ÿWPCO … 0~V 0xÔ 0kL 0k· 0š" 0~¼ 0Ñ: 0ä 0¦ï 0÷• 0 Œ 0– 01´ 0Cå 0V( 0Ï~ 0¤M 0¤ñ 0Õ 0¼X 0» 0ÙÏ 0£¨ 0£KUBî %0 0z6 0Ù° 1‰ 0äŽ r 0=ƒ 0FÀ 0P 1“V 0·é„  0O$#Es# 0}u# 0xò# 0j$ 0j÷$ 0ea% 0WÆ% 0W& 0„t& 0jø& 0¹b' 0Ì( 0ç( 0áw) 0ôX* 0L+ 0S, 0-m- 0@š. 0»Ú/ 0Ž•0 0Ž#1 0­±1 0¦^2 0¥3 0é3 0Žl4 0Žú4 1·ˆ5?6n­O6 04ü6 B074M7 0a7Šþ7 0Jˆ9ŠÒ9w@\; 0Jœ; 0Tæ; 0^:< 0h˜< 0@= D3@= 0rs= 0|å= 0†a> 0ç> 1uw?U,ì? 0d@U,|@U6¨@B)Þ@DCA AMJAU*—A-ÁAîB$Dv~'FvÓ¥G AOxMÆÇM 0DN D/ÑN BOV& ÿÿ8Document[8]Document Styleà0..àà8` ..` àÌVÿÿ8Document[4]Document Styleà..àò òòò.óó€€ó óV ÿÿ8Document[6]Document Styleà8..àÌV ÿÿ8Document[5]Document Styleà0..àÌV/ÿÿ8Document[2]Document StyleÌò òÔ2ÔA.Ô3  Ô€òòÔ  ÔÔ  ÔÌó óóóV& ÿÿ8Document[7]Document Styleà0..àà0` ..` àÌzU ÿÿ:Right Par[1]Right-Aligned Paragraph NumbersàÐ.. àÔ2ÔI.Ô3  Ô€ˆà°..°àà0..àÌzh ÿÿ:Right Par[2]Right-Aligned Paragraph Numbersà..ààÐ` ..øàÔ2ÔA.Ô3  Ô€ˆà..àà0` ..` àÌV?ÿÿ8Document[3]Document StyleÌà..àò òÔ2Ô1.Ô3  Ô€Ô  ÔÔ  Ôó óz{ ÿÿ:Right Par[3]Right-Aligned Paragraph Numbersà..àà` ..` ààи ..P àÔ2Ô1.Ô3  Ô€ˆà` ..` àà0¸ ..¸ àÌzŽ ÿÿ:Right Par[4]Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ ààÐ..¨ àÔ2Ôa.Ô3  Ô€ˆà¸ ..¸ àà0..àÌz¢ ÿÿ:Right Par[5]Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààÐh..ˆàÔ2Ô(1)Ô3  Ô€ˆà..àà0h..hàÌzµ ÿÿ:Right Par[6]Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÐÀ..ààÔ2Ô(a)Ô3  Ô€ˆàh..hàà0À..ÀàÌzÇ ÿÿ:Right Par[7]Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÀ..ÀààÐ..°àÔ2Ôi)Ô3  Ô€ˆàÀ..Ààà0..àÌzÚ ÿÿ:Right Par[8]Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÀ..Ààà..ààÐp..àÔ2Ôa)Ô3  Ô€ˆà..àà0p..pàÌVXÿÿ8Document[1]Document StyleÌÔ  Ôà@ì..8àòòò òÔ  ÔÔ2ÔI.Ô3  Ô€Ô  ÔÔ  ÔÔ  ÔˆÌóóó ól2ÿÿ:Technical[5]Technical Document Styleà..àò òÔ2Ô(1)Ô3  Ô€.€€ó ól2ÿÿ:Technical[6]Technical Document Styleà..àò òÔ2Ô(a)Ô3  Ô€.€€ó ól/%ÿÿ:Technical[2]Technical Document StyleÌò òÔ2ÔA.Ô3  Ô€òòÔ  ÔÔ  ÔóóÌà..àó ól,!ÿÿ:Technical[3]Technical Document StyleÌò òÔ2Ô1.Ô3  Ô€Ô  ÔÔ  Ôà..àó ól(!ÿÿ:Technical[4]Technical Document Styleò òÔ2Ôa.Ô3  Ô€Ô  ÔÔ  Ôà..àó ól:0ÿÿ:Technical[1]Technical Document StyleÌòòò òÔ  ÔÔ2ÔI.Ô3  Ô€Ô  ÔÔ  ÔÔ  ÔÌóóà..àó ól1ÿÿ:Technical[7]Technical Document Styleà..àò òÔ2Ôi)Ô3  Ô€.€€ó ól1ÿÿ:Technical[8]Technical Document Styleà..àò òÔ2Ôa)Ô3  Ô€.€€ó ó<þ6X9`(*Courier 12pt10cpiXR& ÿÿ8BibliogrphyBibliographyà0..àà°..°àÌÌjoÿÿ4Tech InitInitialize Technical StyleÓS€   1 .1 .1 .1 .1 .1 .1 .1 þSÓØØ ÿÿCuy±ÉåTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1fpÿÿ2Doc InitInitialize Document StyleÓ€ÓÇÓS€ #    I. 1. A. a.(1)(a) i) a)SÓØØ !"(ÿÿ$˜˜Ìà0 àà à(ÿÿ$™™à0 àà0 àà à((ÿÿ$ššà0 àà0 àà0 àà à  ÿÿA_ekqw‡DocumentDocument StyleI.1.A.a.(1)(a)i)a)x?ãt2PleadingHeader for Numbered Pleading PaperÓÈÓÑ °ÑÑè°ÑÖ€%ÿÿÖ zÝ ƒ&ÿÿ(ÝÝ  ÝÔ€&«XXXÔÓÈÓÒX°ÒÒ°°ÒÓÿÿÀ°œXÓß6€G''ü°ø*–d6ßß6€G''°ø*–d6ßÌÌàHHÀà1ˆÌÌàHHÀà2ˆÌÌàHHÀà3ˆÌÌàHHÀà4ˆÌÌàHHÀà5ˆÌÌàHHÀà6ˆÌÌàHHÀà7ˆÌÌàHHÀà8ˆÌÌàHHÀà9ˆÌÌàÐÐÀà10ˆÌÌàÐÐÀà11ˆÌÌàÐÐÀà12ˆÌÌàÐÐÀà13ˆÌÌàÐÐÀà14ˆÌÌàÐÐÀà15ˆÌÌàÐÐÀà16ˆÌÌàÐÐÀà17ˆÌÌàÐÐÀà18ˆÌÌàÐÐÀà19ˆÌÌàÐÐÀà20ˆÌÌàÐÐÀà21ˆÌÌàÐÐÀà22ˆÌÌàÐÐÀà23ˆÌÌàÐÐÀà24ˆÌÌàÐÐÀà25ˆÌÌàÐÐÀà26ˆÌÌàÐÐÀà27ˆÌÌàÐÐÀà28Ô  à.À+Ô('2ŸÓ$¨¨Ý ƒF¤T!ÝÓ  ÓÝ  Ýpÿÿ4Heading 2Underlined Heading Flush LeftòòòòÌóóóóVÿÿ4Heading 1Centered Headingà@ì..ìàòòò òˆÌÌóóó ób* ÿÿ8Bullet ListIndented Bullet Listà0..àððà0` ..` àÌB& ÿÿ$1Document Styleà0..àà8` ..` àÌÌB ÿÿ$2Document Styleà..àò òòò.óó€€Ìó óB ÿÿ$3Document Styleà8..àÌÌB ÿÿ$4Document Styleà0..àÌÌB-ÿÿ$5Document StyleÌò òÔ2ÔÔ3  Ô€òòÔ  ÔÔ  ÔÌÌó óóóB& ÿÿ$6Document Styleà0..àà0` ..` àÌÌdS ÿÿ$7Right-Aligned Paragraph NumbersàÐ..àÔ2ÔÔ3  Ô€ˆà°..°àà0..