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ÔÔ€$ÔÒ  ÒÒ „ ÒÔ€ÔÝ  ÝÑ\R AØ'\ÑÑ\R AØ'\ÑÑ7€|ÜXXdðdÈ7ÑÑ  ÑÓ  ÓÞ ÞÌà@ àIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÌà@ àWESTERN€SECTION€AT€JACKSONÌà àà à€€€€______________________________________________ÌÌò òROBERT€MABON,€as€surviving€Ìspouse€and€personal€representative€Ìof€the€Estate€of€JEWEL€MAE€MABON,€ó óÌà àà àà àà àà àà àà àMadison€Circuit€No.€C„92„317Ìà àPlaintiff„Appellant,ÌVs.à àà àà àà àà àà àà àC.A.€No.€02A01„9702„CV„00039ÌÙ€*ÙßR€'/&A1-j|Fú` à. `€€@ÿRßÌò òJACKSON„MADISON€COUNTYÌGENERAL€HOSPITAL€and€GEORGEÌE.€THOMAS,€M.D.,€ó óÌÌà àDefendants„Appellees.Ì____________________________________________________________________________ÌÌà@ àFROM€THE€CIRCUIT€COURT€OF€MADISON€COUNTYÌà@ àTHE€HONORABLE€WHIT€LAFON,€JUDGEÌÌÌÌà@ àÌà@ àAl€H.€Thomas;€Ira€M.€Thomas€of€MemphisÌà@ àFor€Plaintiff„AppellantÌÌà@ àMarty€R.€Phillips,€Timothy€G.€Wehner;€Rainey,€Kizer,€Ìà@ àButler,€Reviere€&€Bell,€P.L.C.€of€JacksonÌà@ àFor€Defendants„AppelleesÌÌÌÌÌÌÌÌà@ àò òòòAFFIRMEDó óóóÌÌà@ àOpinion€filed:€€ÌÌÌÌÌÌÌÌà àà àà àà àà àà àà àà àò òW.€FRANK€CRAWFORD,Ìà àà àà àà àà àà àà àà àPRESIDING€JUDGE,€W.S.ÌÌÌCONCUR:ÌÌALAN€E.€HIGHERS,€JUDGEÌÌDAVID€R.€FARMER,€JUDGEó óà àà àà àà àà àà àÌ›Ñ7€|ÜXXdðXXdð7ÑÑ  ÑÓÓà àThis€is€a€medical€malpractice€case.€€Plaintiff,€Robert€Mabon€(Mabon),€theÏsurviving€spouse€and€personal€representative€of€the€Estate€of€Jewel€Mae€MabonÏ(Mrs.€Mabon),€appeals€the€order€of€the€trial€court€granting€summary€judgmentÏin€favor€of€defendant,€George€E.€Thomas,€M.D.€€Ìà àOn€November€15,€1991,€Mrs.€Mabon€entered€the€emergency€room€atÏJackson„Madison€County€General€Hospital€(Hospital)€in€Jackson,€TennesseeÏcomplaining€of€severe€abdominal€pain,€nausea,€and€vomiting.€€Mrs.€Mabon€had€aÏhistory€of€arteriosclerotic€heart€disease.€€She€was€admitted€to€Hospital,€and€Dr.ÏThomas,€who€had€been€treating€Mrs.€Mabon€for€about€five€years,€discussed€theÏpossibility€of€surgery€with€her€and€her€family.€€Dr.€Thomas€decided€not€toÏperform€surgery,€and€Mrs.€Mabon€died€approximately€sixteen€hours€after€herÍarrival€at€Hospital.€€Ìà àOn€November€12,€1992,€Mabon€filed€a€complaint€against€Dr.€ThomasÏalleging€that€he€breached€his€duty€of€care€to€Mrs.€Mabon€in€one€or€more€of€theÏfollowing€ways:€€failure€to€take€customary,€reasonable€diagnostic€steps;€failure€toÏtreat€properly;€and€failure€to€respond€in€a€reasonably€prudent€manner.× ƒ0 ××  ×€€TheÏcomplaint€alleges€that€Mrs.€Mabon€was€diagnosed€with€a€small€bowelÏobstruction€upon€her€admission€to€Hospital,€but€that€no€surgery€or€otherÏprocedures€were€undertaken€to€correct€the€obstruction€for€approximatelyÏtwelve€hours.€€The€complaint€further€alleges€that€these€acts€and€omissions€andÏthe€failure€to€provide€proper€medical€care€caused€Mrs.€Mabon€to€have€a€loss€ofÏchance€of€survival€and€caused€Mabon€to€suffer€the€loss€of€consortium€of€hisÏwife.