏthat€the€absence€of€Dr.€Caseððs€clinical€notes€had€on€his€treatment€of€Ms.€Jennings.€ÏDr.€Stewartððs€answers€were€extremely€specific€and€directly€to€the€point.€€He€statedÏthat€he€knew€Dr.€Case€suspected€thoracic€outlet€syndrome€and€that€the€absence€of€Dr.ÏCaseððs€clinical€notes€made€absolutely€no€difference€in€his€examination€or€treatmentÏof€Ms.€Jennings.€€At€one€point€Dr.€Stewart€candidly€stated:ÌÓ€Óà8 ` àà8¸ ` (#` (#àà  àIt€[Ms.€Jenningsððs€history]€would€have€made€noÏdifference,€because€the€thoracic€outlet€syndrome€itself€canÏbe€responsible€for€color€changes,€and€the€fact€that€the€nailÏbeds€could€have€been€transiently€blue€would€neither€haveÏmade€the€diagnosis€nor€would€have€ruled€it€out€and€wouldÏhave€made€no€difference€in€my€examination€or€would€haveÏmade€no€difference€in€the€findings€that€I€had€during€myÏexamination,€nor€in€the€recommendations€I€made.Ð ¸ Ð ¸ Ð  ÐÌÓ€ÓLater,€he€repeated:ÌÓ€Óà8 ` àà8¸ ` (#` (#àAnd€so€had€I€had€that€information€[Dr.€Caseððs€records],€itÏwould€have€been€of€academic€interest,€but€it€would€haveÏmade€no€difference€in€the€examining€technique€that€I€didÏnor€in€the€further€testing.Ð ¸ Ð ¸ Ð  ÐÌÓ€ÓFinally,€after€being€asked€the€same€question€a€third€time,€Dr.€Stewart€stated:ÌÓ€Óà8 ` àà8¸ ` (#` (#àà  àMr.€Shockey,€any€information€that€I€get€that€is€validÏis€important€to€me.€€Some€information€is€more€importantÏthan€others.€€Some€information€I€will€put€more€weight€onÏthat€others,€and€so€Iððm€not€saying€that€this€information€[Dr.ÏCaseððs€clinical€records]€would€have€been€important€orÏunimportant.€€Iððm€just€saying€that€I€would€have€done€theÏsame€thing€if€I€had€had€that€information€as€I€would€have€ð!ðÐ ,3|.2 Ðas€I€did€do€in€the€absence€of€it.Ð ¸ Ð ¸ Ð  ÐÌÓ€ÓThe€only€conclusion€that€a€reasonable€fact„finder€could€draw€from€these€categoricalÏstatements€is€that€the€lack€of€Dr.€Caseððs€clinical€notes€did€not€affect€Dr.€StewartððsÏtreatment€of€Ms.€Jennings€from€and€after€April€23,€1996.€€In€light€of€Dr.€RubinððsÐ ¼9 59 Ðconcession€that€Ms.€Jenningsððs€arm€was€ð ðsalvageable€between€the€dates€of€April€23,Ï1996€and€May€2€or€3,€1996,ðð€there€is€no€evidence€in€this€record€that€Dr.€Caseððs€failureÏto€send€his€clinical€notes€to€Dr.€Stewart€played€any€role€in€the€eventual€loss€of€Ms.ÏJenningsððs€arm.ÌÌà ` àThe€courtððs€reluctance€to€affirm€the€summary€judgment€for€Dr.€Case€appearsÏto€be€based€on€its€concern€about€Dr.€Stewartððs€motives€or€credibility.€€I€do€notÏunderstand€how€this€can€become€