ÿWPC  qtsçz¯9ߊQKXµ'Z¤ÒÜÛ °­C~tGT>¦è9$©Ò~èeû’½}"¨'rÌ ?ˆUÙwý<0˜V厥Ì–ÃFŒ³^“éòŒªÁõ†C{ï÷uÛ†j:úÊ/2íZM˜ks˜E»ÛÅpeÌЯèý÷¹N;š#®ß&¤w¬BjŠžßDwI¯™.aŽÓM“Y˜[í¶èVˆ~s±ªÄ†;®‹‚Evkž\¢ß³k…ÕÇVÐÐfNª˜šÿàü¨ŠLºm“•üG‰ÅÙnîu÷¡DÂaíà|£Ot 0dzy·ÃØKÇâeüóÄô<ÚJî§Ø‚X¤•㡉Àn#ÁÙ{Cú Ècº/~jÇ‹p+µêÉÝù·ù¿*ýÅH¡à˜).:nc.òé8œáO)}gºÖÏû¹8ç 'Ž"& Ðand€òòAlan€E.€Highers,€J.óó,€joined.Ð .(~#' ÐÌJoe€Ô_ÔBednarzÔ_Ô,€Jr.,€Nashville,€Tennessee,€for€the€appellant,€James€Johnson.Ð *^%) ÐÌRobert€L.€Trentham€and€William€S.€Walton,€Nashville,€Tennessee,€for€the€appellee,€SumnerÐ î+>'+ ÐRegional€Health€Systems,€Inc.,€d/b/a€Sumner€Regional€Medical€Center.Ð Þ,.(, ÐÐ Î-)-ý' Ðò òÓ  ÓOPINIONó óÔ#†¼åÔ»XXýû8#ÔÐ ° ÐÓ  ÓÔ‡XýûX»¼åÔÔÔ‡X­¤XXXýûÔÌà  àThe€evidentiary€materials€submitted€in€support€of€and€opposition€to€the€Medical€CenterððsÐ ŒÜ Ðsummary€judgment€motion€revealed€the€following€sequence€of€events.€€On€December22,€1997,€theÐ xÈ Ð77„year„old€Decedent€became€dizzy€and€fell€in€the€living€room€of€the€home€she€shared€with€Johnson.€Ð d´ ÐJohnson€called€an€ambulance€to€transport€the€Decedent€to€the€Medical€Centerððs€emergency€room,Ð P   Ðand€Johnson€followed€the€ambulance€by€vehicle.€€A€triage€assessment€record€completed€on€theÐ < Œ ÐDecedent€indicated€that,€upon€her€arrival€at€the€emergency€room,€the€Decedent€complained€of€painÐ ( x Ðin€her€right€arm€and€sacrum.€€The€Decedent€was€treated€by€William€Little,€M.D.,€who€ordered€thatÐ  d Ðside€rails€be€used€to€restrain€the€Decedent€due€to€her€confusion,€disorientation,€and€impairedÐ  P  Ðjudgment€and€decision„making€ability.€€Ð ì <  ÐÌà  àUpon€his€arrival€at€the€emergency€room,€Johnson€went€to€the€examination€room€where€theÐ Ä  ÐDecedent€was€lying€on€a€Ô_ÔgurneyÔ_Ô.€€According€to€Johnson,€Medical€Center€staff€removed€the€DecedentÐ °  Ðfrom€the€examination€room€for€a€period€of€time€when€they€took€her€to€get€x„rays.€€After€the€DecedentÐ œì  Ðwas€returned€to€the€examination€room,€Johnson€remained€in€the€room€with€the€Decedent.€€In€hisÐ ˆØ  Ðdeposition,€Johnson€testified€that,€by€this€time,€the€Decedent€was€uncommunicative€and€ð ða€little€bitÐ tÄ Ðout€of€it.ðð€€Dr.€Littleððs€report€indicated€that€the€Decedent€was€slightly€sedated€as€a€result€ofÐ `° Ðmedications€administered€to€combat€nausea.€€Ð Lœ ÐÌà  àSometime€in€the€early€morning€hours€of€December23,€1997,€a€Medical€Center€technicianÐ $t Ðentered€the€room€and€asked€Johnson€to€step€outside€so€that€the€technician€could€draw€a€blood€sampleÐ ` Ðfrom€the€Decedent.€€Shortly€after€he€left€the€room,€Johnson€heard€ð ða€real€loud€flop.ðð€€When€JohnsonÐ üL Ðreturned€to€the€examination€room,€he€saw€that€the€Decedent€had€fallen€off€the€Ô_ÔgurneyÔ_Ô€onto€the€floorÐ è8 Ðand€was€lying€on€her€left€side.