€€Ìà àOn€December€18,€1992,€Dr.€Thomas€filed€an€answer€denying,€òòinter€aliaóó,€theÏallegations€in€the€complaint€charging€him€with€any€negligence,€medicalÏmalpractice,€or€careless€act€or€omission.€€In€his€answer,€Dr.€Thomas€asserts€thatÏhe€did€not€consider€Mrs.€Mabon€to€be€an€acceptable€surgical€risk.€€Given€Mrs.ÍMabonððs€past€medical€history€and€condition€at€that€time,€he€felt€that€generalÏanesthesia€presented€a€considerable€risk€that€Mrs.€Mabon€would€die€on€theÏoperating€table.€€He€further€asserts€that€he€discussed€this€fully€with€Mrs.€MabonÏand€her€family€and€that€they€agreed€that€treatment€would€consist€of€efforts€toÏkeep€the€patient€comfortable€and€that€Mrs.€Mabonððs€family€requested€that€noÏresuscitative€measures€be€instituted.€€Dr.€Thomas€asserts€that€he€exercised€hisÏbest€medical€judgment€with€the€degree€of€care,€skill,€ability,€and€learning€as€wasÏregularly€and€customarily€exercised€by€other€competent€physicians€in€theÏcommunity€at€that€time.€€He€also€asserts€that€all€medical€care,€attention,Ïexaminations,€treatments,€prescriptions,€and€procedures€rendered€or€furnishedÏby€him€were€usual,€proper,€and€customarily€accepted€for€Mrs.€MabonððsÏcondition€at€that€time€and€that€he€was€not€guilty€of€negligence.€€He€furtherÏasserts€that€he€did€not€guarantee€to€cure€Mrs.€Mabon€or€to€place€her€in€exactlyÏthe€position€that€she€was€in€prior€to€the€time€he€first€examined€her€onÏNovember€15,€1991.€€Additionally,€he€maintains€that€he€possessed€and€exercisedÏthat€degree€of€skill,€care,€and€learning€ordinarily€possessed€and€exercised€byÏother€competent€members€of€his€profession€and€specialty€in€his€community€onÏthe€dates€of€treatment.€€Ìà à€Dr.€Thomas€filed€a€motion€for€summary€judgment€on€March€24,€1994.€ÍIn€support€of€this€motion,€Dr.€Thomas€filed€an€affidavit€in€which€he€states€thatÏhe€was€and€is€familiar€with€the€recognized€standard€of€acceptable€professionalÏpractice€in€the€medical€community€of€Jackson,€Tennessee€for€physicians€engagedÏin€the€medical€practice€of€general,€vascular,€and€thoracic€surgery.€Dr.€ThomasÏfurther€states€that€in€his€treatment€of€Mrs.€Mabon€he€conformed€to€thisÏrecognized€standard€of€acceptable€professional€practice.Ìà àIn€opposition€to€Dr.€Thomasððs€motion€for€summary€judgment,€MabonÏfiled€the€affidavit€of€Ramon€A.€Shane,€M.D.€on€August€24,€1994.€€Dr.€Shane€isÏlicensed€to€practice€medicine€in€Missouri€and€is€board€certified€in€generalÏsurgery€and€thoracic€surgery.€€Dr.€Shane€states€in€his€affidavit€that€he€is€familiarÏwith€the€recognized€standard€of€acceptable€medical€practice€in€general€surgery,Ïthoracic€surgery,€and€other€related€fields€of€medicine€in€an€area€such€as€Jackson,ÏTennessee€and€at€a€facility€the€size€of€Hospital,€and€that€the€standard€of€care€inÏJackson€and€at€Hospital€would€be€comparable€to€the€cities€and€facilities€atÏwhich€he€has€practiced€medicine.