ÿWPCA Ý5„6,€ÿ¯c§4d9’¥È"3¿ªâ¬&<>%n{†ÔqDñçÖÔþ §á\“ž-rT%Ê|PrÞ S¬ „®À­v2Û¤E\’ùÅз ;^¤~ ‘‹–³5} Ã=ÕørÊØ´y 0»é†×é¿ÿO +;û ž8hØœehÓ\7þ w“ãÃá]ýwòo6²å™dg àÒœ‡@tge=Ö¼»@¿÷×z饒é‡Æ`"ÆïóÜG¯#Є ×áE¬dñາê¯õHDb”{ãêÄ‹óiz¿¡@lãHÑZïPb9d!«@u:_5“5Q¦li2'ª=’¿‰ÜÏtƒ‘ß‚ ì‰~|È*˜0«¼̆hÙˆ²µGgé¾×½áùlHr!óÈ*â§{­ñÓ>KÍF^:m„Ö3—}ívÆô1NÙ~}‚ÝÓúS.ý,n ÈUÇÇR Ú“Ç}/°[ÅqëØúÒ"xP2ïƒÁ Zãé² ·ÝýZèUŸ%ÄÙsú×ìÜï᪚›¤Ú_&%;±$ùš@‘¹ôR¡ ;?zžP,ê~ÌÒnð\ԖغÒ7 ­Û¹‚X{FÚ«2¶†Åýy\~fêŠ~q¯n¿ù< ŽvÞðd#!xUN™ %ç 04í 0³! bÔ wÜ 4à ô 0D íG 4 j< ¦ ¦ m¨ ¨ ç¿ ‘¦¢7ÙÙN²^ ´gÀ4'"[Û}ÃX!ÿ$<% BV&U:s&a­&­&­&­&**á#2#2«444,¯:¯:¯:¯:¯:¯:Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û>Û> 0Pã> D53?3?3?3?3? AQh?ƹ? 0P@ 0DÏ@˜HP LaserJet 8000 DN PSØÚØÚÚØØÚ0'í€"  Z 6Times New Roman Regular¼( ¤U$¡¡Ó  Ó(c(22µ$¤¤Ý ƒ¤U!ÝÓ  ÓÝ  ÝÒ°ÒÒX°ÒÔ€X•_X»¼Ôà ` àòòÚ  Ú0Ú  Úóó- ù-tpO'-  Ú0Ú3|x(#Ã$òòÚ  Ú0Ú  Úóó ãÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú3Ú  ÚóóÝ  ÝÔ_ÔThe€Whites€are€not€taking€issue€with€the€summary€judgment€for€Dr.€Chmell.white v. vanderbilt - opinion Í  ' '  0 .   ÿU‹ÿÀÀÀ ÝÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú2Ú  ÚóóÝ  ÝÔ_ÔCauda€equina€compression€syndrome€is€caused€by€ð ðeither€a€herniated€disc,€or€an€epiduralÐ ° Ðhematoma€or€abscess€that€is€compressing€the€caudal€sack.€€Emergent€surgical€intervention€is€requiredÐ  ð Ðto€prevent€permanent€neurologic€damage.€€Symptoms€include€incontinence,€bilateral€sciatica€andÐ à Ðmotor€weakness€of€the€lower€extremities,€saddle€anesthesia€(partial€or€complete€loss€of€sensation€inÐ €Ð Ðthe€portion€of€the€buttocks,€perineum€and€thighs€that€would€come€into€contact€with€a€saddle€whenÐ pÀ Ðriding€a€horse)€and€even€paraplegia.ðð€€5€Attorneysðð€Textbook€of€Medicine€ðð€15.33€(Roscoe€N.€GrayÐ ` ° Ð&€Louise€J.€Gordy€eds.€3d€ed.€1999).€€Ms.€Whiteððs€compression€was€the€result€of€an€epiduralÐ P   Ðhematoma. ‡Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú4Ú  ÚóóÝ  ÝÔ_ÔDr.€Kostuik€has€published€numerous€articles€on€the€cauda€equina€syndrome.€€òòSee,€e.g.óó,€JohnÐ ° ÐP.€Kostuik,€òòCauda€Equina€Syndrome:€The€Lumbar€Spineóó€(1996);€John€Kostuik,€òòControversies€inÐ  ð ÐCauda€Equina€Syndrome€and€Lumbar€Disk€Herniationóó,€4(2)€Spine€125€(Apr.€1993);€John€P.€KostuikÐ à Ðet€al.,€òòCauda€Equina€Syndrome€and€Lumbar€Disk€Herniationóó,€68A€Journal€of€Bone€and€JointÐ €Ð ÐSurgery€386€(March€1986). ˜Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú1Ú  ÚóóÝ  ÝÔ_ÔSpinal€stenosis€is€the€narrowing€or€compression€of€the€portion€of€the€vertebral€canal€whereÐ ° Ðthe€Ô_ÔcaudaÔ_Ô€equina€is€located.€€The€Ô_ÔcaudaÔ_Ô€equina€is€the€ð ðbundle€of€spinal€nerve€roots€arising€from€theÐ  ð Ðlumbar€enlargement€and€conus€medullaris€and€running€through€the€lower€part€of€the€Ô_ÔsubarachnoidÔ_ÔÐ à Ðspace€within€the€vertebral€canal€below€the€first€lumbar€vertebra;€it€comprises€the€roots€of€all€theÐ €Ð Ðspinal€nerves€below€the€first€lumbar€vertebra.ðð€€Ô_ÔStedmanÔ_Ôððs€Medical€Dictionary€238€(5th€Ô_ÔunabrÔ_Ô.€law.Ð pÀ Ðed.€1982). ÏÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú5Ú  ÚóóÝ  ÝÔ_ÔòòSeeóó€Tenn.€Code€Ann.€ðð€29„26„115(b)€(1980).€€¯y#(L  ]Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú7Ú  ÚóóÝ  ÝÔ_ÔòòSee€Overstreet€v.€Shoneyððs,€Inc.óó,€No.€01A01„9612„CV„00566,€1999€WL€355912,€at€*11Ð ° Ð(Tenn.€Ct.€App.€June€4,€1999)€(Tenn.€R.€App.€P.€11€application€denied€Oct.