€€Johnson€blamed€the€fall€on€the€fact€that€the€technician€had€loweredÐ Ô$ Ðthe€side€rail€on€the€Ô_ÔgurneyÔ_Ô€to€draw€the€Decedentððs€blood.€€Dr.€Littleððs€report€confirmed€JohnsonððsÐ À Ðaccount€of€the€accident,€indicating€that€the€Decedent€ð ðaccidentally€fell€off€of€the€stretcher€landingÐ ¬ü Ðon€the€floor€striking€her€left€cheek€and€headðð€and€that€the€accident€occurred€when€the€ð ð[Ô_Ôs]ideÔ_Ô€rail€wasÐ ˜è Ðdown€while€lab€personnel€was€in€the€room€about€to€draw€blood.ðð€€Ð „Ô ÐÌà  àDr.€Little€examined€the€Decedent€after€she€fell€off€the€Ô_ÔgurneyÔ_Ô€and€reported€that€she€was€notÐ \ ¬ Ðseriously€injured€in€the€fall.€€A€CAT€scan€revealed€that€the€Decedent€did€not€suffer€any€fractures€orÐ H!˜ ÐÔ_ÔintracranialÔ_Ô€hemorrhage€and€that€the€Decedent€sustained€only€a€soft„tissue€injury€in€the€form€ofÐ 4"„  Ðbruising€and€swelling€on€the€left€side€of€her€face.€€Johnson€confirmed€the€occurrence€of€this€injury,Ð  #p! Ðtestifying€in€his€deposition€that€he€observed€bruising€on€the€Decedentððs€left€arm€and€cheekbone€andÐ  $\" Ðaround€her€left€eye.€€Johnson€testified€that€these€bruises€took€more€than€a€month€to€heal.€€Ð ø$H # ÐÌà  àIn€addition€to€these€injuries,€x„rays€taken€at€the€Medical€Center€on€December23,€1997,Ð Ð& "% Ðrevealed€that€the€Decedent€sustained€a€fracture€of€her€right€wrist.€€The€Medical€Centerððs€records€didÐ ¼' #& Ðnot€make€clear€whether€these€x„rays€were€taken€before€or€after€the€Decedent€fell€off€the€Ô_ÔgurneyÔ_Ô.€€InÐ ¨(ø#' Ðcompleting€his€emergency€room€report,€Dr.€Little€did€not€mention€any€complaints€of€right€arm€pain,Ð ”)ä$( Ðnor€did€he€document€any€wrist€or€arm€injury€suffered€by€the€Decedent.€€Ð €*Ð%) ÐÐ l+¼&* Ðà  àThe€Decedentððs€regular€physician,€Sid€King,€treated€the€Decedent€after€she€was€admitted€toÐ ° Ðthe€Medical€Center€for€observation€on€December23,€1997.€€Dr.€King€agreed€that€the€DecedentÐ œì Ðð ðapparently€suffered€some€bruisingðð€as€a€result€of€her€fall€off€the€Ô_ÔgurneyÔ_Ô.€€In€an€affidavit,€however,Ð ˆØ ÐDr.€King€opined€that€the€Decedent€did€not€sustain€any€permanent€injuries€as€a€result€of€this€fall.€€ThisÐ tÄ Ðopinion€was€based,€in€part,€on€the€emergency€room€triage€assessment€record,€which€indicated€thatÐ `° Ðthe€Decedent€complained€of€pain€in€her€sacrum€and€right€arm€upon€her€arrival€at€the€emergencyÐ L œ Ðroom.€€Ð 8 ˆ ÐÌà  àJohnson€disputed€Dr.€Kingððs€statement€that€the€Decedent€suffered€no€permanent€injuries€asÐ  ` Ða€result€of€her€fall€off€the€Ô_ÔgurneyÔ_Ô.€€In€his€deposition,€Johnson€acknowledged€that€it€was€possible€thatÐ ü L  Ðthe€Decedent€fractured€her€wrist€when€she€fell€at€home€and€not€when€she€fell€off€the€Ô_ÔgurneyÔ_Ô.€Ð è 8  ÐJohnson€testified,€however,€that€he€did€not€remember€the€Decedent€complaining€of€pain€in€her€rightÐ Ô$  Ðarm€until€after€she€fell€off€the€Ô_ÔgurneyÔ_Ô.