€€œThe›€affidavit€further€states€that€theÏtreatment€rendered€by€Dr.€Thomas€failed€to€meet€the€accepted€standard€ofÏmedical€care€that€Mrs.€Mabon€could€expect€and€that€should€have€been€availableÏin€a€city€the€size€of€Jackson,€Tennessee.€€Dr.€Shane€opines,€based€upon€aÏreasonable€degree€of€medical€certainty,€that€Mrs.€Mabon€suffered€damages,€andÍultimately€lost€her€life,€as€a€direct€and€proximate€result€of€Dr.€ThomasððsÏnegligence.€Ìà àSubsequently,€Dr.€Shaneððs€deposition€was€taken€and€filed€as€part€of€theÏrecord.€€Dr.€Shane€testified€that€there€is€a€national€standard€of€care€forÏphysicians€and€that€ð ð[I]f€you€had€this€case€in€New€York€city€or€San€Francisco€orÏChicago€or€Memphis,€Tennessee,€or€Jackson,€theyððre€all€the€same.ðð€€Both€partiesÏfiled€memoranda€in€support€of€their€arguments.€€On€January€14,€1997,€the€trialÏcourt€entered€an€order€granting€summary€judgment€to€Dr.€Thomas.€€The€trialÏcourt€found€that€Dr.€Shane€was€not€qualified€to€testify€as€an€expert,€pursuant€toÏT.C.A.€ðð€29„26„115,€as€to€the€recognized€standard€of€acceptable€professionalÏpractice€required€of€a€general€surgeon€practicing€in€Jackson,€Tennessee€or€in€aÏsimilar€community€in€1991.€€As€such,€the€trial€court€found€that€there€was€noÏgenuine€issue€of€material€fact€and€that€Dr.€Thomas€was€entitled€to€a€judgmentÏas€a€matter€of€law.€€€Ìà àMabon€appeals€the€judgment€of€the€trial€court€and€presents€one€issue€for€Ïreview:€whether€the€trial€court€erred€in€granting€summary€judgment€to€Dr.ÏThomas.Ìà àA€trial€court€should€grant€a€motion€for€summary€judgment€only€if€theÏmovant€demonstrates€that€there€are€no€genuine€issues€of€material€fact€and€thatÍthe€moving€party€is€entitled€to€judgment€as€a€matter€of€law.€€Tenn.€R.€Civ.€P.Ï56.03;€€ò òòòByrd€v.€Hallóóó ó,€847€S.W.2d€208,€210€(Tenn.€1993);€òòò òDunn€v.€Hackettó óóó,€833ÏS.W.2d€78,€80€(Tenn.€App.€1992).€€The€party€moving€for€summary€judgmentÏbears€the€burden€of€demonstrating€that€no€genuine€issue€of€material€fact€exists.€òòò òÏByrdó óóó,€847€S.W.2d€at€210.€€On€a€motion€for€summary€judgment,€the€court€mustÏconsider€the€motion€in€the€same€manner€as€a€motion€for€directed€verdict€madeÏat€the€close€of€the€plaintiffððs€proof;€that€is,€ð ðthe€court€must€take€the€strongestÏlegitimate€view€of€the€evidence€in€favor€of€the€nonmoving€party,€allow€allÏreasonable€inferences€in€favor€of€that€party,€and€discard€all€countervailingÏevidence.ðð€òòò ò€Idó óóó.€at€210„11.€€In€òòò òByrdó óóó,€the€Tennessee€Supreme€Court€stated:ÌÓÓà8 àà8 àOnce€it€is€shown€by€the€moving€party€that€there€is€noÏgenuine€issue€of€material€fact,€the€nonmoving€partyÏmust€then€demonstrate,€by€affidavits€or€discoveryÏmaterials,€that€there€is€a€genuine,€material€factÏdispute€to€warrant€a€trial.