àÌÌdf ÿÿ$8Right-Aligned Paragraph Numbersà..ààÐ` ..` àÔ2ÔÔ3  Ô€ˆà..àà0` ..` àÌÌB=ÿÿ$9Document StyleÌà..àò òÔ2ÔÔ3  Ô€Ô  ÔÔ  ÔÌó ófy ÿÿ&10Right-Aligned Paragraph Numbersà..àà` ..` ààи ..¸ àÔ2ÔÔ3  Ô€ˆà` ..` àà0¸ ..¸ àÌÌfŒ ÿÿ&11Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ ààÐ..àÔ2ÔÔ3  Ô€ˆà¸ ..¸ àà0..àÌÌfŸ ÿÿ&12Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààÐh..hàÔ2ÔÔ3  Ô€ˆà..àà0h..hàÌÌf² ÿÿ&13Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÐÀ..ÀàÔ2ÔÔ3  Ô€ˆàh..hàà0À..ÀàÌÌfÅ ÿÿ&14Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÀ..ÀààÐ..àÔ2ÔÔ3  Ô€ˆàÀ..Ààà0..àÌÌfØ ÿÿ&15Right-Aligned Paragraph Numbersà..àà` ..` àภ..¸ àà..ààh..hààÀ..Ààà..ààÐp..pàÔ2ÔÔ3  Ô€ˆà..àà0p..pàÌÌDV!ÿÿ&16Document StyleÌÔ  Ôà@ì..ìàòòò òÔ  ÔÔ2ÔÔ3  Ô€Ô  ÔÔ  ÔÔ  ÔˆÌÌóóó óX/ÿÿ&17Technical Document Styleà..àò òÔ2ÔÔ3  Ô€.€€Ìó óX/ÿÿ&18Technical Document Styleà..àò òÔ2ÔÔ3  Ô€.€€Ìó óX-(ÿÿ&19Technical Document StyleÌò òÔ2ÔÔ3  Ô€òòÔ  ÔÔ  ÔóóÌà..àÌó óX*$ÿÿ&20Technical Document StyleÌò òÔ2ÔÔ3  Ô€Ô  ÔÔ  Ôà..àÌó óX)$ÿÿ&21Technical Document Styleò òÔ2ÔÔ3  Ô€Ô  ÔÔ  Ôà..àÌó óX83ÿÿ&22Technical Document StyleÌòòò òÔ  ÔÔ2ÔÔ3  Ô€Ô  ÔÔ  ÔÔ  ÔÌóóà..àÌó óX/ÿÿ&23Technical Document Styleà..àò òÔ2ÔÔ3  Ô€.€€Ìó óX/ÿÿ&24Technical Document Styleà..àò òÔ2ÔÔ3  Ô€.€€Ìó ó  ÿÿCƒ‰•›£«±Right ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3|x\«<þ6X9`(*Courier 12pt10cpiXXxþ6X@ÉJQX@( ¤T$¡¡Ó  Ó dÔe{ ŸÓ$¨¨(G.21¤$¤¤Ý ƒF¤T!ÝÓ  ÓÝ  ÝÔ€òäºòXXÔà  àòòò òÚ  Ú0Ú  Úó óóóÿMARVINÿÿBERKEÿÿLESLIEÿÿMcWILLIAMSÿÿMcLELLANÿÿCURRIEÿÿBINGHAMÿÿKermitÿÿLowryÿÿBentonÿÿSnyderÿÿSaulsÿÿmulticysticÿ(ÿununderstandableÿ(&ÿretroperitoneumÿ&ÿButterworthÿ(—$ò òòòÚ  Ú0Ú  Úó óóóÿMARVINÿÿBERKEÿÿLESLIEÿÿMcWILLIAMSÿÿMcLELLANÿÿCURRIEÿÿBINGHAMÿÿKermitÿÿLowryÿÿBentonÿÿSnyderÿÿSaulsÿÿmulticysticÿ(ÿununderstandableÿ(&ÿretroperitoneumÿ&ÿButterworthÿ EeFGKPL/MNeOEPIQÓ€2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô("ÿÿ$££Ò  ÒÒ  ÒGGGG'ÿÿdxd2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  ÔRSTUZ[\] ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)< Œ 9p`(ModernP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(Monaco< Œ 9p`(Courier New% Line 7 diiii7Border 1dd€VjCþÿ << Gÿÿ< Œ 9p`(Arial #Ý ƒF!ÝÑ  ÑÑ#€d#ÑÔ€_ÔÔ€hÔÝ  ÝÔ€lÔÔ€lÔÓ  ÓÔ YYY ÔFILEDÔ€lXÔÌÌò òMarch€28,€1996ÌÌCecil€Crowson,€Jr.ÌÔ€lôÔAppellate€Court€Clerkó ó Ý ƒF!ÝÑ#€d#ÑÔ€_ÔÔ€hÔÝ  ÝÝ ƒI$ÝÔ€hôÔà àòòò òÚ  ÚÚ  Úó óóóÝ  Ýà àThese€words„„"where€way"„„are€as€they€appear€in€the€transcript.Ì Ý ƒF!ÝÑ#€d#ÑÔ€_ÔÔ€hÔÝ  ÝÝ ƒI$ÝÔ€hôÔà àòòò òÚ  ÚÚ  Úó óóóÝ  Ýà à(d)€In€a€malpractice€action€as€described€in€subsection€(a)€of€thisÏsection,€the€jury€shall€be€instructed€that€the€claimant€has€the€burden€ofÏproving,€by€a€preponderance€of€the€evidence,€the€negligence€of€the€defendant.€ÏThe€jury€shall€be€further€instructed€that€injury€alone€does€not€raise€aÏpresumption€of€the€defendant's€negligence.ÌPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'@Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑMonacoÑÑ ÑÒ  BA:Op Monaco ÒÒ  BA:Op Monaco Ò€V‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒF!ÝÔ . ÔÔ€_ÔÓ&€ggX„d&ÓÑ#€ggXd#ÑÔ€hÔÝ  ÝÑ  Ñ›Ñ7€?XXdÈdÈ7ÑÑ\R AØ'\ÑÑ ` ÑÑ  ÑÑ , ÑÑ 5 ÑÑ  ÑÑ€i §u` ќـ€ÙßL€kmj;+'h|` Å `€€Lß›à@ àIN€THE€COURT€OF€APPEALSÏOF€TENNESSEEÌÌà@ àEASTERN€SECTIONÌÌÌÌÌÌÌSHEILA€SEATSà@ à)à àSULLIVAN€COUNTYÌà@ à)à à03A01„9509„CV„00313Ìà àPlaintiff„Appelleeà àà@ à)Ìà@ à)Ìà@ à)Ìà àv.à àà@ à)à àHON.€JOHN€S.€McLELLAN,€III,Ì€€€€€€€€€€€€€€€€€€€€€€€à@ à)à àJUDGEÌà à€€€€€€€€€€€€€€€€€€€à@ à)ÌKERMIT€LOWRY,€M.D.à@ à)Ìà@ à)à àÌà àDefendant„Appellantà àà à€€à@ à)à àAFFIRMED€AND€REMANDEDà àÌÌÌÌÌÌÌRICHARD€M.