ÿWPCt! …# VUNa %¯ 0˜µU<M w@‰ 4É Ý ì UDô 0J8 0Ü‚ 0D^ 0T¢ 0^ö 0hT 0r¼ 0|. 0†ª 00 1uÀ 0d5U>™B)×DC AMCU*„º¦> äv~î D3lvÓŸ 0@r B² AOÏÆ 0Dä D/(! BW!˜HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPTÀäÌÀÀÌÀä0 (ÈhH  Z ‹6Times New Roman RegularX(püƒ$¡¡Ò°ÒÒ„°ÒÑTR[¤ AØ'ÿ Legal[¤ AØ'ÿ Legal AØ'ÿ Legal AØ'ÿ LegalTÑ-šBu Z‹$Arrus BT Roman 3D4D5U6D7U8î9H:;Ó€EDÒ Ø3|xG8 ±ZŠ,Century-WP Regular2 ÿÿ0Indent1Ô2ÔÔ3  Ô(Œ(3`d$¤¤Ý ƒüƒ!ÝÒ°ÒÒ„°ÒÑTR[¤ AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÝ  Ýà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ 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  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(&Times New Roman% Line 7 d""""7Border 1dd€-#Cþÿ << Gÿÿ< Œ 9p`(Arial zÝ ƒ!ÝÑ  ÑÑ#€d#ÑÔ€!ÔÒ  ÒÒ „ ÒÑ\R AØ'\ÑÝ  ÝÔ€%ÔÔ€%ÔÓ  Óò òÔ YYY ÔFILEDÔ€%XÔÌÌOctoberÏ11,Ï1996ÌÌCecilÏW.ÏCrowsonÌAppellateÏCourtÏClerkÔ  Ôó ó œÝ ƒ!ÝÑ#€d#ÑÔ€!ÔÒ  ÒÒ „ ÒÑ\R AØ'\ÑÝ  ÝÝ ƒ$Ýà àòòÚ  ÚÚ  ÚóóÝ  Ý€€Ô€ÔMrs.€Shadrick€has€a€derivative€cause€of€action€for€loss€of€consortium€and€willÏnot€be€referred€to€further.Ô€!ÔÌ Ý ƒ!ÝÑ#€d#ÑÔ€!ÔÒ  ÒÒ „ ÒÑ\R AØ'\ÑÝ  ÝÝ ƒ$Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝÔ€ÔThe€complaint,€naming€various€other€defendants,€also€presents€a€productsÏliability€cause€of€action€and€seeks€to€maintain€the€suit€as€a€class€action.€€The€record€doesÏnot€disclose€any€ruling€by€the€court€as€to€class€certification.ÌPtPtHPð€ÿÜÿìô”(üHPð€P € €'KKKK'ÿÿdxdStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  BA Op Geneva ÒÒ  BA Op Geneva Ò("ÿÿ$££Ò  ÒÒ  Ò d€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€!ÔÒ  ÒÒ „ ÒÑ\R AØ'\ÑÝ  ÝÑ7€uXXdìdÈ7ÑÑ  ÑÔ€ÔÓ  ÓÑ  Ñà@ àIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÌà@ àWESTERN€SECTION€AT€NASHVILLEÌà àà à€€€________________________________________________ÌÌò òDONALD€R.€SHADRICK,€and€wife,ÌVALERIE€SHADRICK,€ó óÌÌà àPlaintiffs„Appellants,Ìà àà àà àà àà àà àà àDavidson€Circuit€No.€94C„4135ÌVs.à àà àà àà àà àà àà àC.A.€No.€01A01„9604„CV„00145ÌÌò òCENTENNIAL€MEDICAL€CENTERÌand€WESLEY€L.€COKER,€M.D.,€ó óÌÌà àDefendants„Appellees.Ì___________________________________________________________________________ÌÌà@ àFROM€THE€DAVIDSON€COUNTY€CIRCUIT€COURTÌà@ àTHE€HONORABLE€WALTER€C.€KURTZ,€JUDGEÌÌÌà@ àG.€Thomas€Nebel,€John€B.€CarlsonÌà@ àWilliams€&€Associates,€P.C.€of€NashvilleÌà@ àFor€Plaintiffs„AppellantsÌÌÌà@ àRobert€L.€Trentham,€G.€Brian€JacksonÌà@ àTrabue,€Sturdivant€&€DeWitt€of€NashvilleÌà@ àFor€Appellee,€Wesley€L.€CokerÌÌà@ àC.€J.€Gideon,€Jr.,€William€S.€Walton€of€NashvilleÌà@ àFor€appellee,€HCA€Health€Service€of€Tennessee€d/b/aÌà@ àCentennial€Medical€CenterÌÌÌà@ àòòò òAFFIRMED€IN€PART,€VACATED€IN€PART€AND€REMANDEDÌÌà@ àó óóóOpinion€filed:ÌÙ€€ÙßL€$&#;+'h|9ô¡` à. `€€LßÌÌÌÌà àà àà àà àà àà àà àà àò òW.ÏFRANK€CRAWFORD,Ìà àà àà àà àà àà àà àà àPRESIDING€JUDGE,€W.S.ÌÌÌÌCONCUR:ÌÌALAN€E.€HIGHERS,€JUDGEÌÌBEN€H.€CANTRELL,€JUDGEó óÌÌÑ ° ÑÓÓ›à àPlaintiffs,€Donald€R.€ShadrickÏand€wife,€Valerie€ShadrickÏ(hereinafter€Mr.€Shadrick× ƒ' ××  ×),€appealÏfrom€the€order€of€the€trial€courtÏthat€granted€summary€judgment€toÏdefendants,€Centennial€MedicalÏCenter€(CMC)€and€Wesley€L.ÏCoker,€M.D.Ìà àIn€December€of€1988,€plaintiffÍDonald€Shadrick€suffered€a€disabling€work„related€back€injury.€€In€March€of€1989,€Mr.ÏShadrick€began€seeing€Dr.€Wesley€Coker,€an€orthopaedic€surgeon€in€Nashville.€€AfterÏexamining€Mr.€Shadrick,€Dr.€Coker€determined€that€surgery€was€necessary,€and€on€AprilÏ13,€1989,€Dr.€Coker€performed€a€percutaneous€dissectomy€on€Mr.€Shadrickððs€spine.€€Dr.ÏCokerððs€office€notes€for€April€18,€1989,€indicate€that€Mr.