€€In€this€regard,€Rule€56.05Ïprovides€that€the€nonmoving€party€cannot€simply€relyÏupon€his€pleadings€but€must€set€forth€òòspecific€factsóóÏshowing€that€there€is€a€genuine€issue€of€material€factÏfor€trial.Ì€à@ àÌÓÓòòò òIdó óóó.€at€211€(citations€omitted)€(emphasis€in€original).€€The€phrase€ð ðgenuineÏissueðð€as€stated€in€Rule€56.03€refers€to€genuine€factual€issues,€and€does€notÏinclude€issues€involving€legal€conclusions€to€be€drawn€from€the€facts.€€òòò òId.€Ïó óóóWhere€a€genuine€dispute€exists€as€to€any€material€fact€or€as€to€the€conclusionsÍto€be€drawn€from€those€facts,€a€court€must€deny€a€motion€for€summaryÏjudgment.€òòò ò€Id.€ó óóó(citing€òòò òDunnó óóó,€833€S.W.2d€at€80).€€We€must€decide€whether€theÏlegal€conclusions€on€which€the€trial€courtððs€grant€of€summary€judgment€wasÏbased€are€correct.€€Our€review€is€de€novo€on€the€record€with€no€presumption€ofÏthe€correctness€of€the€trial€courtððs€conclusions€of€law.€€òòò òUnion€Planters€Nat'lÏBank€v.€American€Home€Assurance€Co.ó óóó,€865€S.W.2d€907,€912€(Tenn.€App.Ï1993).€€Ìà àWith€these€principles€in€mind,€we€first€look€at€a€plaintiff's€burden€in€aÏmedical€malpractice€case€as€set€forth€in€the€pertinent€provisions€of€T.C.A.€ððÏ29„26„115:€ÌÓÓà8 àà8 àò ò29„26„115.€€Claimantððs€burden€in€malpracticeÏaction€ð"ð€Expert€testimony€ð"ð€Presumption€ofÏnegligence€ð"ð€Jury€instructions.€ð"ð€ó ó(a)€In€aÏmalpractice€action,€the€claimant€shall€have€the€burdenÏof€proving€by€evidence€as€provided€by€subsection€(b):Ìà8 àà8 à(1)€The€recognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€the€specialty€thereof,€ifÏany,€that€the€defendant€practices€in€the€community€inÏwhich€he€practices€or€in€a€similar€community€at€theÏtime€the€alleged€injury€or€wrongful€action€occurred;Ìà8 àà8 à(2)€That€the€defendant€acted€with€less€than€or€failedÏto€act€with€ordinary€and€reasonable€care€inÏaccordance€with€such€standard;€€andÌà8 àà8 à(3)€As€a€proximate€result€of€the€defendant's€negligentÏact€or€omission,€the€plaintiff€suffered€injuries€whichÏwould€not€otherwise€have€occurred.€€Ìà8 àà8 à(b)€No€person€in€a€health€care€profession€requiringÏlicensure€under€the€laws€of€this€state€shall€beÍcompetent€to€testify€in€any€court€of€law€to€establishÏthe€facts€required€to€be€established€by€subsection€(a)Ïunless€he€was€licensed€to€practice€in€the€state€or€aÏcontiguous€bordering€state€a€profession€or€specialtyÏwhich€would€make€his€expert€testimony€relevant€toÏthe€issues€in€the€case€and€had€practiced€thisÏprofession€or€specialty€in€one€of€these€states€duringÏthe€year€preceding€the€date€that€the€alleged€injury€orÏwrongful€act€occurred.€€€This€rule€shall€apply€to€expertÏwitnesses€testifying€for€the€defendant€as€rebuttalÏwitnesses.€€€The€court€may€waive€this€subsection€whenÏit€determines€that€the€appropriate€witnessesÏotherwise€would€not€be€available.ÌÌÓÓT.C.A.