€€Johnson€further€testified€that€he€was€not€informed€of€theÐ À  ÐDecedentððs€fractured€wrist€until€after€she€fell€off€the€Ô_ÔgurneyÔ_Ô,€and€this€information€was€provided€a€fewÐ ¬ü  Ðdays€later€by€Dr.€King,€who€did€not€treat€the€Decedent€in€the€emergency€room.€€Johnson€stated€that,Ð ˜è  Ðafter€the€Decedent€fractured€her€wrist,€she€could€not€eat€without€assistance,€and€she€did€not€fullyÐ „Ô  Ðrecover€the€use€of€her€right€arm.€€Ð pÀ ÐÌà  àApproximately€four€months€after€her€fall,€the€Decedent€died€from€pneumonia.€€The€deathÐ H˜ Ðcertificate€listed€the€Decedentððs€underlying€cause€of€death€as€chronic€obstructive€pulmonaryÐ 4„ Ðdisease(Ô_ÔCOPDÔ_Ô),€a€condition€from€which€the€Decedent€had€suffered€for€more€than€ten€years.€€In€hisÐ  p Ðaffidavit,€Dr.€King€opined€that€the€Decedentððs€December23,€1997,€fall€off€the€Ô_ÔgurneyÔ_Ô€did€not€causeÐ  \ Ðor€contribute€to€her€death€almost€four€months€later.€€Johnson€did€not€offer€any€evidence€to€contradictÐ øH ÐDr.€Kingððs€opinion€as€to€the€cause€of€the€Decedentððs€death,€other€than€to€express€his€belief€that€theÐ ä4 Ðfall€accelerated€the€general€decline€of€the€Decedentððs€health.€€Ð Ð  ÐÌà  àIn€moving€for€summary€judgment,€the€Medical€Center€conceded€that,€as€a€result€of€fallingÐ ¨ø Ðoff€the€Ô_ÔgurneyÔ_Ô,€the€Decedent€suffered€a€soft„tissue€injury€in€the€form€of€bruising.€€Nevertheless,€theÐ ”ä ÐMedical€Center€insisted€that€it€was€entitled€to€summary€judgment€because€the€evidence€failed€toÐ €Ð Ðshow€that€the€Decedent€suffered€either€permanent€injury€or€death€as€a€result€of€the€fall.€€Ð l¼ ÐÌà  àIn€opposing€the€Medical€Centerððs€motion€for€summary€judgment,€Johnson€submitted€theÐ D!” Ðaffidavit€of€JackR.€Ô_ÔUhrigÔ_Ô,€a€medical€doctor€who€specialized€in€internal€medicine.€€Dr.€Ô_ÔUhrigÔ_Ô€opinedÐ 0"€  Ðthat€the€nurse€or€technician€who€drew€the€Decedentððs€blood€deviated€from€the€applicable€standardÐ #l! Ðof€care€by€failing€to€ensure€that€the€side€rails€were€up€at€all€times€or€to€take€other€precautions€toÐ $X" Ðensure€that€the€Decedent€did€not€fall€off€the€Ô_ÔgurneyÔ_Ô.€€Dr.€Ô_ÔUhrigÔ_Ô€also€opined€that€this€deviation€causedÐ ô$D # Ðthe€Decedent€to€fall€off€the€Ô_ÔgurneyÔ_Ô€and€to€suffer€injuries€that€she€ð ðotherwise€would€not€haveÐ à%0!$ Ðsuffered.ððÐ Ì&"% ÐÌà  àAt€the€hearing€on€the€Medical€Centerððs€summary€judgment€motion,€Johnsonððs€counselÐ ¤(ô#' Ðconceded€that€the€record€contained€ð ðno€medical€proof,€or€any€other€evidence€which€causally€relatesÐ )à$( Ðor€otherwise€supports€any€theory€that€the€death€of€Ô_ÔBelviaÔ_Ô€Johnson€on€April19,€1998€was€caused€byÐ |*Ì%) Ð[the€Medical€Center]€or€by€any€of€the€events€alleged€in€the€complaint.