€4,€1999). *Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú6Ú  ÚóóÝ  ÝÔ_ÔIn€their€motion€to€waive€the€locality€rule,€the€defendants€represented€to€the€trial€court€thatÐ ° ÐDr.€Kostuik€has€written€the€ð ðpreeminent€medical€article€on€the€development€and€treatment€of€caudaÐ  ð Ðequina€syndromeðð€and€that€the€ð ðresults€of€Kostuickððs€[sic]€study€are€of€great€significance€in€refutingÐ à  Ðplaintiffððs€[sic]€theory€in€this€case€that€the€defendants€acted€too€slowly€in€conducting€surgery€inÐ ° Ðresponse€to€plaintiffððs€presentation€of€cauda€equina€syndrome.ðð€€In€a€supporting€affidavit,€Dr.Ð  ð ÐSpengler€stated€that€Dr.€Kostuikððs€study€ð ðmay€affect€a€determination€as€to€the€applicable€standardÐ à Ðof€care€in€this€case€and€may€help€refute€plaintiffsðð€theory€that€earlier€surgical€intervention€on€Ms.Ð €Ð ÐWhite€would€have€spared€her€any€injury.ðð€€ Ý ƒb¾¸"ÝÓ  ÓÝ  ÝÔ_ÔÔ€ ¼¡«»»¼ÔÔ€ ¸†» ¼¡«ÔÓ  Óò òÔ Ad ÔFILEDÔ€ XK X ¸†ÔÐ  ÐÌDecember€30,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdA„Ôó ó ÑÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú13Ú  ÚóóÝ  ÝÔ_ÔThe€Whites€also€indicated€that€they€intended€to€rely€on€either€the€testimony€of€or€portionsÐ ° Ðof€the€depositions€of€the€defendant€physicians.€€It€is€obvious€that€the€Whites€did€not€intend€to€useÐ  ð Ðthese€depositions€with€regard€to€the€issues€of€standard€of€care€or€causation. ¹Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú8Ú  ÚóóÝ  ÝÔ_ÔòòSeeóó€8€Charles€A.€Wright,€et€al.,€òòFederal€Practice€and€Procedureóó€ðð€2029,€at€428„29€(2d€ed.Ð ° Ð1994).€€This€treatise€notes€that€Fed.€R.€Civ.€P.€26€draws€a€distinction€between€experts€who€have€beenÐ  ð Ðretained€or€specifically€employed€in€anticipation€of€litigation€or€preparation€for€trial€but€who€are€notÐ à Ðexpected€to€testify€and€experts€who€have€been€consulted€informally€but€who€have€not€been€retained.€Ð €Ð ÐTenn.€R.€Civ.€P.€26€does€not€draw€this€distinction. õÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú11Ú  ÚóóÝ  ÝÔ_ÔThe€deposition€is€not€subject€to€a€hearsay€objection.€€òòSeeóó€Tenn.€R.€Evid.€804(b)(1). 2Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú9Ú  ÚóóÝ  ÝÔ_ÔIn€1997,€the€Tennessee€Supreme€Court€amended€Tenn.€R.€Civ.€P.€26.02(4)(A)(ii)€to€permitÐ ° Ðdepositions€of€experts€as€a€matter€of€right. d,O²ÀAZ‹"Arial Regular WÝ ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú12Ú  ÚóóÝ  ÝÔ_ÔNegligence€and€causation€are€normally€required€to€be€established€by€expert€medicalÐ ° Ðtestimony.€€òòSee€Kennedy€v.€Holderóó,€1€S.W.3d€670,€672€(Tenn.€Ct.€App.€1999);€òòStokes€v.€Leungóó,€651Ð  ð ÐS.W.2d€704,€706€(Tenn.€Ct.€App.€1982).€€However,€the€need€for€expert€medical€proof€can€beÐ à Ðdispensed€with€when€the€acts€of€negligence€are€so€obvious€that€they€come€within€the€commonÐ €Ð Ðknowledge€of€laypersons.€€òòSee€Ayers€v.€Rutherford€Hosp.,€Inc.óó,€689€S.W.2d€155,€160€(Tenn.€Ct.€App.Ð pÀ Ð1984).€€The€common€knowledge€exception€to€Tenn.€Code€Ann.€ðð€29„26„115€is€inapplicable€in€thisÐ ` ° Ðcase. Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú10Ú  ÚóóÝ  ÝÔ_ÔCourts€construing€rules€similar€to€Tenn.€R.€Civ.€P.€26€have€held€that€a€party€may€place€aÐ ° Ðpreviously€designated€testifying€expert€beyond€the€reach€of€an€opposing€party€by€redesignating€theÐ  ð Ðexpert€from€a€testifying€witness€to€a€consultant€prior€to€the€witnessððs€deposition.€€òòSee€Ross€v.Ð à ÐBurlington€Northern€R.R.óó,€136€F.R.D.€638,€638„39€(N.D.€Ill.