€29„26„115€(a)„(c)€(1980).€à àà àà àÌà àIn€the€instant€case,€the€existence€or€nonexistence€of€a€disputed€materialÏfact€depends€on€the€testimony€of€Mabonððs€witness,€Dr.€Shane.€€The€trial€judgeÏhas€broad€discretion€in€determining€the€qualifications€for€admissibility€ofÏtestimony€of€expert€witnesses.€òòò òShelby€County€v.€Bardenó óóó,€527€S.W.2d€124,€131Ï(Tenn.€1975).€€à à€Ìà àIn€ò òòòAyers€v.€Rutherford€Hospital,€Inc.óóó ó,€689€S.W.2d€155€(Tenn.€App.€1984),€Ïthe€plaintiff€brought€an€action€against€a€physician€for€medical€malpracticeÏallegedly€committed€during€childbirth€at€a€hospital€in€Murfreesboro,€Tennessee.€Ïò òòòId.ó óóó€at€156.€€The€child€was€later€admitted€to€Vanderbilt€University€MedicalÏCenter€in€Nashville,€Tennessee€because€of€a€seizure€disorder.€€ò òòòId.ó óóó€€The€trialÏcourt€granted€summary€judgment€for€the€defendant€physician,€and€on€appeal,Íthe€seminal€issue€before€the€court€was€the€admissibility€of€the€testimony€of€theÏplaintiffððs€expert€witness,€Dr.€Abramson.€€ò òòòId.€ó óóóat€163.òòò ò€€óóó óÌà àThe€allegations€in€the€complaint€required€the€plaintiff€to€prove€theÏstandard€of€care€required€of€physicians€practicing€obstetrics€in€MurfreesboroÏand€a€failure€to€conform€to€such€standard€of€care€by€the€defendant€physician.€Ïò òòòId.ó óóó€at€162.€€In€opposition€to€the€defendantððs€motion€for€summary€judgment,€theÏplaintiff€filed€the€€affidavit€of€Dr.€Abramson,€who€was€licensed€in€theÏWashington€D.C.,€Maryland,€and€Virginia.€€ò òòòId.ó óóó€at€157.€€In€his€affidavit,€Dr.ÏAbramson€stated€that€he€was€familiar€with€the€standard€of€care€as€it€wouldÏpertain€to€a€community€such€as€Murfreesboro,€Tennessee€and€that€theÏdefendants€breached€that€standard.€€ò òòòId.€ó óóóat€158.€€The€plaintiff€also€submitted€Dr.ÏAbramsonððs€deposition,€in€which€he€testified:ÌÓÓà8 à[T]hat€he€had€never€been€to€Murfreesboro,€did€not€know€where€inÏTennessee€the€city€was€located,€had€no€knowledge€of€whetherÏMurfreesboro€was€a€large€or€small€town,€knew€no€individuals€inÏMurfreesboro,€knew€no€physicians,€other€than€the€defendants€inÏthis€suit,€who€practiced€medicine€in€Murfreesboro,€and€that€he€didÏnot€know€where€defendant€physicians€were€trained€or€the€size€ofÏthe€hospital€in€which€[the€child]€was€born.€€ÌÌò òòòÓÓId.€óóó óat€163.€€He€further€stated€that€the€standard€of€care€does€not€varyÏthroughout€the€country€and€that€there€is€a€national€standard€that€does€notÏchange€with€locality.€€ò òòòId.óóó óÌà àThe€defendant€submitted€an€affidavit€by€Dr.€Boehm,€who€stated€that€theÏstandard€of€care€varies€significantly€between€localities€and€that€there€is€a€clearÏdifference€between€the€standard€of€care€in€hospitals€in€Murfreesboro€and€a€largeÏteaching€hospital€such€as€Vanderbilt.€ò òòò€Id.€€óóó óBased€on€this€record,€this€CourtÏfound€that€the€trial€court€did€not€abuse€its€discretion€in€refusing€to€allow€Dr.