ðð€€Citing€the€provisions€of€theÐ h+¸&* ÐMedical€Malpractice€Act,׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€however,€Johnson€insisted€that€summary€judgment€was€improper€becauseÐ ° Ðthe€record€contained€evidence€that€the€Decedentððs€fall€off€the€Ô_ÔgurneyÔ_Ô€caused€her€to€suffer€ð ðinjuriesÐ œì Ðthat€she€would€not€otherwise€have€suffered.ðð€€The€trial€court€rejected€this€argument€and,€relying€uponÐ ˆØ ÐJohnsonððs€concession€at€the€hearing,€granted€the€Medical€Centerððs€motion€for€summary€judgment.€Ð tÄ ÐÌà  àSummary€judgment€is€appropriate€only€when€the€partiesðð€ð ðpleadings,€depositions,€answersÐ L œ Ðto€interrogatories,€and€admissions€on€file,€together€with€the€affidavits,€if€any,€show€that€there€is€noÐ 8 ˆ Ðgenuine€issue€as€to€any€material€fact€and€that€the€moving€party€is€entitled€to€a€judgment€as€a€matterÐ $ t Ðof€law.ðð€€Tenn.€R.€Civ.€P.€56.04.€€In€determining€whether€or€not€a€genuine€issue€of€material€factÐ  ` Ðexists€for€purposes€of€summary€judgment,€the€courts€are€required€to€consider€the€question€in€theÐ ü L  Ðsame€manner€as€a€motion€for€directed€verdict€made€at€the€close€of€the€plaintiffððs€proof.€€ò òòòSeeóóó ó€ò òòòByrdv.Ð è 8  ÐHalló óóó,€847€S.W.2d€208,€210€(Tenn.€1993).€€That€is,€the€trial€court,€and€this€court€on€appeal,€ð ðmustÐ Ô$  Ðtake€the€strongest€legitimate€view€of€the€evidence€in€favor€of€the€nonmoving€party,€allow€allÐ À  Ðreasonable€inferences€in€favor€of€that€party,€and€discard€all€countervailing€evidence.ðð€€ò òòòIdó óóó.€at€210„11.Ð ¬ü  ÐÌà  àThis€court€has€recognized€that,€as€a€general€rule,€a€defendant€moving€for€summary€judgmentÐ „Ô  Ðmay€avail€itself€of€two€avenues:€€(1)the€defendant€ð ðmay€negate€an€essential€element€of€theÐ pÀ Ðnonmoving€partyððs€claim,ðð€or€(2)the€defendant€ð ðmay€establish€an€affirmative€defense,€such€as€theÐ \¬ Ðstatute€of€limitations,€that€defeats€the€claim.ðð€€òòò òAllied€Sound,€Inc.v.€Ô_ÔNeelyÔ_Ôó óóó,€909€S.W.2d€815,€820Ð H˜ Ð(Tenn.€Ct.€App.€1995)€(citing€òòò òByrdv.€Halló óóó,€847€S.W.2d€at€215€n.5).€€In€this€case,€the€Medical€CenterÐ 4„ Ðsought€to€obtain€a€summary€judgment€by€the€first€avenue,€that€of€negating€an€essential€element€ofÐ  p ÐJohnsonððs€claim€for€medical€malpractice.€€The€trial€court€granted€the€Medical€Centerððs€motion€forÐ  \ Ðsummary€judgment€because€the€court€agreed€that€the€record€contained€no€evidence€to€support€theÐ øH Ðcausation€element€of€Johnsonððs€medical€malpractice€claim.Ð ä4 ÐÌà  àIn€a€medical€malpractice€action,€the€plaintiff€has€the€burden€of€proving€that€the€defendantÐ ¼  Ðfailed€to€act€in€accordance€with€the€recognized€standard€of€acceptable€professional€practice€in€theÐ ¨ø Ðdefendantððs€community.€€ò òòòSeeó óóó€Tenn.€Code€Ann.€ðð29-26-115(a)(1),€(a)(2)€(1980).