€1991);€òòCounty€of€Los€Angeles€v.Ð €Ð  ÐSuperior€Courtóó,€271€Cal.€Rptr.€698,€703„04€(Ct.€App.€1990);€òòReeves€v.€Boyd€&€Sons,€Inc.óó,€654Ð ° ÐN.E.2d€864,€874„75€(Ind.€Ct.€App.€1995);€òòGeneral€Motors€Corp.€v.€Jacksonóó,€636€So.€2d€310,€313„14Ð  ð Ð(Miss.€1992).€€Some€courts,€however,€will€not€give€this€effect€to€the€redesignation€of€a€testifyingÐ à Ðexpert€if€they€determine€that€the€parties€are€undertaking€to€suppress€evidence€or€seeking€to€shield€theÐ €Ð Ðexpert€witness€from€discovery€for€any€other€improper€purpose€that€violates€the€clear€purpose€andÐ pÀ Ðintent€of€the€discovery€rules.€€òòSee€In€re€Doctorsðð€Hosp.€of€Loredoóó,€2€S.W.3d€504,€506€(Tex.€App.Ð ` ° Ð1999);€òòCastellanos€v.€Littlejohnóó,€945€S.W.2d€236,€239„40€(Tex.€App.€1997).€€Likewise,€courts€haveÐ P   Ðheld€that€the€redesignation€of€an€expert€witness€does€not€affect€right€of€discovery€for€examiningÐ @  Ðphysicians€under€Tenn.€R.€Civ.€P.€35,€sòòee€Kennedy€v.€Superior€Courtóó,€75€Cal.€Rptr.€2d€373,€375€(Ct.Ð 0 € ÐApp.€1998);€òòPinkett€v.€Brittinghamóó,€567€A.2d€858,€860€(Del.€1989),€and€that€an€expert€cannot€beÐ  p  Ðdesignated€as€a€testifying€expert€for€some€purposes€and€a€consulting€expert€for€others.€òòSee€FurnitureÐ `  ÐWorld,€Inc.€v.€D.A.V.€Thrift€Stores,€Inc.óó,€168€F.R.D.€61,€63€(D.N.M.€1996).€€€€€ ×Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú14Ú  ÚóóÝ  ÝÔ_ÔòòBut€see€Cogdell€v.€Brownóó,€531€A.2d€1379,€1382€(N.J.€Super.€Ct.€Law.€Div.€1987);€òòFenlonÐ ° Ðv.€Thayeróó,€506€A.2d€319,€323€(N.H.€1986)€(holding€that€the€identity€of€who€originally€retained€anÐ  ð Ðexpert€is€material€to€the€weight€and€credibility€of€the€expertððs€testimony). ¡Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú15Ú  ÚóóÝ  ÝÔ_ÔThe€parties€made€Dr.€Kostuik€a€central€figure€in€this€case€whether€he€testified€or€not.€€HisÐ ° Ðarticles€were€mentioned€in€the€presence€of€the€jury€on€at€least€six€occasions€while€Drs.€Spengler€andÐ  ð ÐJones€and€their€physician€expert€were€on€the€stand.€€During€cross„examination,€one€of€the€WhitesððÐ à Ðlawyers€asked€Dr.€Chmell€if€he€was€aware€that€the€defendants€had€retained€Dr.€Kostuik€to€render€anÐ €Ð Ðopinion€in€this€case.€€While€the€trial€court€found€that€the€question€was€improper,€it€concluded€thatÐ pÀ Ðthe€lawyerððs€reference€to€Dr.€Kostuikððs€original€employment€had€not€been€intentional.€€SimplyÐ ` ° Ðmentioning€which€party€originally€retained€a€particular€expert€witness€does€not€necessarily€requireÐ P   Ðreversal.€€òòSeeóó€òòPeterson€v.€Willieóó,€81€F.3d€at€1038.€€Other€remedial€action,€such€as€curative€or€limitingÐ @  Ðinstructions,€may€also€be€warranted€in€appropriate€circumstances.€€In€this€case,€the€defendants€didÐ 0 € Ðnot€request€the€trial€court€to€give€a€curative€instruction€after€the€trial€court€admonished€the€WhitesððÐ  p  Ðlawyer€about€the€question.€€Accordingly,€we€perceive€no€basis€for€holding€€that€the€Whitesðð€lawyerððsÐ `  Ðinadvertent€statement€should€prevent€them€from€obtaining€relief€from€the€trial€courtððs€erroneousÐ P  Ðdecision€to€prevent€them€from€using€Dr.€Kostuikððs€deposition€at€trial.€€ "Ý ƒU$ÝÓ  ÓÒ°ÒÒX°ÒÔ€X"X»¼Ôà ` àòòÚ  Ú16Ú  ÚóóÝ  ÝÔ_ÔWe€must€address€a€rather€disingenuous€argument€in€the€defendantsðð€brief€to€uphold€theÐ ° Ðexclusion€of€Dr.€Kostuikððs€testimony.€€The€defendants€argue€that€the€trial€court€properly€excludedÐ  ð Ðthe€testimony€because€the€Whites€had€not€obtained€a€waiver€of€the€locality€rule.