€CURRIE,€JR.,€OF€KINGSPORT€FOR€APPELLANTÌÌJOHN€S.€BINGHAM€and€DANIEL€B.€MINOR€OF€KINGSPORT€FOR€APPELLEEÌÌÌÌÌÌà àà àà àà à€€òòO€P€I€N€I€O€NóóÌÌÌÌÌà àà àà àà àà àà à€€à àà àà àGoddard,€P.J.€ÌÌÌÌÌÓÓà àà àKermit€Lowry€appeals€a€medical€malpractice€judgmentÏrendered€against€him€in€the€amount€of€$65,000€in€favor€of€SheilaÍSeats.€€He€insists€on€appeal€that€the€Trial€Court€was€in€error€inÏnot€directing€a€verdict€in€his€favor€at€the€conclusion€of€all€theÏproof€and€in€refusing€to€charge€the€jury€certain€of€his€specialÏrequests.ÌÌà àà àOn€January€24,€1991,€Dr.€Lowry€performed€surgery€on€œMs.›ÏSeats,€who€had€previously€undergone€a€hysterectomy€to€remove€herÏtubes€and€ovaries.€€During€the€course€of€this€operation€Ms.€œSeats'›Ïureter€was€injured€by€Dr.€Lowry€suturing€the€ureter€or€the€ureterÏwall.€€As€a€result€it€was€necessary€for€Ms.€Seats€to€undergoÏconsiderable€medical€procedures€and€to€incur€considerable€medicalÏexpenses.ÌÌà àà àIn€our€review€of€the€first€issue€relative€to€a€directedÏverdict€we€are€required€to€take€the€strongest€legitimate€view€ofÏthe€evidence€in€favor€of€Ms.€Seats€and€allow€all€reasonableÏinferences€to€be€drawn€therefrom,€as€well€as€to€discard€allÏcountervailing€evidence.€€òòBenton€v.€Snyderóó,€825€S.W.2d€409Ï(Tenn.1992);€òòSauls€v.€Evansóó,€635€S.W.2d€377€(Tenn.1982).ÌÌà àà àAlthough€there€is€testimony€to€the€contrary,€Dr.€MonteÏW.€Phillips,€the€expert€who€appeared€for€Ms.€Seats,€testified,Ïamong€other€things,€the€following:ÌÌÒ  ÒÒ  ÒÓÓQà àHave€you€reviewed€the€records€in€this€case?ÌÌAà àYes,€I€have.ÌÌQà àDid€you€come€to€the€conclusion€that€Dr.€KermitÏLowry€deviated€from€the€recognized€standards€ofÏacceptable€professional€practice„„ÌÌAà àYes,€I€did.ÌÌQà à„„in€the€specialty€of€general€surgery€in€Bristol,ÏTennessee,€or€a€similar€community?ÌÌAà àYes.ÌÌà à.€.€.€.ÌÌQà àDr.€Phillips,€as€you€know€and€as€the€ladies€andÏgentlemen€of€the€jury€have€been€told,€Sheila€Seats€had€aÏhysterectomy€approximately€two€years€prior€to€theÏsurgery€to€remove€her€ovaries.€€How€does€this€affect€theÏinside€anatomy€of€a€person,€and€in€particular,€based€onÏyour€review€of€the€records,€how€did€it€affect€SheilaÏSeats?ÌÌAà àAll€right.€€You€can€do€a€hysterectomy€and€two€yearsÏlater€you€can,€for€some€reason€or€another€have€to€re„enter€that€abdomen€and€go€back€in€there€and€find€a€fewÏadhesions€and€very€little€change.€€Very€often,€however,Ïand€I€mean€very€often,€when€someone€has€had€aÏhysterectomy,€especially€at€age€28,€you€presume€it€wasÏfor€some€disease€process,€and€you€re„enter€the€pelvisÏfor€any€other€reason,€very€frequently€you€find€yourÏovaries€and€the€fallopian€tubes€attached€to€theÏperitoneal€wall,€pulled€down€out€of€their€normalÏposition.€€And€when€they€are€multicystic€or€polycystic,Ïyou€see€all€kinds€of€wild€and€almost,€to€me,Ïununderstandable€situations.ÌÌà àI€have€personally€taken€the€ureter€out€of€theÏcenter€of€an€ovary€in€a€bad€cystic€affair€where€way× ƒn ××  ×€theÏureter€got€right€out€in€the€center€running€through€theÏmiddle€of€the€ovary.€€I've€done€that€several€times.ÌÌQà àIs€this€something€that€a€reasonable€and€competentÏsurgeon€should€anticipate?ÌÌAà àFlat€out€yes.ÌÌà à.€.€.€.ÌÌQà àDoes€the€standard€of€care,€tell€me€whether€or€notÏin€your€opinion€the€standard€of€care€requires€theÏsurgeon€to€anticipate€that€the€ureter€itself€may€beÏadhered€to€other€structures€or€itself€may€not€be€in€itsÏnormal€location?ÌÌAà àAbsolutely.€Flat€out€yes.ÌÌQà àTell€me€whether€or€not„„ÌÌAà àLet€me€dispel€something.