€€In€addition,€theÐ ”ä Ðplaintiff€is€required€to€prove€that,€ð ð[Ô_Ôa]sÔ_Ô€a€proximate€result€of€the€defendantððs€negligent€act€orÐ €Ð Ðomission,€the€plaintiff€suffered€injuries€which€would€not€otherwise€have€occurred.ðð€€Tenn.€CodeÐ l¼ ÐAnn.€ðð29-26-115(a)(3)€(1980).€€This€latter€requirement€describes€the€causation€element€of€a€medicalÐ X ¨ Ðmalpractice€claim.Ð D!” ÐÌà  àAfter€reviewing€the€evidentiary€materials€submitted€at€the€summary€judgment€hearing,€weÐ #l! Ðconclude€that€the€trial€courtððs€grant€of€summary€judgment€must€be€reversed.€€As€conceded€byÐ $X" ÐJohnson€at€the€hearing,€the€record€contains€no€evidence€to€support€his€claim€that€the€Medical€CenterÐ ô$D # Ðstaffððs€negligence€caused€or€contributed€to€the€Decedentððs€death€in€April€1998.€€To€the€contrary,€theÐ à%0!$ ÐMedical€Center€presented€evidence€that€there€was€no€causal€relationship€between€the€DecedentððsÐ Ì&"% ÐDecember€1997€fall€off€the€Ô_ÔgurneyÔ_Ô€and€the€Decedentððs€April€1998€death,€and€Johnson€submitted€noÐ ¸'#& Ðproof€to€contradict€this€evidence.Ð ¤(ô#' ÐÐ )à$( Ðà  àNevertheless,€we€reverse€the€summary€judgment€because€we€agree€with€Johnsonððs€contentionÐ ° Ðthat€the€record€does€contain€evidence€to€support€his€claim€that,€due€to€the€Medical€Center€staffððsÐ œì Ðnegligence,€the€Decedent€sustained€ð ðinjuries€which€would€not€otherwise€have€occurred.ðð€€Tenn.€CodeÐ ˆØ ÐAnn.€ðð€29-26-115(a)(3)€(1980).€€Although€the€record€does€not€make€clear€whether€the€DecedentÐ tÄ Ðfractured€her€wrist€in€the€fall€at€her€home€or€in€the€fall€in€the€emergency€room,€the€evidence€wasÐ `° Ðundisputed€that€the€Decedent€suffered€a€soft„tissue€injury€when€she€fell€off€the€Ô_ÔgurneyÔ_Ô.€€Moreover,Ð L œ Ðthe€record€indicated€that€the€Decedent€underwent€additional€diagnostic€procedures€as€a€result€of€herÐ 8 ˆ Ðfall€off€the€Ô_ÔgurneyÔ_Ô,€and€the€evidence€does€not€reveal€which€party€bore€the€expense€of€these€additionalÐ $ t Ðtests.Ð  ` ÐÌà  àIn€insisting€that€the€trial€court€properly€granted€summary€judgment€in€this€case,€the€MedicalÐ è 8  ÐCenter€contends€that€Johnsonððs€complaint€sought€recovery€only€for€the€Decedentððs€death€andÐ Ô$  Ðð ðserious€and€permanentðð€injuries.€€The€Medical€Center€argues€that,€inasmuch€as€the€record€containsÐ À  Ðno€evidence€that€the€Decedent€suffered€death€or€a€ð ðserious€and€permanentðð€injury€as€a€result€of€herÐ ¬ü  Ðfall€off€the€Ô_ÔgurneyÔ_Ô,€the€trial€court€correctly€granted€the€Medical€Centerððs€motion€and€dismissedÐ ˜è  ÐJohnsonððs€complaint.€€Ð „Ô  ÐÌà  àWe€conclude€that€this€argument€lacks€merit.€€Rule8€of€the€Tennessee€Rules€of€CivilÐ \¬ ÐProcedure€provides€that€ð ð[Ô_Ôn]oÔ_Ô€technical€forms€of€pleading...