€Shadrickððs€back€pain€increasedÏfollowing€the€surgery.€€On€May€12,€1989,€Dr.€Coker€performed€a€second€surgery€on€Mr.ÏShadrick€in€which€he€excised€one€of€the€discs€in€Mr.€Shadrickððs€spine.€€Dr.€Cokerððs€notesÏfollowing€the€second€surgery€indicate€that€Mr.€Shadrick€continued€to€experience€pain€inÏhis€back€following€the€surgery.€€On€February€5,€1990,€Dr.€Coker€performed€a€thirdÏsurgery€on€Mr.€Shadrickððs€spine.€€The€third€surgery€involved€the€injection€of€a€steroidÏinto€his€back.€€Dr.€Cokerððs€March€6,€1990€notes€state€that€the€steroid€injection€did€notÏalleviate€Mr.€Shadrickððs€pain,€and€that€following€the€injection€ð ð[h]is€pain,€in€fact,€isÏsomewhat€worse€across€his€foot€into€his€right€leg€in€a€classic€distribution€which€he€hadÏdescribed€all€along.ðð€€Ìà àOn€March€12,€1990,€Mr.€Shadrick€underwent€a€fourth€surgery€which€is€theÏsubject€of€this€litigation.€€Prior€to€the€surgery,€Mr.€Shadrick€signed€a€consent€formÏprovided€by€the€hospital€in€which€he€consented€to€the€performance€of€a€ð ðright€L5„S1Ïlaminectomy€with€fusionðð€by€Dr.€Coker.€€The€surgical€procedure€was€performed€atÏWestside€Hospital€(now€Centennial€Medical€Center),€and€during€the€procedure,€Dr.ÍCoker€inserted€ð ðpedicleðð€screws€into€Mr.€Shadrickððs€spine.€€In€his€affidavit,€Mr€ShadrickÏstates€that€prior€to€the€surgery€he€was€never€informed€that€screws€would€be€placed€in€hisÏback.€€€Mr.€Shadrickððs€affidavit€states€that€when€he€awoke€from€the€operation,€Dr.€CokerÏinformed€him€that€screws€had€been€implanted€in€his€back.€€Mr.€Shadrick€alleges€thatÏalthough€Dr.€Coker€informed€him€of€the€screw€implantation,€ð ðthis€information€did€notÏmean€anything€to€.€.€.€[him]€because€nobody€ever€told€.€.€.€[him]€about€any€risks€of€injuryÏor€any€problems€that€could€be€caused€by€the€screws.ðð€€Mr.€Shadrick€states€that€followingÏthe€surgery,€Dr.€Coker€assured€him€that€the€use€of€the€pedicle€screws€was€ð ðroutineÏtreatmentðð€for€the€type€of€surgery€performed€on€him.€€Mr.€Shadrick€avers€that€Dr.ÏCoker€never€informed€him€that€the€screws€were€experimental,€that€the€screws€had€notÏbeen€approved€by€the€Food€and€Drug€Administration€(FDA),€or€that€the€screws€couldÏcause€him€any€problems.€€Ìà àMr.€Shadrick€contends€that€following€the€March€12,€1990,€surgery,€his€backÏcondition€became€worse.€€On€September€20„26,€Mr.€Shadrick€was€hospitalized€to€repairÏa€broken€screw€in€his€back.€€The€hospital€discharge€summary€indicates€that€Dr.€CokerÏbelieved€that€the€broken€screw€was€caused€by€repeated€falls€by€Mr.€Shadrick.€€€OnÏOctober€31€through€November€5,€1990,€Mr.€Shadrick€was€hospitalized€in€order€toÏsurgically€remove€the€screws€from€his€back.€€Dr.€Cokerððs€notes€following€the€NovemberÏsurgery€state,€ð ðPostoperatively,€he€continued€to€experience€leg€pain€and€I€wonder€if€heÍsimply€doesnððt€have€intraneural€scar€about€which€we€will€not€be€able€to€do€much€ofÏanything.€€I€discussed€this€with€him€in€detail€and€he€went€on€home.ðð€€The€dischargeÏsummary€states€that€Mr.€Shadrick€continued€to€complain€of€pain€in€his€back€followingÏthe€removal€of€the€screws.€€Ìà àOver€the€course€of€approximately€three€years€following€removal€of€the€pedicleÏscrews,€Mr.€Shadrick€continued€to€see€Dr.€Coker€regarding€his€back€pain.€€At€one€point,Ïduring€the€course€of€treatment,€Mr.€Shadrickððs€attorney€wrote€a€€letter€to€Dr.€CokerÏrequesting€certain€medical€records€and€an€explanation€for€Mr.€Shadrickððs€pain.€€By€letterÏdated€September€13,€1991,€Dr.