€€The€Whites€had€noÐ à Ðobligation€to€obtain€this€waiver€because€the€defendants€had€already€obtained€the€waiver€from€the€trialÐ €Ð Ðcourt€over€the€Whitesðð€objections.€€The€trial€court€based€its€decision€to€exclude€Dr.€KostuikððsÐ pÀ Ðtestimony€on€a€misapplication€of€Tenn.€R.€Civ.€P.€26.02(4)(B)€and€Tenn.€R.€Evid.€403,€not€byÐ ` ° Ðapplying€the€locality€rule.€€By€successfully€seeking€a€waiver€of€the€locality€rule€for€their€own€benefit,Ð P   Ðthe€defendants€effectively€hoisted€themselves€on€their€own€petard.€€ ((3¾¸$££Ý ƒ¤U!ÝÓ  ÓÝ  Ý)ÿÿ!dxdxabZc[Cþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5((3¾¸$¢¢Ý ƒ¤U!ÝÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óÝ ƒ¤U!ÝÓ  ÓÝ  ÝÔ_ÔÑ„°ÑÒ°ÒÒX°ÒÑTR[° AØ'ÿ Legal3Ø' AØ'ÿ Legalÿ3Ø'TÑÑ€ÑÑ8€Ž ÐWhite€is€a€retired€railroad€conductor,€and€Ms.€White€retired€as€a€salesperson€in€1983€to€takeÐ Ä  Ðcare€of€her€mother.€€Prior€to€the€events€giving€rise€to€this€lawsuit,€Ms.€White€had€generallyÐ Jš" Ðbeen€in€good€health€and€had€been€devoting€most€of€her€time€and€energy€to€homemaking,Ð Ð $ Ðgardening,€church€activities,€and€serving€as€a€Red€Cross€volunteer€at€a€local€hospital.€€Ð V"¦& ÐÌà ` àAfter€Ms.€White€began€to€experience€lower€back€pain,€she€consulted€several€Jackson„Ð b%² * Ðarea€physicians€who€determined€that€surgery€was€indicated€but€who€also€recommended€thatÐ è&8", Ðthe€surgery€be€postponed€for€a€time.€€As€Ms.€Whiteððs€back€pain€worsened,€she€consulted€Dr.Ð n(¾#. ÐDan€M.€Spengler,€a€Nashville€orthopaedic€surgeon.€€Dr.€Spengler€diagnosed€Ms.€WhiteððsÐ ô)D%0 Ðcondition€as€spinal€stenosis׃×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€and€recommended€surgery.€€€€On€October€25,€1991,€Dr.€SpenglerÐ z+Ê&2 Ðand€Dr.€Clement€K.€Jones,€a€fellow€in€spinal€surgery,€performed€the€surgery€at€VanderbiltÐ -P(4 ÐUniversity€Medical€Center.€€The€surgery€was€a€success€and€is€not€the€subject€of€thisÐ †.Ö)6 Ðlitigation.Ð  0\+8 Ðâ âÐ ’1â,: Ðà ` àMs.€Whiteððs€post„operative€recovery€was€uneventful€for€the€first€two€days€followingÐ ° Ðâ âsurgery.€€At€11:00€p.m.€on€Sunday,€October€27,€1991,€Catalina€Baun,€Ms.€Whiteððs€nurse,Ð 6† Ðconducted€a€neurovascular€examination€with€normal€results.€€However,€four€hours€later€atÐ ¼  Ðapproximately€4:00€a.m.€on€October€28,€1991,€Ms.€White€asked€her€husband€to€summon€Ms.Ð B ’ ÐBaun€because€she€was€suffering€from€pain€in€her€lower€buttocks€and€right€leg€that€ð ðwas€justÐ È  Ðso€bad,€I€could€hardly€stand€it.ððÐ N ž  ÐÌà ` àMs.€Baun,€following€standard€physicianððs€orders,€gave€Ms.€White€pain€medication.€Ð Zª  ÐAt€4:18€a.m.,€Ms.€Baun€paged€Dr.€Robert€Bradley€Wyrsch,€the€junior€resident€orthopaedicÐ à0  Ðphysician€on€duty,€because€Ms.€Whiteððs€pain€had€not€lessened.€€A€dispute€exists€concerningÐ f¶  Ðwhether€Ms.€Baun€told€Dr.€Wyrsch€that€Ms.€Whiteððs€symptoms€were€new€and€progressive.€Ð ì< ÐDr.€Wyrsch€simply€instructed€Ms.€Baun€to€give€Ms.€White€more€pain€medication.€Ð r ÐApproximately€two€hours€later,€between€6:00€and€6:30€a.m.,€€Ms.€White€was€examined€forÐ øH Ðthe€first€time€by€Dr.€Michael€J.€Chmell,€a€second„year€orthopaedic€resident.€€Dr.€ChmellÐ ~Î Ðordered€more€pain€medication€and€asked€Dr.€Jones,€who€had€assisted€Dr.€Spengler€duringÐ T ÐMs.€Whiteððs€surgery,€to€examine€Ms.€White.Ð ŠÚ ÐÌà ` àDr.€Jones€eventually€examined€Ms.€White€between€8:15€and€8:30€a.m.