€are€requiredðð€and€directs€the€courtsÐ H˜ Ðof€this€state€to€construe€all€pleadings€ð ðso...€as€to€do€substantial€justice.ðð€€ò òòòBennettv.€HowardÐ 4„ ÐÔ_ÔJohnsonsÔ_Ô€Motor€Lodgeó óóó,€714€S.W.2d€273,€281€(Tenn.€1986)€(quoting€Tenn.€R.€Civ.€P.€8.05,€8.06);Ð  p Ðò òòòaccordó óóó€ò òòòÔ_ÔLamonsÔ_Ôv.€Chamberlainó óóó,€909€S.W.2d€795,€800€(Tenn.€Ct.€App.€1993);€ò òòòIrvinv.€City€ofÐ  \ ÐClarksvilleó óóó,€767€S.W.2d€649,€652€(Tenn.€Ct.€App.€1988).€€In€our€view,€the€allegations€of€JohnsonððsÐ øH Ðcomplaint,€whereby€he€sought€to€recover€for€the€Decedentððs€ð ðserious€and€permanent€injuries,€painÐ ä4 Ðand€suffering,€[and]€medical€expenses,ðð€were€sufficiently€broad€to€cover€the€injuries€suffered€by€theÐ Ð  ÐDecedent€in€this€case,€whether€the€injury€consisted€of€a€soft„tissue€injury,€which€the€Medical€CenterÐ ¼  Ðconceded€was€caused€by€the€Decedentððs€fall€off€the€Ô_ÔgurneyÔ_Ô,€or€a€fractured€wrist,€the€cause€of€whichÐ ¨ø Ðthe€parties€disputed.€€Ð ”ä ÐÌà  àIn€rejecting€the€Medical€Centerððs€argument€that€Johnson€can€recover€only€for€the€DecedentððsÐ l¼ Ðpermanent€injuries,€we€observe€that€the€provisions€of€the€Medical€Malpractice€Act€do€not€limit€aÐ X ¨ Ðplaintiffððs€recovery€in€this€manner.€€As€we€previously€indicated,€the€Act€requires€only€that€theÐ D!” Ðplaintiff€demonstrate€that,€ð ð[Ô_Ôa]sÔ_Ô€a€proximate€result€of€the€defendantððs€negligent€act€or€omission,€theÐ 0"€  Ðplaintiff€suffered€injuries€which€would€not€otherwise€have€occurred.ðð€€Tenn.€Code€Ann.€ððÐ #l! Ð29-26-115(a)(3)€(1980).€€The€Act€does€not€prevent€a€plaintiff€from€recovering€damages€for€non„Ð $X" Ðpermanent€injuries.€€ò òòòSeeó óóó€ò òòòidó óóó.;€ò òòòsee€alsoó óóó€Tenn.€Code€Ann.€ðð€29-26-119€(1980)€(providing€that€damagesÐ ô$D # Ðawarded€in€medical€malpractice€action€ð ðmay€include€(in€addition€to€other€elements€of€damagesÐ à%0!$ Ðauthorized€by€law)€actual€economic€losses€suffered€by€the€claimant€by€reason€of€the€personal€injury,Ð Ì&"% Ðincluding,€but€not€limited€to€cost€of€reasonable€and€necessary€medical€care,€rehabilitation€services,Ð ¸'#& Ðand€custodial€care,€loss€of€services€and€loss€of€earned€incomeðð).Ð ¤(ô#' ÐÌà  àThe€trial€courtððs€judgment€of€dismissal€is€reversed,€and€this€cause€is€remanded€for€furtherÐ |*Ì%) Ðproceedings€consistent€with€this€opinion.€€Costs€of€this€appeal€are€taxed€to€the€appellee,€SumnerÐ h+¸&* ÐRegional€Health€Systems,€Inc.,€d/b/a€Sumner€Regional€Medical€Center,€and€its€surety,€for€whichÐ ° Ðexecution€may€issue€if€necessary.Ô#†XýûXXX­¤÷#ÔÔ#†¼åÔ»XXýûØ#ÔÔ‡XýûX»¼åÔÔÐ œì ÐÌòòóóÔ#†¼åÔ»XXýûýY#ÔÔ€XýûX»¼åÔÔÔ‡X­¤XXXýûÔà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àà0À(#À(#àÔ#†XýûXXX­¤zZ#Ô___________________________________€ÐxÈ(#(# Ðà  àà ` àà ¸ àà  àà h àà À àà  àDAVID€R.€FARMER,€JUDGE