€€A€surgeon€is€a€little€bitÏmore€than€a€mechanic.€€He's€also€a€doctor.€€So€he's€gotÏto€think€a€little.ÌÌQà àI€understand.ÌÌAà àWe're€not€considered€right€bright€in€the€staff,€youÏknow.€€You€still€got€to€think€a€little.ÌÌQà àTell€me€whether€or€not€the€standard€of€careÏrequires€the€surgeon€at€the€beginning€of€the€case,€atÏthe€beginning€of€the€surgery€to€be€conscious€of€the€factÏthat€it€may€become€necessary€during€the€surgery€toÏactually€physically€identify€the€ureter?ÌÌAà àYes,€Sir,€it€does.€€This€operation€should€never€beÏdone€by€anyone€unwilling€to€do€that€and€anyone€whoÏdoesn't€have€the€judgment€to€know€when€to€do€that.ÌÌQà àTell€me,€Dr.€Phillips,€whether€or€not€the€standardÏof€care€requires€that€the€surgeon€be€aware€and€consciousÏof€the€ureter€and€it's€location€throughout€this€entireÏsurgical€procedure?ÌÌAà àYes.€€And€after€his€gloves€are€off€and€he'sÏstanding€in€the€room.€€He€has€to€think€about€it€then.€ÏIs€there€any€way€in€the€world€that€I€could€have€hurt€oneÏof€those€ureters.€€He's€got€to€say€that€to€himself.€€AndÏif€there€is€any€suggestion€or€thought€or€fleetingÏthought€œthat€that›€might€have€occurred,€he€should€get€aÏurologist€shoot€that€scope€up€there€and€take€twoÏpictures€or€shoot€some€dye€and€look€and€make€absolutelyÏsure€that€hasn't€hurt.ÌÌà àWhat€I€am€saying€is€there€is€a€little€15„minuteÏprocedure,€three€or€four€different€ones,€that€you€canÏdo,€any€one€of€which,€that€can€tell€you€absolutely€thatÏyou€have€not€closed€off€this€ureter€that€you€can€doÏright€then,€right€there€before€you€ever€get€out€of€theÏroom€or€before€the€procedure€is€completely€over.€€It€isÏcheckable€readily.€€It's€not€like€many€things€thatÏaren't€checkable.ÌÌQà àTell€me€whether€or€not€the€standard€of€careÏrequires€the€surgeon€when€he€clamps€that€mesentery€andÏthose€vessels€to€know€what's€in€between€that€clamp?ÌÌAà àAbsolutely.€€It€does€not€require€that€he€see€theÏureter€at€that€moment,€but€it€does€require€that€he€knowÏwhat's€in€that€clamp.ÌÌQà àDoes€that€standard€require€that€he€satisfy€himselfÏthat€the€ureter€is€not€in€that€clamp?ÌÌAà àYes,€it€does.ÌÌQà àDoes€the€standard€of€care€require€the€surgeon€toÏknow€not€only€what€heððs€clamping€but€also€what€heððsÏstitching€or€sewing€up?ÌÌAà àYes,€it€does.ÌÌà à.€.€.€.ÌÌQà àDr.€Phillips,€you€told€us€that€it€was€your€opinionÏthat€Dr.€Lowry€deviated€from€the€standard€of€care.ÌÌAà àRight.ÌÌQà àIn€your€opinion€did€that€deviation€cause€Mrs.ÏSeats'€injury€to€her€ureter.ÌÌAà àYes,€it€did.ÌÌà à.€.€.€.ÌÌQà àIs€there€anything€in€Dr.€Lowry's€deposition€or€inÏthat€Operative€Note€that€you€have€before€you€that€wouldÏindicate€that€Dr.€Lowry€recognized€intellectually,€asÏyou€say,€that€at€some€point€during€this€operation€heÏmight€need€to€physically€locate€that€ureter?ÌÌAà àNo.ÌÌQà àIs€the€contrary,€in€fact,€true,€based€on€yourÏreview€of€his€deposition?ÌÌAà àThe€contrary€is€true.ÌÌQà àAnd€what€statement€attributed€to€Dr.,€did€Dr.€LowryÏmake?ÌÌAà àI€saw€in€the€deposition€two€places.€€One€said€thatÏyou€can't€see€the€ureter€in€the€retroperitoneum.€€That'sÏan€absolute€falsehood.€€And,€two,€that€the€ovary€wasÏlifted€up€and€the€clamp€was€placed€behind€it€and€someÏkind€of€sewing„„and€I'm€not€trying€to€be€mean„„some€kindÏof€sewing€that€I€don't€really€understand€occurred.€€AndÏthe€ovary€was€cut€out€and€it€was,€that€was€that.ÌÌQà àAs€far€as€preparation€for€the€case€and€thinkingÏabout€having€to€find€the€ureter,€was€there€a€statementÏmade€by€Dr.€Lowry€in€his€deposition?ÌÌAà àYeah.