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($$   1  \\' dxdP Pd X"  _XUXXX_fX_XU   Ad FILED_XUX_f  July14,1999CecilCrowson,Jr.AppellateCourtClerkdAh GGGG'dxd,cAZ"Arial Regular FT!   _  7JXXdd7TR[A'Legal3'A' Legal3'T`   XTXJXXX rS]^<,(j 8` `@Ef ` 8ttxP`  r@| | INTHECOURTOFAPPEALSATNASHVILLE  `  tS]^>.*jxI` `@E ` 8ttxPI tߛPATRICIAA.MERLO@*@@*)0  p (#(# @*)   8   PlaintiffAppellant@*)0  (#(# @*)  AppealNo. h    `  @*)  01A019811CV00610 x  0    v.@*)  DavidsonCircuit X  Ѐ@*)  No.97C3703    @*)@*)   P  G.PATRICKMAXWELL,M.D.@*) x  andNASHVILLEPLASTIC  @*)   @  SURGERY,LTD @*)     @*)  DefendantsAppellees@*)   8 @@@APPEALEDFROMTHECIRCUITCOURTOFDAVIDSONCOUNTY@ THEHONORABLEMARIETTAM.SHIPLEY,JUDGERobertL.Huskey514HillsboroBlvd.Manchester,TN37355  AttorneyforPlaintiffAppellantNoelF.StahlE.ToddPresnellBryanK.WilliamsCORNELIUS&COLLINS,LLP511UnionStreet,Suite2700Nashville,TN37219  AttorneysforDefendantsAppellees@<< VACATEDANDREMANDED   `    HoustonM.Goddard,PresidingJudge  @.$/ CONCUR:FRANKS,J.SUSANO,J.@$OPINION 86,9 QX=XXTXJ   ` PatriciaA.Merloappealsthedismissalofhersuit  :0> allegingmedicalmalpracticeagainstPatrickMaxwell,M.D.,and ;l2@ theNashvillePlasticSurgery,Ltd.,bysummaryjudgment.Ms.MerlobroughtsuitallegingDr.MaxwellfailedtoobtainherinformedconsentfortheuseofsiliconeimplantsduringmultiplebreastreconstructionsurgeriesandfurtherthatDr._Maxwell_negligentlychosetousesiliconeimplantsratherthansaline.TheCircuitCourtofDavidsonCountydismissedMs.Merlosclaimsfinding,asamatteroflaw,thatMs.Merlosclaimswerebarredontheirfacebythethreeyearstatuteofrepose.   @  @` Facts l      ` In1987,Ms.MerlocametoDr.Maxwell,whopracticesunderthenameofNashvillePlasticSurgery,_Ltd_.,duetoherdiagnosisofbreastcancerandherneedtohavebilateralmastectomiesandbreastreconstructionsurgery.Ms.MerloallegesthatsheandDr.Maxwelldiscussedthetypesofimplantswhichcouldbeusedinherprocedure.Dr.MaxwellinformedMs.Merlothathecoulduseeithersalinebreastimplantsorsiliconegelbreastimplants.Dr.MaxwellfurtherinformedMs.Merlothatsiliconegelimplantswereknowntobeagreaterhealthhazardthanthesalineimplants.Ms.MerloaskedforthesalineimplantstobeusedandallegesthatDr.Maxwellassuredherthathewasusingsalineimplantsinherprocedures.   ` OnJune10,1987,Dr.Maxwellperformedbilateralsubcutaneousmastectomiesontheplaintiff.Duringthisprocedure,Dr.Maxwellinsertedsalinetissueexpanders,whichallowedgradualexpansionofbreasttissuethroughperiodicinjectionofsalinesolutionintotheexpanders.OnAugust27,1987,Dr.MaxwellperformedbreastreconstructiononMs.Merlo. 90: Duringthisprocedure,Dr.Maxwellremovedthesalinetissueexpandersandreplacedthemwithsiliconegelimplantsinsteadofthesalineimplants.OnJuly24,1990,Dr.MaxwellperformedadditionalbreastreconstructionsurgeryonMs.Merlo.Dr.MaxwellremovedMs.Merlosexistingimplants,andreplacedthemwithtwosiliconegelimplantsineachbreast.OnAugust20,1991,Dr.MaxwellperformedafinalsurgeryonMs.Merlo.Duringthisfinalprocedure,Dr.MaxwellremovedMs.Merlosimplants,andreplacedthemwithnewlydesignedsiliconegelimplants.Ms.MerloallegesthatshewasleadtobelievethatsalineimplantswereusedduringtheentirecourseoftreatmentbyDr.Maxwell.   ` InDecemberof1996,Ms.MerloreturnedtoDr.Maxwellforthepurposeofevaluationandpreparationforasubsequentsurgerytoreplaceherimplants.Whileinhisoffice,Ms.Merlowaspresentedaformauthorizingtheuseofsiliconeimplants.Ms.Merlorefusedtosigntheformstatingthatshewouldneverallowtheuseofsiliconeinherbody.Dr.Maxwellspersonnel  :04 respondedthatsiliconehadalreadybeenimplantedinherbody.Uponhearingthisresponse,Ms.Merlobecamehysterical.Formanyyearssincetheoriginalimplant,Ms.Merlosufferedphysicalproblemsconsistentwithsiliconeimplantsandleakageofsilicone,butMs.MerlohadneverconsideredtheimplantstobethesourceofherhealthproblemsbecauseshehadalwaysbeenassuredthatDr.Maxwellusedsalineimplants,insteadofsilicone,duringherbreastreconstructionprocedures.         ` InJuneandSeptemberof1997,Ms.Merlohadtheherimplantsreplaced_by_ԀtheAtlantaPlasticSurgery,P.A.Duringthecourseoftheremovalofthesiliconegelimplants,siliconewasfoundtobeemanatingfromatearinthecapsuleofoneoftheimplants.   ` SubsequenttotheofficevisitofDecemberof1996,Ms.MerlospokewithDr.MaxwellwhoadmittedthathecouldfindnonotationsinhisrecordsshowingthathehadinformedMs.Merlothathehadusedsiliconeimplants.Ms.Merloalsoexaminedasetofherrecordsandfailedtofindanyindicationsthatshehadbeeninformedoftheuseofsilicone.   ` _Ms.Merlofiled_ԀthissuitonNovember25,1997,withinoneyearoflearningoftheuseofsiliconebyDr.Maxwell.Ms.MerloallegedinhercomplaintthatDr.MaxwellfailedtogetherinformedconsentfortheuseofsiliconebreastsimplantsduringherbreastreconstructionsurgeriesandfurtherallegedthatDr.  :04 Maxwellnegligentlyperformedthosesurgeriesbychoosingtousethesiliconegelbreastimplants.Dr.MaxwellfiledhisAnsweronFebruary2,1998.   ` OnMarch13,1998,Dr.MaxwellfiledaMotionforSummaryJudgmentpursuanttoRule56oftheTennesseeRulesofCivilProcedure.TheMotionforSummaryJudgmentassertedthatMs.MerlosclaimwasbarredbythethreeyearstatuteofreposecontainedinT.C.A.2926116(a)(3).Ms.MerlofiledherresponsetotheMotionforSummaryJudgmentonApril27,1998.InordertoallowMs.Merloadditionaltimetoobtaindiscovery,theTrialCourtinitiallyscheduledthehearingontheMotionforSummaryJudgmentonSeptember28,1998.   ` OnAugust19,1998,Ms.MerlofiledaMotiontoAmendseekingtoaddanadditionalparagraphtohercomplaintwhichstated:Inadditiontotheforegoing,PlaintiffwouldshowtotheCourtthatunderthefactsofthiscase,theDefendants...areguiltyoffraudulentconcealmentintheutilizationofthesiliconeimplantswhileallthetimekeepingsamefromthePlaintiffandleadinghertocontinuetobelieveuntilDecemberof1996,thatherimplantswereofsalinesolution. !  ThisMotiontoAmendwassupportedbyaSupplementalAffidavitinwhichMs.MerloassertedthatDr.Maxwellledhertobelievethatsalineimplants,insteadofsiliconegelimplants,wereusedinherprocedures;furthermore,Ms.MerlostatedinthisAffadavittAffidavitthathermedicalrecordsdidnotindicatethatshehadevenbeennotifiedoftheuseofsiliconegelimplants.  :04 Ї   ` OnAugust24,1998,Ms.MerlofiledaMotiontoCompelallegingthatDr.MaxwellfailedtorespondappropriatelytoherDiscovery.Ms.Merlospecificallysoughtamorecompleteresponsetothefollowingquestion: HaveyoueverreceivedanytreatmentforalcoholordrugabusefromJanuaryof1987untilthepresentandifso,whenandatwhatinstitutionandattachtotheseInterrogatories,acopyofyourcompletetreatmentrecordfromthatinstitution?Dr.MaxwellrespondedtothisInterrogatorybystating: OnJanuary18,1997,Ivoluntarilyadmittedmyselftoanalcoholrehabilitation/treatmentcenterforalcoholdependency,andIsuccessfullycompletedthatprogram.Idonothavepossessionofmycompletetreatmentrecord.Ms.MerlosoughttocompelDr.MaxwelltoprovidethenameandinstitutionatwhichhereceivedtreatmentandacopyofhisrecordsinordertosubstantiateallegationsoftheuseofcocaineorotherdrugsduringtheperiodofMs.Merlostreatment.   ` Dr.Maxwellobjectedtosupplyinganymoreinformationthangiveninhisanswerastherequesteddocumentswereirrelevant,privileged,confidential,andnotsubjecttodiscovery.Dr.MaxwellfurtherarguedthathehadalreadystatedinhisresponsestotheInterrogatoriesthathedidnotuseillegaldrugsatanytimefrom1987tothepresent.TheTrialCourtsustainedDr.MaxwellsobjectiononSeptember21,1998,therebydenyingtheinformationtoMs.Merlo.  :04    ` Dr.MaxwellsMotionforSummaryJudgmentwasheardonOctober30,1998.TheTrialCourtfoundthatMs.MerlosclaimswerebarredbythethreeyearstatuteofreposeandgrantedDr.MaxwellsMotionforSummaryJudgment.Inmakingthisdetermination,theTrialCourtstatedthatMs.MerlosComplaintdidnotcontainallegationssufficienttosupportaclaimforfraudulentconcealmentasanexceptiontothestatuteofrepose.TheTrialCourtfoundthatMs.MerlosMotiontoAmendwasneverdocketednorheardbythecourt,butfurtherheldthat,evenifleavetoamendwasgrantedand/orMs.MerlosComplaintwasdeemedsufficienttoallegefraudulentconcealment,Ms.Merlofailedtoprovidesufficientevidencetoestablishtheessentialelementsoffraudulentconcealment.   ` Ms.MerlofiledherNoticeofAppealonNovember20,1998submittingthefollowingissuesforreview:I.DidtheHonorableCircuitJudgecommitreversibleerrorbygrantingSummaryJudgmentinfavoroftheDefendantsholdingthecasewasbarredbythethree(3)yearstatuteofreposedespiteallegationsandAffidavitsoffraudulentconcealmentbytheDefendants?II.DidtheHonorableTrialJudgecommiterrorinnotallowingthePlaintifftoobtainDiscoveryinformationaboutDr.Maxwells treatmentforalcoholordrugabusewhichrecordsmightdisclose @8.2 informationabouthisillegaluseofdrugsduringthetimeofhistreatmentofthePlaintiff?    @  @` StatuteofRepose  0   ` InaddressingMs.Merlosfirstissue,werecognizethatthestandardsgoverninganappellatecourt'sreviewofatrialcourt'sactiononamotionforsummaryjudgmentarewellsettled.Sinceourinquiryinvolvespurelyaquestionoflaw,nopresumptionofcorrectnessattachestothetrialcourt'sjudgment.Carvellv.Bottoms,900S.W.2d23,26(Tenn.1995).  OurtaskisconfinedtoreviewingtherecordtodeterminewhethertherequirementsofRule56oftheTennesseeRulesofCivilProcedurehavebeenmet.Cowdenv.SovranBank/Cent.S.,816 !8 S.W.2d741,744(Tenn.1991).Rule56.03oftheTennesseeRulesofCivilProcedureprovidesthatsummaryjudgmentisonlyappropriatewhere:(1)thereisnogenuineissuewithregardtothematerialfactsrelevanttotheclaimordefensecontainedinthemotion,Byrdv.Hall,847S.W.2d208,210(Tenn.1993);and *!$ (2)themovingpartyisentitledtoajudgmentasmatteroflawontheundisputedfacts.Andersonv.StandardRegisterCo.,857 .X%( S.W.2d555,559(Tenn.1993).Themovingpartyhastheburdenofprovingthatitsmotionsatisfiestheserequirements.Downenv. x2), AllstateIns.Co.,811S.W.2d523,524(Tenn.1991). X4*.    ` Thestandardsgoverningtheassessmentofevidencein 8.2 thesummaryjudgmentcontextarealsowellestablished.Courts 904 mustviewtheevidenceinthelightmostfavorabletothenonmovingpartyandmustalsodrawallreasonableinferencesinthenonmovingparty'sfavor.Byrd,847S.W.2dat210-11.Courts   shouldgrantasummaryjudgmentonlywhenboththefactsandtheconclusionstobedrawnfromthefactspermitareasonablepersontoreachonlyoneconclusion.Byrd,847S.W.2dat210-11. `     ` Sinceneitherpartyquestionsthatthreeyearshadpassedsincethedateoftheallegedmalpractice,weturntowhethertherearedisputedissuesofmaterialfactregardingfraudulentconcealmentonthepartofDr.Maxwellsoastoavoidapplicationofthethree-yearstatuteofrepose.   ` OurSupremeCourthasfullyexplainedandexploredtherequirementsnecessarytoestablishfraudulentconcealmentinShadrickv.Coker: %  [A]plaintiffinalackofinformedconsentcase(oranyothermedicalmalpracticecase)attemptingtotollthestatuteofreposecontainedinT.C.A.29-26-116(a)(3)byrelyinguponthefraudulentconcealmentexceptiontothestatutemustestablishthat(1)thehealthcareprovidertookaffirmativeactiontoconcealthewrongdoingorremainedsilentandfailedtodisclosematerialfactsdespiteadutytodoso,(2)theplaintiffcouldnothavediscoveredthewrongdespiteexercisingreasonablecareanddiligence,(3)thehealthcareproviderknewofthefactsgivingrisetothecauseofactionand,(4)aconcealment,whichmayconsistofthedefendantwithholdingmaterialinformation,makinguseofsomedevicetomisleadtheplaintiff,orsimplyremainingsilentandfailingtodisclosematerialfactswhentherewasadutytospeak.̀:::Shadrickv.Coker,963S.W.2d726,736(Tenn.1998).Ifthe P7-1 plaintiffestablishesfraudulentconcealmentonthepartofthe 09/3 defendant,theplaintiffhasoneyearafterdiscoverytobringthecauseofaction.Tenn.CodeAnn.29-26-116(a)(3)(1980).   ` Withregardtothefirstrequirement,thatthedefendanttookaffirmativeactiontoconcealthecauseofactionorremainedsilentandfailedtodisclosematerialfactsdespiteadutytodoso,whenthereisaconfidentialorfiduciaryrelationshipbetweentheparties,the"failuretospeakwherethereisadutytospeakistheequivalentofsomepositiveactorartificeplannedtopreventinquiryorescapeinvestigation."Hallv.DeSaussure,41Tenn.App.572,581,297S.W.2d81,85   (1956).Furthermore, suchadutyariseswhereaconfidentialrelationshipexists,asbetweenphysicianandpatient.Insuchcases,thereisadutytodisclose,andthatdutymayrendersilenceorfailuretodiscloseknownfactsfraudulent.Benton #@ v.Snyder,825S.W.2d409,414(Tenn.1992)(emphasisinoriginal) %  (citationsomitted).Withregardtothefinalelement,thissamephysicianpatientrelationship impose[s]adutytomakeafulldisclosureofthematerialfacts,meresilenceornondisclosuremayconstituteconcealment.Shadrickv.Coker,963S.W.2d726, -#& 736(Tenn.1998).   ` Afterthoroughreviewoftherecord,wefindthatthereisevidencesufficienttocreateajuryissueonallofthekeyelementsoffraudulentconcealment.evenwithoutamendmentofMs.MerlosComplaint.WeholdthatthejurycouldreasonablyfindthatDr.MaxwellconcealedtheuseofsiliconebreastimplantsbyleadingMs.Merlotobelievethatsaline  :04 implantswereusedinherprocedures.ThejurycouldalsoinferconcealmentfromDr.Maxwellsfailuretodisclosetheuseofthesiliconegelimplantsandtherisksandpotentialcomplicationsinvolveddespitearelationshipcreatingadutytodisclose.ThroughbothDr.MaxwellsfailuretodisclosethatsiliconeimplantswereusedandhisactionswhichledMs.Merlotobelievethatsalineimplantswereusedinalloperations,ajurycouldreasonablyinferthatDr.Maxwellhadknowledgeofthefactsgivingrisetothecauseofaction. p  `    ` WearealsopersuadedthatMs.MerlocouldhavereasonablybelievedDr.Maxwell,despiteherphysicalailments,whenhetoldherthatshewasreceivingsalinebreastsimplants.Furthermore, [w]hethertheplaintiffexercisedreasonablecareanddiligenceindiscoveringtheinjuryorwrongisusuallyaquestionoffactforthejurytodetermine.Shadrickv.Coker %  963S.W.2d726,737(Tenn.1998)(quotingWyattv.A-Best,Co., `'  910S.W.2d851,854(Tenn.1995)).Finally,wealsofindthatMs.MerlosComplaintcontainedsufficientallegations,specificallythoserelieduponabove,tosupportaclaimoffraudulentconcealment.   `    ` AftertakingthestrongestlegitimateviewofMs.Merlosevidence,discardingallcountervailingevidenceandallowingallreasonableinferencestotheplaintiff,weholdthat morethanoneconclusioncanbedrawnfromtheevidencepresented @8.2 forthereasonsstatedabove.Therefore,wefindthatthisisnotanappropriatecaseforsummaryjudgment.   Ms.MerlosDiscoveryRequest  L   ` WenowturntoMs.MerlossecondissuewhethertheTrialCourterredindenyingMs.MerloaccesstoinformationconcerningDr.Maxwellstreatmentforalcoholordrugabuse.Ms.MerloarguesthatevidenceofdrugoralcoholdependencycouldexplainmalpracticecommittedbyDr.Maxwell.   ` Aspreviouslynoted,duringpretrialdiscovery,Ms.MerloservedthefollowinginterrogatoryonDr.Maxwell: HaveyoueverreceivedanytreatmentforalcoholordrugabusefromJanuaryof1987untilthepresentandifso,whenandatwhatinstitutionandattachtotheseInterrogatories,acopyofyourcompletetreatmentrecordfromthatinstitution?Dr.MaxwellrespondedtothisInterrogatorybystating: OnJanuary18,1997,Ivoluntarilyadmittedmyselftoanalcoholrehabilitation/treatmentcenterforalcoholdependency,andIsuccessfullycompletedthatprogram.Idonothavepossessionofmycompletetreatmentrecord.TheTrialCourtrefusedtoforceDr.Maxwelltosupplyanymoreinformationregardinghisrehabilitationprogramand,instead,sustainedDr.Maxwellsobjectiontothisquestion.  8.2    ` Itiswellsettledthatdecisionswithregardtopre trialdiscoverymattersrestwithinthesounddiscretionofthetrialcourt.Thedecisionofthetrialcourtindiscoverymatterswillnotbedisturbedonappealunlessaclearabuseofdiscretionisdemonstrated.Bentonv.Snyder,825S.W.2d409,  416(Tenn.1992)(citingPainev.Ramsey,591S.W.2d434,436 `  (Tenn.1979).WAlthoughwebelievethatMs.Merloshouldbeprovidedwithatleastthenameoftherehabilitationcenter,wefindnoclearabuseofdiscretionatthistime.#TX> XXQX #VXXXTX>    ` FortheforegoingreasonsthejudgmentoftheTrial ` Courtisvacatedandthecauseremandedforfurtherproceedingsconsistentwiththisopinion.CostsofappealareadjudgedagainsttheDefendants.̀   `       `     h   _______________________________   `     h   HoustonM._Goddard_,_P.J._ԀCONCUR:________________________________HerschelP.Franks,J.________________________________CharlesD.Susano,Jr.,J.