ÏAbramsonððs€testimony€as€an€expert.€€ò òòòId.ó óóó€at€163.€€The€Court€affirmed€theÏgranting€of€summary€judgment.€€òòò òId.ó óóóÌà àIn€òòò òCardwell€v.€Bechtoló óóó,€724€S.W.2d€739€(Tenn.1987)€the€Supreme€CourtÏaffirmed€the€trial€courtððs€grant€of€a€directed€verdict€at€the€close€of€the€plaintiffððsÏevidence€because€ð ðno€admissible€expert€testimony€existed€on€the€recordÏrelevant€to€the€standard€of€care€in€the€locality€of€an€osteopath€in€similarÏcircumstances.ðð€€€òòò òId.ó óóó€at€754.€€€The€Court€said:ÌÓÓà8 àAlthough€the€standard€of€care€may€be€established€by€theÏdefendant's€own€admissions,€òòò òTutton€v.€Pattersonó óóó,€òòò òsupraó óóó,€at€270,Ïthat€is€not€the€case€here.€€€Moreover,€òòò òSearle€v.€Bryantó óóó,€òòò òsupraó óóó,€atÏ65,€held€that€T.C.A.€ðð€29„26„115(b)€ð ðcontains€no€requirement€thatÏthe€witness€practice€the€same€specialty€as€the€defendant,ðð€but,€asÏpreviously€noted,€the€witness€must€be€sufficiently€familiar€with€theÏstandard€of€care€of€the€profession€or€specialty€and€be€able€to€giveÏrelevant€testimony€on€the€issue€in€question.€€€òòò òCfó óóó.€òòò òIson€v.€McFalló óóó,Ïòòò òsupraó óóó.€€€Without€the€requisite€threshold€evidence€of€the€standardÏof€care€in€the€locality,€regardless€of€the€other€requirements€of€theÏstatute,€Plaintiffs€were€not€able€to€demonstrate€ð ða€breach€of€dutyÏto€the€patient€to€use€that€degree€of€skill€and€learning€which€isÏordinarily€used€under€similar€circumstances€by€members€in€goodÏstanding€in€his€profession.ðð€€òòò òMerryman€v.€Bunchó óóó,€òòò òsupraó óóó,€24ÍTenn.App.€at€410„411,€145€S.W.2d€at€561€(citations€omitted).€€ÌÌÓÓ724€S.W.2d€at€754.Ìà àIn€ò òòòOsler€v.€Burnettó óóó,€1993€WL€90381,€No.€02A01„9202„CV„00046€(Tenn.ÏApp.€March€30,€1993),€an€unpublished€opinion€of€this€Court,€the€plaintiffsÏappealed€the€trial€courtððs€grant€of€summary€judgment€on€the€basis€that€theirÏproffered€expert€was€not€familiar€with€the€requisite€standard€of€care.€€ò òòòId.ó óóó€at€*1.€€ÏIn€ò òòòOsleró óóó,€the€defendant€stated€that€the€standard€of€care€in€Jackson,€theÏcommunity€in€which€the€defendant€practiced,€was€different€from€that€withÏwhich€the€plaintiffððs€expert€was€familiar,€and€the€plaintiffððs€expert€agreed.€€ò òòòId.€ó óóóatÏ*1„2.€€The€plaintiffððs€expert€also€admitted€that€he€was€not€familiar€with€theÏmedical€standards€in€Jackson.€€ò òòòId.ó óóó€at€*3.€€Because€he€was€not€familiar€with€theÏstandard€in€Jackson€or€in€a€community€similar€to€Jackson,€the€Court€affirmedÏthe€grant€of€summary€judgment.€€ò òòòId.ó óóó€at€*6.€Ìà àIn€the€case€before€us,€Dr.€Shane€states€in€his€affidavit€that€he€was€familiarÏwith€the€recognized€standard€of€acceptable€medical€practice€in€an€area€such€asÏJackson,€Tennessee€and€at€a€facility€the€size€of€Hospital.