€€He€said€he€doesn't€ever€look€for€it,€thatÏyou€don't€have€to€look€for€it,€that€you€do€thisÏprocedure€this€way,€and€based€on€doing€this€procedureÏthis€way,€this€doesn't€very€often€happen€but€it€canÏhappen.€€Well,€isn't€that€nice?ÌÌQà àDoes€this€happen€very„„ÌÌAà àIf€you're€careful€this€does€not€have€to€happen€atÏall.€€It€does€not€at€all,€ever.€€And€if€it€does€happen,Ïthere's€something€wrong€with€you€when€you're€doing€it.€ÏI€don't€know€what€it€is€and€don't€care€what€it€is,€butÏsomething's€wrong€with€you.€€Slop€talk€like€that,€liftÏsomething€up,€put€a€clamp€on,€cut€it€out,€I€don't€wantÏany€part€of€it.€ÌÌà à.€.€.€.ÌÌQà àDr.€Phillips,€based€on€your€examination€of€theÏrecords€and€Dr.€Lowry's€deposition,€what€is€your€opinionÏabout€how€the€ureter€was€injured,€how€the€stitch€was€putÏin€it,€how€this€all€happened?ÌÌAà àWell,€if€you,€if€you€read€the,€the€Operative€NoteÏand€try€to€visualize€the€way€this€occurred,€what€youÏfind€is€that€the€ovary€and€the€fallopian€tube€are€liftedÏup€on,€on€the€membrane,€my€shirt€sleeve€being€theÏmembrane,€and€the€clamp€is€put€beneath€them€and€theÏdissection€is€carried€out€over€the€clamp€or€next€to€theÏovary,€all€of€this€with€the€intent€of€preventing€anyÏinjury.€€But€that€in€there€the€ureter€was€pulled€and€aÏligature,€which€was€apparently€put€in€with€a€suture,€inÏall€probably€[sic]€went€around€the€ureter€or€a€knuckleÏof€the€ureter€and€obstructed€it€because€later€we€findÏout€that€the€ureter€was€obstructed.€€That€doesn't€meanÏthat€it€was€caught€up€in€tissue€and€kinked€or€partiallyÏobstructed€or€pulled€out€of€position.€€It€wasÏobstructed.€€Well,€it's€virtually€got€to€have€a€tieÏaround€it€to€be€completely€obstructed.ÌÌà àAnd€you€kind€of€get€an€intellectual€substantiationÏof€that€when€you€find€out€that€48€hours€later€the€doctorÏwho€works€to€correct€the€injury€takes€out€a€piece€of€theÏinjury€because€he€said€it's€devitalize.€€It's,€it'sÏinjured€to€the€point€he's€fearful€of€leaving€it,€beingÏafraid€that€it€will€rot€and€a€hole€will€come€in€andÏurine€will€leak€out€and€kill€you,€or€being€afraid€thatÏit€will€stenose€on€down€and€very€slowly€close€off€over€aÏlong€period€of€time.ÌÌQà àLet€me€take€you€back€to€one€thing€you€said€a€fewÏminutes€ago.€€I€believe€I€heard€you€say€that€if€thatÏstitch€in€the€ureter€had€been€removed€during€theÏoperation€or€shortly€thereafter€that€she€would€have€beenÏokay.€€Did€I€understand€that€right?ÌÌAà àYeah.€€If€it€had€been€removed€anytime€in€the€nextÏtwo,€three,€or€four€hours€it€would€have€been€all€right.ÌÌQà àAre€you€saying€that€then€had€he€caught€his€error€inÏsurgery€and€fixed€it€there€that€none€of€this€subsequentÏsurgery€by€Dr.€Butterworth€and€none€of€these€visits€toÏDr.€Butterworth€in€the€emergency€room€would€have€beenÏnecessary?ÌÌAà àAbsolutely.€€None€of€that.€€That's€why€I€got€soÏangry€about€the€question.€€If€he€had€just€thought,€"IsÏthis€hurt,"€and€found€out,€none€of€this€would€occur.€ÏThey€wouldn't€be€having€the€grief€they're€having.€€IÏwouldn't€be€up€here€from€Florida,€and€that€wouldn't€beÏall€over€the€board€there,€and€this€girl€wouldn't€haveÏbeen€going€back€and€forth€to€see€the€doctor€with€tubesÏhanging€out€of€her.ÌÌà à.€.€.€.ÌÌQà àAs€I€understand€it,€what€your€testimony€basicallyÏcomes€down€to€is€that€you€say€Dr.€Lowry€deviated€fromÏthe€standard€of€care€because€this€lady€ended€up€with€aÏcomplication.ÌÌAà àNo,€not€at€all.€€You€didn't€listen.€€I€said€that€heÏdeviated€from€the€standard€of€care€because€she€had€aÏsimple,€semi„routine€operation€that€resulted€in€a€severeÏureteral€injury,€one€necessitating€having€to€take€aÏsegment€of€the€ureter€out€two€days€later€and€left€anÏoperating€room€and€went€into€a€ward€where€she€had€painÏand€somebody€discovered€that€she€was€sick.