€and€diagnosedÐ –æ" Ðher€condition€as€cauda€equina€syndrome,׃×Ý ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€a€rare€complication€of€spinal€surgery.€€Dr.€JonesÐ  l$ Ðsummoned€Dr.€Spengler€who€conducted€his€own€examination€and€ordered€an€emergencyÐ ¢!ò& Ðmyelogram€to€confirm€the€location€of€the€compression.€€At€11:30€a.m.,€the€physiciansÐ (#x( Ðreviewed€the€myelogram,€and€at€12:35€p.m.,€Ms.€White€underwent€emergency€surgery.€€Ð ®$þ* ÐÌà ` àBecause€of€these€post„operative€complications,€Ms.€White€lost€bowel€and€bladderÐ º' #. Ðcontrol€and€suffered€back€pain€for€several€months.€€She€still€experiences€pain€and€discomfortÐ @)$0 Ðthat€interferes€with€daily€activities€such€as€sitting,€standing,€walking,€and€sexual€relations.€Ð Æ*&2 ÐShe€also€underwent€a€colostomy€and€has€been€required€to€catheterize€herself€because€of€herÐ L,œ'4 Ðbladder€problems.Ð Ò-")6 Ðâ âÐ X/¨*8 Ðà ` àThe€Whites€filed€a€malpractice€suit€in€the€Circuit€Court€for€Davidson€County€againstÐ ° Ðâ âDrs.€Spengler,€Jones,€Wyrsch,€and€Chmell€and€Vanderbilt€University€Medical€Center,Ð 6† Ðseeking€to€recover€damages€for€the€delay€in€diagnosing€and€treating€the€causa€equinaÐ ¼  Ðsyndrome.€€The€trial€court€granted€Dr.€Chmell€a€summary€judgment€prior€to€trial€and€directedÐ B ’ Ðverdicts€for€Drs.€Spengler€and€Wyrsch€at€the€close€of€the€plaintiffððs€proof.€€Thereafter,€theÐ È  Ðjury€returned€a€verdict€for€Dr.€Jones€and€Vanderbilt€University€Medical€Center.€€On€thisÐ N ž  Ðappeal,€the€Whites€take€issue€with€the€trial€courtððs€refusal€to€permit€them€to€use€theÐ Ô $  Ðdeposition€testimony€of€one€of€the€defendantsðð€experts€designated€as€a€testifying€witness,€theÐ Zª  Ðdirected€verdicts€for€Drs.€Spengler€and€Wyrsch,€and€the€trial€courtððs€refusal€to€strike€theÐ à0  Ðtestimony€of€one€of€the€defendantsðð€experts.׃ ×Ý ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€Ð f¶  ÐÌà@ÕÕ.Dàò òII.ˆÐ r Ðà@5 5 DàòòThe€Exclusion€of€Dr.€John€P.€Kostuikððs€Deposition€Testimonyó óóóˆÐ øH ÐÌà ` àWe€first€take€up€the€question€regarding€the€Whitesðð€efforts€to€introduce€portions€of€theÐ T Ðdepositions€of€one€of€the€defendantsðð€designated€experts€during€their€case„in„chief,€as€wellÐ ŠÚ Ðas€their€desire€to€use€these€depositions€in€rebuttal€and€to€cross„examine€the€defendantsðð€otherÐ `  Ðexpert€witnesses.€€The€trial€court€held€that€the€Whites€could€not€use€these€depositions€for€anyÐ –æ" Ðpurpose€until€the€defendants€actually€called€the€expert€as€a€witness.€€We€disagree.Ð  l$ ÐÌà@ÛÛ.Dàò òA.ó óˆÐ (#x( ÐÌà ` àAfter€the€Whites€filed€suit,€the€defendants€enlisted€the€assistance€of€Dr.€John€P.Ð 4&„!, ÐKostuik,€an€orthopaedic€surgeon€recognized€nationally€as€an€expert€on€the€development€andÐ º' #. Ðtreatment€of€cauda€equina€syndrome.׃€×Ý ƒ #ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€€Because€Dr.€Kostuik€lives€and€practices€in€Maryland,Ð @)$0 Ðthe€defendants€sought€and€obtained€a€judicial€waiver€of€the€locality€rule׃ø×Ý ƒ #ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€to€enable€him€toÐ Æ*&2 Ðtestify.׃° ×Ý ƒ #ÃÝòòÚ  Ú6Ú  ÚóóÝ  Ý×  ×€€The€Whites€first€deposed€Dr.€Kostuik€by€telephone€on€August€21,€1996.€€During€thisÐ L,œ'4 Ðdeposition,€Dr.€Kostuik€opined€that€Ms.€Baun€and€Dr.€Wyrsch€should€have€conducted€theirÐ ° Ðown€neurovascular€examination€of€Ms.€White€after€she€began€complaining€of€pain€at€4:00Ð 6† Ða.m.€on€October€28,€1991.€€In€addition,€he€stated€that€Ms.