€€Coker€responded€as€follows:ÌÓÓà8 àà8 àIn€response€to€your€second€paragraph€regarding€trying€toÏreconcile€Donaldððs€pain€problem€based€on€emotional€as€wellÏas€physical€realities,€there€is€no€question€that€he€had€aÏruptured€disc€and€that€his€pain€was€consistent€with€thatÏproblem.€€I€think€to€simplify€what€has€happened,€it€mightÏbe€reasonable€to€say€that€Donaldððs€emotions€have€becomeÏimprinted€with€the€pain€that€he€initially€experienced€and€hisÏemotions€have€not€let€go€of€that€pain€even€though€his€discÏand€nerve€appear€to€have€let€go€of€it.€€This€type€of€fixationÏis€not€unheard€of€but€it€certainly€is€a€difficult€situation€toÏresolve.€€Obviously,€Don€has€had€several€surgical€procedures,Ïnone€of€which€have€made€him€any€better.€€The€differentialÏspinal€test€plus€the€psychological€tests€indicated€that€he€hasÏa€fixation€on€the€pain€which€is€not€supported€by€his€physicalÏfindings.€€This€does€not€imply€in€any€way€that€Donald€isÏmentally€deranged,€it€only€indicates€that€he€hasÏunconsciously€grasped€the€concept€of€having€chronic€painÏand€will€not€consciously€dismiss€that€from€his€mind.€€That€isÏthe€best€I€can€do€in€explaining€this€condition€to€you.€€IÏmight€also€add€that€Dr.€Frye€was€very€reluctant€to€getÍinvolved€with€trying€to€counsel€this€boy€and€I€think€that€is€aÏgood€indication€of€how€hard€it€is€to€clear€this€sort€ofÏsituation.ÌÌà àÌÓÓà àMr.€Shadrick€contends€that€he€did€not€discover€that€the€screws€were€the€cause€ofÏhis€ð ðproblemsðð€until€December€17,€1993,€when€he€saw€an€episode€of€ABCððs€televisionÏprogram,€ð ð20/20,"€which€discussed€pedicle€screws.€€Mr.€Shadrick€states€that€whileÏviewing€the€ð ð20/20"€program,€he€first€learned€that€the€pedicle€screws€were€experimental,Ïand€that€the€screws€had€been€found€to€cause€a€number€of€problems€in€patients.Ìà àOn€December€16,€1994,€Mr.€Shadrick€filed€this€lawsuit€against,€òòinter€aliaóó,Ïdefendants€Dr.€Coker€and€Centennial€Medical€Center.× ƒ( ××  ×€€The€complaint€avers€that€Mr.ÏShadrick€continues€to€suffer€pain€and€other€medical€problems€as€a€result€of€theÏimplantation€of€the€pedicle€screws€in€his€spine.€€The€complaint€sues€Dr.€Coker€and€CMCÏfor€medical€malpractice,€lack€of€informed€consent,€battery,€and€fraudulentÏmisrepresentation€by€their€failure€to,€òòinter€aliaóó,€obtain€Mr.€Shadrickððs€consent€to€implantÏthe€screws,€inform€Mr.€Shadrick€that€the€pedicle€screws€were€not€FDA€approved,€informÏMr.€Shadrick€that€the€screws€were€experimental€and€classified€as€investigational€by€theÏFDA,€and€inform€Mr.€Shadrick€of€the€risks€associated€with€the€pedicle€screws.€€TheÏcomplaint€further€avers€that€Dr.€Coker€and€CMC€fraudulently€concealed€the€ð ðtrue€factsÍconcerning€their€actions€and€the€true€nature€of€the€pedicle€or€back€screws€and€relatedÏhardware€from€plaintiffs.ðð€€Ìà àThe€defendantsðð€answers€join€issue€on€the€material€allegations€of€the€complaintÏand€assert€that€Mr.€Shadrickððs€actions€are€barred€by€the€statute€of€limitations€andÏstatute€of€repose€for€medical€malpractice€actions,€T.C.A.€ðð€29„26„116€(a)(1)€and€(3)Ïrespectively.€€On€July€28,€1995,€CMC€filed€a€motion€for€summary€judgment€contendingÏthat€Mr.€Shadrickððs€actions€are€barred€by€the€three„year€statute€of€repose€and€the€one„year€statute€of€limitations.€€On€August€7,€1995,€Dr.€Coker€filed€an€identical€motion€forÏsummary€judgment€relying€on€the€memorandum€of€law€filed€by€CMC€in€support€of€itsÏmotion€for€summary€judgment.€€On€October€3,€1995,€the€trial€court€filed€aÏMemorandum€and€Order€which€granted€CMC€and€Dr.€Coker€summary€judgment€becauseÏof€the€statute€of€limitations€and€statute€of€repose€in€the€above€statute.