€€That's€whatÏI€said.ÌÌà à.€.€.€.ÌÌQà àSo€you're€saying€the€fact€that€it€occurred€is€proofÏof€the€negligence.ÌÌAà àI'm€saying€you€should€do€this€operation€and€notÏinjury€anybody,€yes,€flat€out,€and€if€you€have,€youÏshould€know€it.€€And€it's€that€simple€and€that€easy€toÏunderstand.ÌÌÌÌÒ ° ÒÒ ° ÒÓÓà àà àIt€is€the€insistence€of€Dr.€Lowry€that€Dr.€Phillips€andÏthe€jury€improperly€and€contrary€to€T.C.A.€29„26„115(d)œ× ƒo ××  ×›€presumed€ÏDr.€Lowry€was€guilty€of€negligence€because€of€the€injury€which€sheÏreceived.ÌÌà àà àIn€light€of€Dr.€Phillips'€testimony€hereinbefore€setÏout,€we€conclude€that€this€is€not€the€case.€€Indeed,€Dr.€PhillipsÏtestified€that€Dr.€Lowry€was€negligent€because€of€his€actionsÏrather€than€because€of€the€result€of€his€surgical€procedure.€€ÌMoreover,€we€are€inclined€to€believe€that€the€prohibition€againstÏa€jury€presuming€negligence€does€not€preclude€an€expert€fromÏtestifying€that€a€physician€is€guilty€of€negligence€based€upon€theÏinjury€received,€especially€in€light€of€T.C.A.€29„26„115(c),€whichÏprovides€the€following:ÌÌÒ  ÒÒ  ÒÓÓœà à(c)›€In€a€malpractice€action€as€described€inÏsubsection€(a)€of€this€section€there€shall€be€noÏpresumption€of€negligence€on€the€part€of€the€defendant.€ÏProvided,€however,€there€shall€be€a€rebuttableÏpresumption€that€the€defendant€was€negligent€where€it€isÏshown€by€the€proof€that€the€instrumentality€causingÏinjury€was€in€the€defendant's€(or€defendants')€exclusiveÏcontrol€and€that€the€accident€or€injury€was€one€whichÏordinarily€doesn't€occur€in€the€absence€of€negligence.ÌÌÌÌÒ ° ÒÒ ° ÒÓÓà àà àBy€his€second€issue€Dr.€Lowry€insists€that€the€CourtÏcommitted€reversible€error€in€refusing€to€charge€portions€of€hisÏspecial€requests€numbers€two€and€four,€and€all€of€his€requestÏnumber€three.ÌÌà àà àThe€omitted€portion€of€the€special€requests€are€set€outÏin€Dr.€Lowryððs€brief€as€follows:€€(See€appendix€for€entire€text€ofÏall€three€special€requests.)ÌÌÒ  ÒÒ  ÒÓÓà@ àòòSPECIAL€REQUEST€NO.€2óóÌÌPhysicians€must€be€allowed€a€wide€range€in€the€exerciseÏof€their€judgment€and€discretion.€€The€science€ofÏmedicine€is€not€an€exact€science.€€In€many€instancesÏthere€can€be€no€fixed€rule€by€which€to€determine€theÏduty€of€a€physician,€and€he€must€often€use€his€own€bestÏjudgment€and€act€accordingly.€€By€reason€of€that€fact,Ïthe€law€will€not€hold€a€physician€guilty€of€negligence,Ïeven€though€his€judgment€may€later€prove€erroneous€in€aÏgiven€case,€unless€it€be€shown€that€the€course€pursuedÏwas€clearly€against€the€course€recognized€as€correct€byÏthe€profession€generally€and€the€specialty€practiced€byÏthe€defendant€physician€as€it€existed€in€January€1991,Ïin€Bristol,€Tennessee€and€similar€communities.ÌÌAs€long€as€there€is€room€for€an€honest€difference€ofÏopinion€among€competent€physicians,€a€physician€who€usesÏhis€own€best€judgment€cannot€be€found€guilty€ofÏnegligence€even€though€it€may€afterwards€develop€that€heÏwas€mistaken.€€Where€there€is€a€difference€of€opinionÏamong€physicians€with€reference€to€the€treatment€to€beÏgiven€in€a€particular€case,€a€physician€will€not€be€heldÏliable€for€malpractice€if€he€follows€the€course€ofÏtreatment€advocated€by€a€considerable€number€ofÏphysicians€of€good€standing€in€his€profession.ÌÌà@ àòòSPECIAL€REQUEST€NO€3óóÌÌIn€order€for€an€expert€witness€to€testify€as€to€theÏstandard€of€care€of€a€physician€in€this€or€similarÏcommunity,€such€witness€must€first€demonstrate€knowledgeÏof€what€that€standard€is.