€Whiteððs€condition€should€have€beenÐ ¼  Ðdiagnosed€earlier€than€8:30€a.m.€and€that€obtaining€the€myelogram€caused€an€unnecessaryÐ B ’ Ðdelay€of€the€remedial€surgery.Ð È  ÐÌà ` àDespite€Dr.€Kostuikððs€seemingly€adverse€testimony€during€the€telephone€deposition,Ð Ô $  Ðthe€defendants€decided€to€obtain€a€videotaped€deposition€from€Dr.€Kostuik€for€possible€useÐ Zª  Ðat€trial.€€Accordingly,€the€partiesðð€lawyers€traveled€to€Baltimore€and€again€deposed€Dr.Ð à0  ÐKostuik€on€August€29,€1996.€€On€this€occasion,€Dr.€Kostuik€repeated€that€Ms.€Baun€shouldÐ f¶  Ðhave€performed€a€nursing€neurovascular€examination€on€Ms.€White€at€4:00€a.m.€and€that€Dr.Ð ì< ÐWyrsch€should€have€examined€Ms.€White€when€he€first€received€Ms.€Baunððs€call.€€He€alsoÐ r Ðstated€that€Dr.€Jonesððs€response€had€not€been€prompt€and€that€there€was€no€ð ðabsoluteÐ øH Ðindicationðð€than€a€myelogram€needed€to€be€performed.€Ð ~Î ÐÌà ` àThe€Whites€listed€Dr.€Kostuik€as€one€of€their€potential€witnesses€on€their€witness€listÐ ŠÚ Ðfiled€on€September€3,€1996,€and€also€disclosed€that€Dr.€Kostuikððs€two€depositions€wereÐ `  Ðamong€the€exhibits€they€planned€to€introduce€at€trial.€€On€the€following€day,€the€defendants€Ð –æ" Ðfiled€their€witness€and€exhibit€list€stating€that€Dr.€Kostuik€was€among€the€witnesses€ð ðwhoÐ  l$ Ðmay€be€called€to€testify.ðð€€Ð ¢!ò& ÐÌà ` àWhen€the€trial€commenced€on€September€9,€1996,€the€Whites€requested€the€trial€courtÐ ®$þ* Ðto€limit€the€number€of€expert€witnesses€called€by€the€defendants.€€The€defendants€sought€toÐ 4&„!, Ðhead€off€the€Whitesðð€use€of€Dr.€Kostuikððs€testimony€by€filing€motions€in€limine€to€preventÐ º' #. Ðthe€Whites€from€using€Dr.€Kostuikððs€depositions€and€from€alluding€to€the€substance€of€anyÐ @)$0 Ðof€their€expertsðð€testimony€during€voir€dire,€opening€statements,€or€during€the€cross„Ð Æ*&2 Ðexamination€of€any€other€defense€witness.€€During€a€hearing€on€these€motions,€the€defendantsÐ L,œ'4 Ðinformed€the€trial€court€that€Dr.€Kostuik€was€ð ðparticularly€important€in€terms€of€causationððÐ Ò-")6 Ðand€that€Dr.€Kostuik€would€testify€in€person€if€called€as€a€witness.€€Based€on€theseÐ X/¨*8 Ðrepresentations,€the€trial€court€declined€to€grant€the€Whitesðð€motion€to€limit€the€number€ofÐ Þ0.,: Ðâ âthe€defendantsðð€witnesses.€€The€court€also€ruled€that€the€Whites€could€not€use€Dr.€KostuikððsÐ d2´-< Ðdepositions€in€their€case„in„chief€but€reserved€deciding€whether€to€permit€them€to€use€theÐ ° Ðdepositions€in€rebuttal€or€during€their€cross„examination€of€the€defendantsðð€expert€witnesses.Ð 6† Ðâ âÌà ` àThe€subject€of€Dr.€Kostuikððs€deposition€resurfaced€on€September€13,€1996€before€theÐ B ’ Ðdefendants€began€to€present€their€evidence.€€The€trial€court€inquired€whether€the€parties€hadÐ È  Ðfound€any€additional€authorities€regarding€the€permissible€use€of€the€depositions.€€After€theÐ N ž  Ðparties€restated€their€positions,€the€trial€court€decided€that€it€was€not€ready€to€rule€on€the€useÐ Ô $  Ðof€Dr.€Kostuikððs€depositions€but€indicated€that€it€was€inclined€to€permit€the€Whites€to€useÐ Zª  Ðthem€for€cross„examination€and€rebuttal€with€some€limitations.€€Ð à0  ÐÌà ` àAt€the€beginning€of€the€next€day€of€trial,€the€trial€court€ruled€definitively€that€theÐ ì< ÐWhites€could€not€use€Dr.€Kostuikððs€depositions€for€rebuttal€if€the€defendants€did€not€call€himÐ r Ðas€a€witness.