€€TheÏMemorandum€and€Order€states€in€pertinent€part:ÌÓÓÔ€ Ôà8 àà8 àÔ€ÔMr.€Shadrickððs€claim€is€barred.€€He€knew€that€the€screwsÏhad€been€placed€in€his€back€in€March€of€1990€and€heÏacknowledged€that€ð ðno€one€told€me€before€the€operationÏthat€the€screws€would€be€implanted.ðð€€Furthermore,€heÏknew€in€November,€1990€that€one€of€the€screws€had€brokenÏand€had€to€be€replaced.€€He€also€stated€in€his€affidavit€thatÏð ðsince€the€surgery€of€March€12,€1990€my€physical€conditionÏhas€become€worse€than€it€was€before€the€surgery.ððÌÌà àà àà àà à*à àà à*à àà à*ÌÌà8 àà8 àThe€Court€is€also€of€the€opinion€that€the€record€before€theÍcourt€fails€to€establish€facts€warranting€the€application€ofÏthe€fraudulent€concealment€exception€to€Mr.€ShadrickððsÏclaim.€€ò òòòSee€Benton€v.€Snyderó óóó,€825€S.W.2d€409,€414€(Tenn.Ï1992)€and€ò òòòSoldano€v.€Owens„Corning€Fiberglass€Corporationó óóó,Ï696€S.W.2d€887,€889€(Tenn.€1985).€€Here,€neither€theÏdoctor€nor€the€hospital€made€any€false€statements€orÏassertions€to€Mr.€Shadrick.€€The€plaintiffs€contention€seemsÏto€be€that€lack€of€consent€is€tantamount€to€fraudulentÏconcealment.€€You€prove€the€first€and€the€second€follows.€ÏSuch€is€not€the€law.€€Here€there€was€no€affirmativeÏconcealment€and€the€facts€were€such€that€the€plaintiff€knewÏor€was€on€notice€of€inquiry€that€the€implantation€of€theÏscrews€had€been€unsuccessful€and€possibly€harmful.€€Even€ifÏthe€doctor€or€the€hospital€should€have€told€the€plaintiffÏmore€about€the€screws,€such€information€does€not€changeÏthe€fact€that€the€plaintiff€knew€or€should€have€known€inÏ1990€that€there€was€a€problem€with€the€screws.€€ò òòòCf.€VanceÏv.€Schulderó óóó,€547€S.W.2d€927,€930€(Tenn.€1977)€and€ò òòòCookseyÏv.€Cumberland€Mental€Health€Servicesóóó ó,ò òòò€óóó óNo.€01A01„9302„CV„00063,€1993€Tenn.€App.€LEXIS€552€(Aug.€18,€1993).ÌÌÌÓÓ€€€€€€€On€November€2,€1995,€Mr.€Shadrick€filed€a€Motion€to€Alter€or€Amend€the€orderÏgranting€summary€judgment€which€the€court€denied.ÓÓÌÌÓÓà àA€trial€court€should€grant€a€motion€for€summary€judgment€only€if€the€movantÏdemonstrates€that€there€are€no€genuine€issues€of€material€fact€and€that€the€moving€partyÏis€entitled€to€judgment€as€a€matter€of€law.€€Tenn.R.Civ.P.€56.03;€ò òòòByrd€v.€Hallóóó ó,€847ÏS.W.2d€208,€210€(Tenn.€1993);€òòò òDunn€v.€Hackettó óóó,€833€S.W.2d€78,€80€(Tenn.€App.€1992).€ÏThe€party€moving€for€summary€judgment€bears€the€burden€of€demonstrating€that€noÏgenuine€issue€of€material€fact€exists.€òòò òByrdó óóó,€847€S.W.2d€at€210.€€When€a€motion€forÍsummary€judgment€is€made,€the€court€must€consider€the€motion€in€the€same€manner€asÏa€motion€for€directed€verdict€made€at€the€close€of€the€plaintiff's€proof;€that€is,€"the€courtÏmust€take€the€strongest€legitimate€view€of€the€evidence€in€favor€of€the€nonmoving€party,Ïallow€all€reasonable€inferences€in€favor€of€that€party,€and€discard€all€countervailingÏevidence."€òòò òIdó 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€party€mustÏthen€demonstrate,€by€affidavits€or€discovery€materials,€thatÏthere€is€a€genuine,€material€fact€dispute€to€warrant€a€trial.Ï[citations€omitted].€€In€this€regard,€Rule€56.05€providesÏthat€the€nonmoving€party€cannot€simply€rely€upon€hisÏpleadings€but€must€set€forth€òòò òspecific€factsó óóó€showing€thatÏthere€is€a€genuine€issue€of€material€fact€for€trial.Ì€à@ àÌÓÓòòò òIdó óóó.€at€211.€(emphasis€in€original).€€Ìà àThe€summary€judgment€process€should€only€be€used€as€a€means€of€concluding€aÏcase€when€there€are€no€genuine€issues€of€material€fact,€and€the€case€can€be€resolved€onÏthe€legal€issues€alone.€€òòò òIdó óóó.