€€It€then€becomes€the€functionÏof€you,€the€jury,€to€decide€whether€that€knowledge€isÏsufficient,€and€to€what€extent,€if€any,€his€opinion€isÏentitled€to€be€considered€by€you€in€deciding€whether€aÏdefendant€has€practiced€in€accordance€with€or€below€theÏstandard€of€care€prevailing€in€Bristol,€Tennessee€or€aÏsimilar€community.€€This€is€what€is€meant€by€the€"weightÏof€the€testimony"€and€you€are€the€judge€of€that€weight.ÌÌI€charge€you€further€that€testimony€by€an€expert€witnessÏthat€he€personally€would€use€or€prefer€another€orÏdifferent€method€or€procedure€than€that€employed€by€Dr.ÏLowry€or€that€such€different€method€would€be€"better"€orÏ"more€appropriate"€for€the€treatment€of€Sheila€Seats,Ïdoes€not€establish€the€applicable€standard€of€care,€andÏthe€fact€that€such€alternative€method€was€not€followedÏwould€not€create€liability€or€require€you€to€findÏnegligence€or€malpractice€on€the€part€of€a€defendantÏunless€you€also€find€from€a€preponderance€of€theÏevidence€that€the€method€and€means€used€by€Dr.€Lowry€inÏthe€care€of€Sheila€Seats€was€contrary€to€the€standardÏgoverning€the€practice€of€general€surgery€in€Bristol,ÏTennessee€or€similar€communities.ÌÌà@ àòòSPECIAL€REQUEST€NO.€4óóÌÌIt€is€a€physicianððs€privilege€to€decide€between€one€ofÏtwo€or€more€courses€in€the€treatment€of€his€patient,€andÍhe€cannot€be€held€responsible€for€an€erroneous€exerciseÏof€judgment.€€This€privilege€is€subject,€however,€to€theÏlimitation€that€before€exercising€judgment,€theÏphysician€should€inform€himself€by€proper€examination€soÏas€to€ascertain€the€facts€and€circumstances€on€which€aÏreasonable€exercise€of€judgment€might€rest.€€This€isÏwhat€physicians€refer€to€as€the€exercise€of€clinicalÏjudgment.ÌÌ...The€law€credits€the€physician€with€the€presumptionÏthat€he€has€discharged€his€full€duty....ÌÌMere€negligence€on€the€part€of€Dr.€Lowry,€standingÏalone,€is€not€sufficient€under€the€law€of€Tennessee€toÏrender€him€liable.€€Before€you€can€find€Dr.€LowryÏliable,€you€must€find€from€the€evidence€that€SheilaÏSeats€suffered€injury€which€resulted€from€his€lack€ofÏcare€and€skill.€€A€bare€possibility€of€such€result€isÏnot€sufficient.€€If€you€find€from€the€evidence€that€theÏinjury€to€Sheila€Seatsðð€ureter€may€have€been€due€to€oneÏof€two€or€more€causes,€any€one€of€which€may€have€beenÏthe€sole,€proximate€cause,€before€you€can€find€for€theÏplaintiff,€you€must€also€find€from€the€evidence€that€asÏbetween€the€two€or€more€causes€it€was€Dr.€LowryððsÏnegligence€that€caused€the€condition.€€If,€on€theÏevidence,€equally€probable€causes€of€the€condition€areÏpresent€for€one€or€more€of€which€Dr.€Lowry€is€notÏresponsible,€you€are€not€permitted€under€the€law€toÏspeculate,€guess€or€surmise€as€to€the€actual€cause.€ÏThus,€if€you€find€that€the€expert€medical€evidence€showsÏmore€than€one€equally€probable€cause€for€Sheila€SeatsððÏcondition,€for€one€or€more€of€which€Dr.€Lowry€is€notÏresponsible,€the€plaintiff€has€failed€to€sustain€theÏburden€of€proof€and€your€verdict€will€be€for€theÏdefendant.ÌÌÌÌÒ ° ÒÒ ° ÒÓÓà àà àOur€review€of€the€special€requests,€vis„a„vis,€€theÏcharge€as€given,€persuades€us€that€although€the€requests€may€haveÏbeen€sanctioned€in€earlier€cases€by€this€Court€and€the€SupremeÏCourt,€the€Trial€Court€did€not€commit€reversible€error.€€HisÍcharge,€as€given,€which„„as€appropriate€to€the€facts€of€this€case„„employed€almost€the€exact€language€of€the€Pattern€JuryÏInstructions,€told€the€jury€that€negligence€could€not€be€presumedÏnor€inferred€from€the€results€of€a€doctor's€actions,€and€that€aÏdoctor€is€not€a€guarantor€of€the€results€of€his€treatment.