€€However,€the€trial€court€held€that€the€Whites€could€use€the€depositions€duringÐ øH Ðtheir€cross„examination€of€the€defendantsðð€experts€as€long€as€they€established€that€the€witnessÐ ~Î Ðhad€read€Dr.€Kostuikððs€depositions€and€they€avoided€mentioning€that€Dr.€Kostuik€hadÐ T Ðoriginally€been€the€defendantsðð€witness.€€Later,€the€trial€court€modified€its€holding€by€statingÐ ŠÚ Ðthat€ð ðunless€that€expert€is€going€to€be€called€to€testify€at€trial,€a€party€has€the€right€toÐ `  Ðdesignate€.€.€.€[him]€as€a€consultant€at€any€point.€€And€once€they€[the€defendants]€elect€not€toÐ –æ" Ðutilize€.€.€.€[the€expert]€at€trial,€the€other€party€may€not€.€.€.€discover€the€opinions.€€And€if€theyÐ  l$ Ðhave€been€discovered,€if€there€have€been€depositions,€[the€other€party]€.€.€.€may€not€utilizeÐ ¢!ò& Ðthose€depositions€at€trial.ððÐ (#x( ÐÌà@áá.Dàò òB.ó óˆÐ 4&„!, Ðà@Ë Ë Dàòòò òStandards€for€Reviewing€Evidentiary€Decisionsó óóóˆÐ º' #. ÐÌà ` àThe€admission€or€exclusion€of€evidence€is€within€the€trial€courtððs€discretion.€€òòSeeÐ Æ*&2 ÐSeffernick€v.€Saint€Thomas€Hosp.óó,€969€S.W.2d€391,€393€(Tenn.€1998);€òòOtis€v.€CambridgeÐ L,œ'4 ÐMut.€Fire€Ins.€Co.óó,€850€S.W.2d€439,€442€(Tenn.€1992).€€The€discretionary€nature€of€theÐ Ò-")6 Ðdecision€does€not€shield€it€completely€from€appellate€review€but€does€result€in€subjecting€itÐ X/¨*8 Ðto€less€rigorous€appellate€scrutiny.€€òòSee€Tennessee€Depððt€of€Health€v.€Frisbeeóó,€No.€01A01„Ð Þ0.,: Ð9511„CH„00540,€1998€WL€4718,€at€*2€(Tenn.€Ct.€App.€Jan.€9,€1998)€(No€Tenn.€R.€App.€P.Ð d2´-< Ð11€application€filed);€òòBIF€v.€Service€Constr.€Co.óó,€No.€87„136„II,€1988€WL€72409,€at€*2Ð ê3:/> Ð(Tenn.€Ct.€App.€July€13,€1988)€(No€Tenn.€R.€App.€P.€11€application€filed)€.€€Because,€by€theirÐ p5À0@ Ðvery€nature,€discretionary€decisions€involve€a€choice€among€acceptable€alternatives,Ð ö6F2B Ðâ âreviewing€courts€will€not€second„guess€a€trial€courtððs€exercise€of€its€discretion€simplyÐ |8Ì3D Ðbecause€the€trial€court€chose€an€alternative€that€the€appellate€courts€would€not€have€chosen.€Ð ° ÐòòSee€Overstreet€v.€Shoneyððs,€Inc.óó,€___€S.W.3d€___,€___€(Tenn.€Ct.€App.€1999).׃×Ý ƒ #ÃÝòòÚ  Ú7Ú  ÚóóÝ  Ý×  ×Ð 6† Ðâ âÌà ` àDiscretionary€decisions€require€conscientious€judgment.€€òòSee€€BIF€v.€Service€Constr.Ð B ’ ÐCo.óó,€1988€WL€72409,€at€*2.€€They€must€take€the€applicable€law€into€account€and€must€alsoÐ È  Ðbe€consistent€with€the€facts€before€the€court.€€òòSee€Overstreet€v.€Shoneyððs,€Inc.óó,€___€S.W.3dÐ N ž  Ðat€___.€€Appellate€courts€will€set€aside€a€discretionary€decision€only€when€the€trial€court€hasÐ Ô $  Ðmisconstrued€or€misapplied€the€controlling€legal€principles€or€has€acted€inconsistently€withÐ Zª  Ðthe€substantial€weight€of€the€evidence.òò€€See€Overstreet€v.€Shoneyððs,€Inc.óó,€___€S.W.3d€at€___.€Ð à0  ÐThus,€a€trial€courtððs€discretionary€decision€should€be€reviewed€to€determine:€(1)€whether€theÐ f¶  Ðfactual€basis€for€the€decision€is€supported€by€the€evidence,€(2)€whether€the€trial€courtÐ ì< Ðidentified€and€applied€the€applicable€legal€principles,€and€(3)€whether€the€trial€courtððsÐ r Ðdecision€is€within€the€range€of€acceptable€alternatives.€€òòSee€BIF€v.€Service€Constr.€Co.óó,€1988Ð øH ÐWL€72409,€at€*3.€€Appellate€courts€should€permit€a€discretionary€decision€to€stand€ifÐ ~Î Ðreasonable€judicial€minds€can€differ€concerning€its€soundness.€€òòSee€Overstreet€v.€Shoneyððs,Ð T ÐInc.óó,€___€S.W.3d€at€___.