€at€210€(citing€òòò òBellamy€v.€Federal€Express€Corpó óóó.,€749€S.W.2dÏ31,€33€(Tenn.€1988)).€€Summary€judgment€is€not€to€be€used€as€a€substitute€for€a€trial€ofÏgenuine€and€material€factual€issues.€òòò òByrdó óóó,€847€S.W.2d€at€210€(citing€òòò òBlocker€v.€RegionalÏMedical€Ctró óóó.,€722€S.W.2d€660,€660„61€(Tenn.€1987)).€€Where€a€genuine€dispute€exists€asÏto€any€material€fact€or€as€to€the€conclusions€to€be€drawn€from€those€facts,€a€court€mustÏdeny€a€motion€for€summary€judgment.€òòò òByrdó óóó,€847€S.W.2d€at€211€(citing€òòò òDunnó óóó,€833ÏS.W.2d€at€80).Ì€à àMr.€Shadrick€has€appealed,€and€he€presents€the€following€issues€as€stated€in€hisÏbrief:€€ÌÓÓà8 àà8 à1.€€Whether€the€trial€court€erred€in€granting€summaryÏjudgment€to€Centennial€Medical€Center€and€Dr.€Coker€andÏdenying€plaintiffsðð€Motion€to€Alter€or€Amend,€holding€that,Ïas€a€matter€of€law,€the€one€year€statute€of€limitations€barredÏthe€claims€of€Donald€and€Valerie€Shadrick.ÌÌà8 àà8 à2.€€Whether€the€trial€court€erred€in€granting€summaryÏjudgment€to€Centennial€Medical€Center€and€Dr.€Coker€andÏin€denying€plaintiffsðð€Motion€to€Alter€of€Amend,€holdingÏthat€as€a€matter€of€law,€the€doctrine€of€fraudulentÏconcealment€did€not€toll€the€applicable€statute€ofÏlimitations€and€the€applicable€statute€of€repose€as€to€theÏclaims€of€Donald€and€Valerie€Shadrick.Ìà àÌà àSection€29„26„116€of€Tennessee€Code€Annotated€provides€in€pertinent€part:ÌÌà8 àà8 àò òStatute€of€limitations.€„€Counterclaim€for€damagesó ó.€„„Ï(a)(1)€The€statute€of€limitations€in€malpractice€actions€shallÏbe€one€(1)€year€as€set€forth€in€ðð€28„3„104.€€ÌÌà8 àà8 à(2)€In€the€event€the€alleged€injury€is€not€discovered€withinÏthe€said€one€(1)€year€period,€the€period€of€limitation€shallÏbe€one€(1)€year€from€the€date€of€such€discovery.ÌÌà8 àà8 à(3)€In€no€event€shall€any€such€action€be€brought€more€thanÏthree€(3)€years€after€the€date€on€which€the€negligent€act€orÏomission€occurred€except€where€there€is€fraudulentÏconcealment€on€the€part€of€the€defendant€in€which€case€theÏaction€shall€be€commenced€within€one€(1)€year€afterÏdiscovery€that€the€cause€of€action€exists.€€ÌÌÓÓT.C.A.€ðð€29„26„116€(1980).Ìà àMr.€Shadrickððs€complaint€alleged€medical€malpractice,€lack€of€informed€consent,Íbattery,€and€fraudulent€misrepresentation.€€However,€Mr.€Shadrickððs€supportingÏaffidavits€did€not€address€any€causes€of€action€other€than€lack€of€informed€consent,€andÏthere€is€simply€no€proof€to€support€any€allegations€of€negligence€on€the€part€of€Dr.ÏCoker€and€thus,€there€is€no€proof€that€Dr.€Coker€knowingly€concealed€any€suchÏnegligence.€€The€only€issue€to€consider€is€the€allegation€of€the€lack€of€informed€consentÏand€the€application€of€the€statute€of€€limitations€and€the€statute€of€repose€to€this€causeÏof€action.€Ìà àThe€complaint€in€this€case€was€filed€December€16,€1994,€and€the€surgery€formingÏthe€basis€of€Mr.€Shadrickððs€complaint€occurred€in€March,€1990.€€Basically,€Mr.€ShadrickððsÏcomplaint€alleges€that€defendant,€Dr.€Coker,€performed€the€surgery€without€obtaining€anÏð ðinformed€consentðð€from€plaintiff,€Donald€Shadrick.€€More€particularly,€Mr.€ShadrickÏasserts€that€the€use€of€the€pedicle€screws€was€experimental€and€not€approved€for€use€byÏthe€FDA,€that€he€was€not€aware€of€this€fact€and€was€not€so€informed€by€Dr.€Coker€andÏthat€if€he€had€been€so€informed€he€would€not€have€consented€to€the€surgical€procedure.€ÏWe€must€first€examine€what€disclosure€is€required€under€the€applicable€standard€of€careÏto€obtain€informed€consent.Ìà àSection€29„26„118€provides:ÌÓÓà8 àò òà8 à29„26„118.