ÌAdditionally,€the€charge€as€given€covered€in€substance€part€of€theÏomitted€material€in€the€special€request.€€œÌÌà àà àMoreover,€we€are€inclined€to€believe€that€the€specificsÏset€out€in€the€requested€charge€would€have€been€inferred€by€theÏjury€from€the€charge€as€given.€€Still€further,€we€conclude€thatÏeven€if€it€was€error€to€refuse€the€charges,€it€was€harmless€asÏcontemplated€by€Rule€36€of€the€Tennessee€Rules€of€AppellateÏProcedure€in€that€it€is€obvious€from€the€jury€verdict€itÏaccredited€the€testimony€of€Dr.€Phillips€over€the€testimony€to€theÏcontrary€by€Dr.€Lowry€and€the€expert€appearing€on€his€behalf.€ÌÌà àà àFinally,€as€to€this€issue,€the€jury€was€specificallyÏcharged€the€following:ÌÌÒ  ÒÒ  ÒÓÓà àNow,€in€order€to€recover€the€Plaintiff€must€proveÏby€preponderance€of€the€evidence€and€by€expert€medicalÏproof€the€following:€(1)€The€recognized€standard€ofÏacceptable€professional€practice€in€the€profession€andÏin€the€specialty€thereof€that€Dr.€Lowry€practiced€in€theÍcommunity€in€which€he€practiced,€that€being€Bristol,ÏTennessee,€or€in€a€similar€community€at€the€time€thatÏthe€alleged€injury€or€wrongful€action€occurred.€€(2)ÏThat€Dr.€Lowry€acted€with€less€than€or€failed€to€actÏwith€ordinary€and€reasonable€care€in€accordance€withÏsuch€standard.€€And€(3)€that€as€a€proximate€result€ofÏDr.€Lowryððs€negligent€act€or€omission€Sheila€SeatsÏsuffered€injuries€which€would€not€otherwise€haveÏoccurred.ÌÌà àIn€an€action€where€medical€malpractice€is€allegedÏyou€may€not€presume€negligence€on€the€part€of€Dr.€Lowry.€ÏThe€Plaintiff,€before€she€may€be€permitted€to€recoverÏhas€the€burden€of€proving€by€a€preponderance€of€theÏevidence€and€by€expert€medical€testimony€that€Dr.€LowryÏwas€negligent€or,€stated€another€way,€he€deviated€fromÏthe€acceptable€professional€practice€required€of€him€inÏthe€practice€of€general€surgery€in€the€care€of€SheilaÏSeats€and€that€such€deviation€proximately€caused€SheilaÏSeats'€injury.ÌÌà àThe€fact€that€Sheila€Seats€may€have€suffered€a€badÏoutcome,€that€is€to€say€that€her€left€ureter€was€injuredÏduring€surgery,€does€not€allow€you€to€presume€that€Dr.ÏLowry€was€negligent€in€this€care€of€her.€€NegligenceÏmust€always€be€proved€by€a€preponderance€of€theÏevidence.ÌÌà àA€physician€or€a€surgeon€such€as€Dr.€Lowry€is€notÏnegligent€simply€because€his€efforts€provedÏunsuccessful.€€It€is€possible€for€a€physician€or€surgeonÏto€err€in€judgment€or€to€be€unsuccessful€in€hisÏtreatment€without€being€negligent.€€By€undertakingÏtreatment€he€does€not€guarantee€a€good€result,€but€he€isÏresponsible€for€an€injury€to€his€patient€resulting€fromÏhis€lack€of€the€requisite€knowledge€and€skill€or€hisÏfailure€to€exercise€reasonable€care€or€to€use€his€bestÏjudgment.ÌÌÌÌÒ ° ÒÒ ° ÒÓÓà àà àWe€have€no€hesitancy€in€concluding€that€the€jury€wouldÏcertainly€have€exonerated€Dr.€Lowry€absent€a€finding€that€Ms.ÍSeats€had€carried€her€burden€of€proving€that€he€was€negligent€andÏthat€his€negligence€was€the€proximate€cause€of€her€injuries.ÌÌà àà àFor€the€foregoing€reasons€the€judgment€of€the€TrialÏCourt€is€affirmed€and€the€cause€remanded€for€collection€of€theÏjudgment€and€costs€below.€€Costs€of€appeal€are€adjudged€againstÏDr.€Lowry€and€his€surety.ÌÌÓÓà àà àà àà àà àà à_______________________________Ìà àà àà àà àà àà àHouston€M.€Goddard,€P.J.€ÌÌÌCONCUR:ÌÌÌÌÌ________________________________ÌDon€T.€McMurray,€J.ÌÌÌÌ________________________________ÌCharles€D.€Susano,€Jr.,€J.ÌÌ