€€He€further€states€thatÏthe€standard€of€care€in€Jackson€and€at€Hospital€would€be€comparable€to€theÏcities€and€facilities€at€which€he€has€practiced€medicine€and€is€the€same€for€NewÏYork€city€and€other€large€cities€and,€in€effect,€is€a€national€standard.€€Dr.€ShaneÍalso€states€that€Dr.€Thomas€failed€to€meet€the€standard€of€care€that€ð ðòòshouldÏhave€been€availableóóðð€in€a€city€the€size€of€Jackson,€Tennessee.€€(EmphasisÏsupplied).€€Dr.€Shaneððs€statement€concerning€the€standard€of€care€that€ð ðshouldÏhave€been€availableðð€is€significant€in€that€it€illustrates€that€his€statement€in€hisÏaffidavit€regarding€the€standard€of€care€is€premised€on€the€national€standard€ofÏcare€and€not€on€the€standard€of€care€for€Jackson€or€similar€communities.€ÏAdmittedly,€in€his€œdiscovery€deposition,›€€he€quite€readily€admits€his€completeÏlack€of€knowledge€of€Jacksonððs€medical€œcommunity›œ:›ÌœQ:à àWhatððs€the€population,€Dr.€Shane,€of€Jackson,€Tennessee?ÌA:€€à àI€donððt€know€exactly.ÌQ:€à àHow€many€hospitals€are€there€in€Jackson?ÌA:€à àI€donððt€know.ÌQ:€€à àDo€you€know€if€there€are€any€colleges€or€universities€there?ÌA:€à àNo,€I€donððt.ÌQ:€à àDo€you€know€if€there€are€any€medical€schools€there?ÌA:€à àNot€for€sure.ÌQ:€à àDo€you€know€how€many€doctors€there€are€in€Jackson?ÌA:€à àNo.ÌQ:€€à àDo€you€know€what€medical€specialties€are€represented€in€Jackson?ÌA:€à àNo,€I€donððt.ÌQ:€à àHave€you€ever€been€to€Jackson?ÌA:€à àNo.ÌQ:€à àDo€you€know€any€doctors€that€practice€in€Jackson?ÌA:€à àNo.ÌQ:€à àHave€you€ever€treated€any€patients€from€Jackson?ÌA:€à àNot€that€Iððm€aware€of.ÌQ:€à àDo€accepted€standards,€that€is€the€standard€of€care,€do€they€change€withÏtime?ÌA:€à àYes,€they€can.ÌQ:€à àIs€the€practice€of€medicine€an€exact€science?ÌA:€à àNo.ÌQ:€à àYou€canððt€completely€practice€medicine€by€whatððs€called€the€cookbookÏmethod,€à àcan€you?ÌA:€à àNo,€you€canððt.ÌQ:€à àYouððve€not€reviewed€any€medical€records€from€Jackson€except€in€thisÏcase,€à àright?ÌA:€à àI€donððt€think€so€that€I€can€recall.Ìà àTo€qualify€as€an€expert,€a€physician€is€not€required€to€be€familiar€with€allÍof€the€medical€statistics€of€a€particular€community.€€ò òòòLedford€v.€Moskowitzó óóó,€742ÏS.W.2d€645,€648€(Tenn.€App.€1987).€€However,€a€complete€lack€of€knowledgeÏconcerning€a€communityððs€medical€resources€would€be€contrary€to€knowledge€ofÏthe€required€standard€of€care.€€The€plaintiffððs€tendered€expert€must€be€familiarÏwith€the€standard€of€care€in€the€community€in€which€the€defendant€practices€orÏin€a€similar€community.€€Without€this€requisite€threshold€evidence€of€theÏstandard€of€care€in€the€locality,€a€plaintiff€cannot€demonstrate€a€breach€of€duty.€Ïò òòòSee€Cardwelló óóó,€724€S.W.2d€at€754.€Ìà àMabon€contends€that€he€has€met€that€threshold€and€that€this€case€isÏdistinguishable€from€ò òòòAyers€ó óóóand€ò òòòOsleróó€ó óbecause€there€was€evidence€in€those€casesÏthat€the€standards€of€care€were€different€and€that€there€is€no€proof€in€this€caseÏthat€the€standard€of€care€in€Jackson,€Tennessee€is€different€from€thatÏpropounded€by€Dr.