€€Proving€inadequacy€of€consentó ó.€„„€In€aÏmalpractice€action,€the€plaintiff€shall€prove€by€evidence€asÏrequired€by€ðð€29„26„115(b)€that€the€defendant€did€notÏsupply€appropriate€information€to€the€patient€in€obtainingÍhis€informed€consent€(to€the€procedure€out€of€whichÏplaintiffððs€claim€allegedly€arose)€in€accordance€with€theÏrecognized€standard€of€acceptable€professional€practice€inÏthe€profession€and€in€the€specialty,€if€any,€that€theÏdefendant€practices€in€the€community€in€which€he€practicesÏand€in€similar€communities.ÌÌÓÓT.C.A.€€ðð€29„26„118€(1980).Ìà àA€physician€is€not€required€to€enumerate€in€detail€every€aspect€of€surgery€orÏevery€possible€thing€that€might€go€wrong.€€ò òòòLongmire€v.€Hoeyó óóó,€512€S.W.2d€307€(Tenn.ÏApp.€1974).€€ÌÓÓà8 àà8 àIn€general,€under€or€apart€from€statute,€the€doctrine€ofÏinformed€consent€requires€a€physician€or€other€health„careÏprovider€to€furnish€an€individual€with€information€sufficientÏto€enable€the€individual€to€give€an€intelligent,€informedÏconsent€to€a€proposed€medical€treatment€or€theÏperformance€of€a€particular€medical€procedure.ÌÌÓÓ70€C.J.S.€òòPhysicians€and€Surgeonsóó€ðð€93€(1987).à àÌà àIn€opposition€to€the€motions€for€summary€judgment,€Mr.€Shadrick€filed€theÏaffidavit€of€Dr.€Raymond€O.€Frederick€which€generally€states€the€standard€of€care€forÏphysicians€and€hospitals€in€Nashville,€Tennessee€at€the€time€of€the€operation€in€question.€ÏThe€affidavit€outlines€the€standard€of€care€as€follows:Ìà à1.€€The€hospital€has€a€duty€to€review€investigational€studies,€research€and€clinicalÏtrials€conducted€in€the€hospital,€including€those€associated€with€pedicle€screws,€and€theÏhospital€must€obtain€written€informed€consent€of€the€patients€to€participate€inÍinvestigational€studies€and/or€clinical€trials.€€Ìà à2.€€The€hospital€must€obtain€written€informed€consent€from€the€patient€when€theÏpatient€is€the€recipient€of€an€investigational€device,€including€any€device€implanted€inÏthe€pedicle€spine.Ìà à3.€€The€hospital€must€make€sure€that€the€patients€who€receive€pedicle€screwÏimplants€are€fully€advised€that€those€implants€are€not€approved€for€use€in€the€pedicleÏspine€except€through€investigational€studies,€and€to€be€sure€that€the€patients€fullyÏunderstood€all€risks€and€alternative€available€treatment,€whether€surgical€or€non„surgical.Ìà à4.€€A€surgeon€must€advise€patients€of€all€material€risks€and€consequences€that€areÏassociated€with€a€surgical€procedure.Ìà à5.€€Both€CMC€and€Dr.€Coker€had€a€duty€to€obtain€written€informed€consent.Ìà à6.€€Both€CMC€and€Dr.€Coker€had€a€duty€to€inform€Mr.€Shadrick€of€theÏinvestigational€or€experimental€nature€of€pedicle€implant€devices.Ìà à7.€€The€informed€consent€should€have€explained€all€of€the€risks€associated€withÏinvestigational€implants.Ìà à8.€€CMC€and€Dr.€Coker€both€knew€or€should€have€known€that€the€pedicle€screwÏimplants€were€investigational€devices.€€CMC€had€a€duty€to€know€whether€investigationalÏdevices€were€being€used€in€its€operating€rooms,€and€both€CMC€and€Dr.€Coker€had€aÏduty€to€know€whether€the€pedicle€screw€implants€used€in€Mr.€Shadrick€wereÍinvestigational€devices€at€the€time€of€the€implant.Ìà à9.€€Use€of€pedicle€screw€implants€was€a€surgical€risk€that€CMC€and€Dr.€CokerÏknew€or€should€have€known€about,€and€they€should€have€informed€Mr.€Shadrick€of€theÏrisk.Ìà à10.€€Mr.€Shadrick€should€have€been€informed€that€the€pedicle€screws€wereÏinvestigational,€which€means€that€they€had€not€been€proven€safe€and€effective€for€use€inÏthe€pedicle€spine€in€the€eyes€of€the€FDA.€€Ìà à11.€€The€failure€to€communicate€these€facts€to€Mr.€Shadrick€was€tantamount€toÏfailure€to€obtain€informed€consent.à àÌà à12.€€The€consent€form€signed€by€Mr.€Shadrick€did€not€come€close€to€satisfyingÏthe€hospitalððs€or€the€doctorððs€duty€to€obtain€informed€consent.€€Ìà à13.€€Both€CMC€and€Dr.€Coker€violated€the€applicable€standard€of€care€withÏrespect€to€informed€consent€with€respect€to€Mr.€Shadrick.Ìà àBoth€defendants,€CMC€and€Dr.€Coker,€assert€that€Mr.€Shadrick€discovered€hisÏcause€of€action€in€March€of€1990€because€when€he€awoke€from€surgery€he€was€told€thatÏpedicle€screws€had€been€implanted€in€his€back,€and€he€knew€that€this€was€the€first€timeÏthat€he€was€aware€such€a€procedure€was€involved.€€They€further€assert€that€if€there€wasÏno€ð ðdiscoveryðð€of€his€cause€of€action€in€March€of€1990,€that€there€was€certainly€aÏð ðdiscoveryðð€in€November€of€1990,€when€Mr.€Shadrick€was€informed€that€one€of€theÍscrews€had€broken€necessitating€a€second€surgery€to€remove€the€broken€screw.€€TheyÏargue€that€he€knew€that€the€screws€had€been€implanted€in€his€back€without€any€consentÏand€that€one€of€the€screws€had€broken€necessitating€a€second€surgery,€and€that€in€theÏexercise€of€reasonable€care€and€diligence€he€should€have€discovered€that€he€had€a€causeÏof€action€at€that€time.€€We€do€not€disagree€that€this€argument€has€merit€so€far€as€itÏapplies€to€the€negligence€or€a€traditional„type€malpractice€action.€€ò òòòTeeters€v.€Curreyó óóó,€518ÏS.W.2d€512,€517€(Tenn.€1974).€€However,€there€is€a€distinction€between€a€typicalÏnegligence€malpractice€case€and€a€case€involving€lack€of€informed€consent€which€is€in€theÏnature€of€an€assault€and€battery€case.€€In€a€lack€of€informed€consent€case,€the€physicianÏcan€be€held€liable€for€injuries€regardless€of€whether€such€injuries€resulted€from€negligenceÏor€otherwise.€€ò òòòRay€v.€Scheibertó óóó,€484€S.W.2d€63,€71€(Tenn.€App.€1972).Ìà àUnder€the€state€of€the€record€before€us,€there€is€a€disputed€issue€of€material€factÏas€to€whether€the€standard€of€care€in€Nashville,€Tennessee€in€1990€required€a€disclosureÏof€the€lack€of€FDA€approval€and€the€experimental€nature€of€the€use€of€pedicle€screws.€ÏThe€fact€that€right€after€surgery€Mr.€Shadrick€was€informed€that€pedicle€screws€had€beenÏimplanted€and€then€later€was€told€that€a€pedicle€screw€had€broken€does€not€put€him€onÏnotice€that€the€procedure€was€experimental€at€the€time€it€was€performed.€€Thus,€weÏmust€respectfully€disagree€with€Dr.€Coker€and€CMC€that€Mr.€Shadrick€ð ðdiscoveredðð€hisÏcause€of€action€for€lack€of€informed€consent€in€1990.Ìà àHaving€established€that€there€is€a€disputed€issue€of€material€fact€as€to€whetherÏthere€was€a€lack€of€informed€consent€in€1990,€we€must€now€determine€whether€theÏthree„year€statute€of€repose€will€bar€Mr.€Shadrickððs€suit.Ìà àIrrespective€of€the€date€that€a€plaintiff€discovers€his€or€her€cause€of€action€forÏmedical€malpractice,€the€statute€of€repose€in€T.C.A.€ðð€29„26„116(a)(3)€operates€as€anÏouter€limit€in€which€a€plaintiff€may€file€an€action.€€The€statute€of€repose€begins€to€runÏon€the€date€of€the€alleged€act€of€malpractice,€rather€than€on€the€date€a€plaintiff€discoversÏthe€injury.€€ò òòòBenton€v.€Snyderó óóó,€825€S.W.2d€409,€413€(Tenn.€1992);òòò ò€Braden€v.€Yoderó óóó,€592ÏS.W.2d€896,€897€(Tenn.€App.€1979).€€However,€as€provided€in€T.C.A.€€ðð€29„26„116(a)(3),Ïthe€three„year€bar€may€be€tolled€where€there€is€fraudulent€concealment€on€the€part€ofÏthe€defendant,€and€in€that€case,€the€action€must€be€brought€within€one€year€after€theÏdiscovery€that€the€cause€of€action€exists.