€Shane.€€He€argues€that€once€Dr.€Shane€set€forth€his€opinionÏthat€the€national€standard€of€care€is€the€same€as€the€standard€of€care€in€Jackson,Ïthe€burden€then€shifted€to€Dr.€Thomas€to€set€forth€a€different€standard€of€careÏfor€Jackson.€€€Ìà àWe€respectfully€disagree€with€this€contention.€€It€is€the€plaintiff€who€isÏcharged€with€the€burden€of€proof€as€to€the€standard€of€care€in€the€communityÏin€which€the€defendant€practices€or€in€a€similar€community.€€T.C.A.€ððÍ29„26„115(a)(1).€€A€plaintiff€who€chooses€to€prove€the€standard€of€care€in€aÏsimilar€community€necessarily€must€prove€that€community€is€similar€to€the€oneÏin€which€the€defendant€practices.€€To€shift€this€burden€to€the€defendant€directlyÏcontradicts€the€plain€language€of€the€statute€and€would€render€the€statute€aÏnullity.€€Under€the€principles€of€summary€judgment,€once€Dr.€Thomas€movedÏfor€summary€judgment€and€submitted€an€affidavit€stating€that€he€complied€withÏthe€standard€of€care€in€Jackson,€the€burden€then€shifted€to€Mabon€to€set€forthÏspecific€facts€that€Dr.€Thomas€failed€to€meet€the€standard€of€care€in€Jackson€orÏa€similar€community.€€Ìà àIn€this€case,€Dr.€Shaneððs€deposition€testimony€leads€us€to€conclude€thatÏhe€is€not€familiar€with€the€standard€of€care€in€Jackson,€Tennessee.€€Moreover,Ïwe€cannot€accept€Dr.€Shaneððs€bare€assertion€that€the€standard€of€care€in€JacksonÏis€the€same€nationwide€and€that€the€level€of€care€with€which€Dr.€Shane€isÏfamiliar€òòshouldóó€have€been€available€in€Jackson.€€This€does€not€comply€with€theÏnonmoving€partyððs€burden€on€a€motion€for€summary€judgment€to€set€forthÏspecific€facts.€€From€our€review€of€the€record,€Dr.€Shane€simply€failed€toÏestablish€that€he€had€knowledge€of€the€requisite€standard€of€care€in€Jackson,ÏTennessee€or€in€a€similar€community.€€€Ìà àWithout€evidence€as€to€the€standard€of€care€in€Jackson€or€in€a€similarÍcommunity,€Mabon€cannot€demonstrate€any€breach€of€duty€to€Mrs.€Mabon.€Ïò òòòSee€Cardwelló óóó,€724€S.W.2d€at€754.€€Mabon€therefore€failed€to€carry€the€burdensÏplaced€on€him€by€T.C.A.€ðð€29„26„115.€€As€such,€there€was€no€genuine€issue€ofÏmaterial€fact,€and€Dr.€Thomas€was€entitled€to€judgment€as€a€matter€of€law.€€TheÏtrial€court€correctly€granted€summary€judgment€to€Dr.€Thomas.€€€€à àÌà àAccordingly,€the€order€of€the€trial€court€is€affirmed.€€Costs€of€this€appealÏare€assessed€against€the€appellant.€€ÌÓÓà àà àà àà àà àà àà à_________________________________Ìà àà àà àà àà àà àà àò òW.€FRANK€CRAWFORD,€Ìà àà àà àà àà àà àà àPRESIDING€JUDGE,€W.S.ó óÌÌò òCONCUR:ÌÌó óò ò____________________________________ÌALAN€E.€HIGHERS,€JUDGEó óÌÌ____________________________________Ìò òDAVID€R.€FARMER,€JUDGEó óœÔ€1ÔÔ€1Ô