€€Where€the€statute€of€repose€defense€isÏestablished,€the€burden€of€proof€shifts€to€the€plaintiff€to€establish€the€claimed€exceptionÏto€the€statute.€€ò òòòBenton,€ó óóó825€S.W.2d€at€414.Ìà àTo€meet€the€burden€of€proof€required,€a€plaintiff€seeking€to€toll€the€statute€ofÏlimitations€on€the€ground€of€fraudulent€concealment€must€prove€that€the€cause€of€actionÏwas€known€to€and€fraudulently€concealed€by€the€defendant.€€ò òòòIdó óóó.€€In€ò òòòBentonó óóó,€the€CourtÏsaid:ÌÓÓà8 àà8 àGenerally,€a€plaintiff€seeking€to€establish€fraudulentÏconcealment€must€prove€that€the€defendant€tookÍaffirmative€action€to€conceal€the€cause€of€action€and€thatÏthe€plaintiff€could€not€have€discovered€the€cause€of€actionÏdespite€exercising€reasonable€diligence.€€ò òòòVance€v.€Schulderó óóó,Ï547€S.W.2d€927,€930€(Tenn.€1977).€€Generally,€theÏaffirmative€action€on€the€part€of€a€defendant€must€beÏsomething€more€than€mere€silence€or€a€mere€failure€toÏdisclose€known€facts.€€There€must€be€some€trick€orÏcontrivance€intended€to€exclude€suspicion€and€preventÏinquiry,€òòor€else€there€must€be€a€duty€resting€on€the€party€knowingÏsuch€facts€to€disclose€them.€€ò òPatten€v.€Standard€Oil€Co.€ofÏLouisianaó óóó,€165€Tenn.€(1€Beeler)€438,€443,€55€S.W.2d€759,Ï761€(1933).€€For€example,€such€a€duty€arises€where€aÏconfidential€relationship€exists,€as€between€physician€andÏpatient.€€In€such€cases,€òòthere€is€a€duty€to€disclose,€and€that€dutyÏmay€render€silence€or€failure€to€disclose€known€facts€fraudulent.óó€€òòò òHallÏv.€€De€Saussure,ó óóó€41€Tenn.€App.€572,€580„84,€297€S.W.2d€81,Ï86„87€(1956),€òòaffððdóó€201€Tenn.€(5€McCanless)€164,€297ÏS.W.2d€90€(1956).€€This€is€the€rule€in€Tennessee€and€inÏother€jurisdictions.€€òòò òSee,€e.g.,€Lasoya€v.€Sunayó óóó,€193€Ga.€App.Ï814,€389€S.E.2d€339€(1989);€ò òòòBorderlon€v.€Peckó óóó,€661€S.W.2dÏ907€(Tex.€1983).ÌÌ825€S.W.2d€at€414€(emphasis€in€original).ÌÌÓÓà àDr.€Coker€had€a€fiduciary€relationship€with€Mr.€Shadrick,€and€if€the€standard€Ìof€care€is€as€outlined€in€Dr.€Frederickððs€affidavit,€Dr.€Coker€was€duty€bound€to€informÏMr.€Shadrick€of€the€experimental€nature€of€the€use€of€pedicle€screws.€€Charged€with€thisÏknowledge,€Dr.€Cokerððs€silence€in€the€face€of€Mr.€Shadrickððs€problems€with€the€screws,Ïraises€a€genuine€issue€of€material€fact€as€to€whether€there€is€a€fraudulent€concealmentÏthat€would€toll€the€three„year€statute€of€repose.€€Ìà àAs€to€CMC,€however,€although€there€is€a€disputed€issue€as€to€whether€CMC€owedÍa€duty€to€obtain€the€informed€consent,€the€record€contains€no€evidence€of€a€continuingÏrelationship€between€CMC€and€Mr.€Shadrick.€€Moreover,€the€relationship€between€Mr.ÏShadrick€and€CMC€is€not€a€fiduciary€relationship€and€there€is€absolutely€nothing€in€theÏrecord€to€show€any€affirmative€action€on€the€part€of€this€defendant€to€conceal€any€factsÏfrom€Mr.€Shadrick.€€Therefore,€the€statute€of€repose€bars€any€claim€against€CMC.€Ìà àAccordingly,€the€order€of€the€trial€court€granting€summary€judgment€to€CMC€isÏaffirmed.€€The€order€granting€summary€judgment€to€defendant€Dr.€Coker€on€the€cause€ofÏaction€for€lack€of€informed€consent€is€vacated€but€is€affirmed€as€to€all€other€causes€ofÏaction€against€this€defendant.€€The€case€is€remanded€to€the€trial€court€for€furtherÏproceedings€consistent€with€this€Opinion.€€Costs€of€the€appeal€are€assessed€one„half€toÏappellants€and€one„half€to€appellees.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:ÌÌÌó ó_________________________________Ìò òALAN€E.€HIGHERS,€JUDGEó óÌÌ_________________________________Ìò òBEN€H.€CANTRELL,€JUDGEó óœ