€€Ð ŠÚ ÐÌà ` àConcluding€that€a€trial€court€improperly€excluded€otherwise€admissible€evidence€doesÐ –æ" Ðnot€end€the€inquiry.€€The€erroneous€exclusion€of€evidence€will€not€require€reversal€of€theÐ  l$ Ðjudgment€if€the€evidence€would€not€have€affected€the€outcome€of€the€trial€even€if€it€had€beenÐ ¢!ò& Ðadmitted.€€òòSee€Hensley€v.€Harbinóó,€782€S.W.2d€480,€482€(Tenn.€Ct.€App.€1989);€òòPankow€v.Ð (#x( ÐMitchellóó,€737€S.W.2d€293,€298€(Tenn.€Ct.€App.€1987).Ð ®$þ* ÐÌà@ÛÛ.Dàòòò òC.óóó óˆÐ º' #. Ðà@X X Dàòòò òThe€Discovery€of€the€Opinions€of€an€Opponentððs€Expertó óóóˆÐ @)$0 ÐÌà ` àThe€Tennessee€Rules€of€Civil€Procedure€permit€the€discovery€of€relevant,€non„Ð L,œ'4 Ðprivileged€information.€€òòSee€Wright€v.€United€Servs.€Auto€Assððnóó,€789€S.W.2d€911,€915€(Tenn.Ð Ò-")6 ÐCt.€App.€1990);€òòDuncan€v.€Duncanóó,€789€S.W.2d€557,€560€(Tenn.€Ct.€App.€1990).€€They€strikeÐ X/¨*8 Ða€balance€between€two€important€policies.€€The€first,€and€perhaps€most€important,€policy€isÐ Þ0.,: Ðthat€discovery€should€enable€the€parties€and€the€courts€to€seek€the€truth€so€that€disputes€willÐ d2´-< Ðbe€decided€by€facts€rather€than€by€legal€maneuvering.€€òòSee€Harrison€v.€Greeneville€Ready„Ð ê3:/> ÐMix,€Inc.óó,€220€Tenn.€293,€302,€417€S.W.2d€48,€52€(1967);€òòPettus€v.€Hurstóó,€882€S.W.2d€783,Ð p5À0@ Ð786€(Tenn.€Ct.€App.€1993).€€The€second€policy€is€that€the€discovery€rules€should€not€permitÐ ö6F2B Ðless€diligent€lawyers€to€benefit€from€the€work€of€their€more€diligent€opponents.€€òòSeeÐ ° ÐVythoulkas€v.€Vanderbilt€Univ.€Hosp.óó,€693€S.W.2d€350,€357€(Tenn.€Ct.€App.€1985).€€BothÐ 6† Ðthese€policies€are€evident€in€the€rules€governing€the€discovery€of€experts.Ð ¼  ÐÌà ` àThe€courts€and€commentators€generally€divide€experts€into€four€classifications€forÐ È  Ðdiscovery€purposes.׃×Ý ƒ #ÃÝòòÚ  Ú8Ú  ÚóóÝ  Ý×  ×€€The€first€classification€includes€experts€a€party€expects€to€call€at€trial.€Ð N ž  ÐAt€the€time€of€this€proceeding,€Tenn.€R.€Civ.€P.€26.02(4)(A)€permitted€the€partyððs€opponentsÐ Ô $  Ðto€learn€by€interrogatories€the€names€of€these€experts€and€the€substance€of€their€testimony.€Ð Zª  ÐFurther€discovery€of€these€experts€could€be€obtained€only€by€agreement€or€on€motion€andÐ à0  Ðcourt€order.׃@×Ý ƒ #ÃÝòòÚ  Ú9Ú  ÚóóÝ  Ý×  ×Ð f¶  ÐÌà ` àThe€second€classification€includes€experts,€whether€retained€or€not,€who€have€beenÐ r Ðconsulted€by€a€party€in€anticipation€of€litigation€or€in€preparation€for€trial€but€who€will€notÐ øH Ðbe€called€as€a€witness.€€€Except€as€provided€in€Tenn.€R.€Civ.€P.€35€pertaining€to€examiningÐ ~Î Ðphysicians,€Tenn.€R.€Civ.€P.€26.02(4)(B)€provides€that€neither€the€identity€of€these€expertsÐ T Ðnor€their€opinions€can€be€discovered€without€a€showing€that€ð ðthe€party€seeking€discoveryÐ ŠÚ Ðcannot€obtain€facts€or€opinions€on€the€same€subject€by€other€means.ðð€€Ð `  ÐÌà ` àThe€third€classification€includes€experts€who€were€not€specifically€retained€inÐ  l$ Ðanticipation€of€litigation€or€in€preparation€for€trial,€such€as€regular€employees€of€a€party€orÐ ¢!ò& Ðtreating€physicians.€€Because€these€experts€do€not€fit€within€Tenn.€R.€Civ.€P.€26.02(4)(A)€orÐ (#x( Ð26.02(4)(B),€their€identity,€as€well€as€their€facts€and€opinions,€are€freely€discoverable€as€withÐ ®$þ* Ðany€ordinary€witness.€€òòSee€Airline€Constr.,€Inc.€v.€Barróó,€807€S.W.2d€247,€258€(Tenn.€Ct.€App.Ð 4&„!, Ð1990);€òòAlessio€v.€Crookóó,€633€S.W.2d€770,€779„80€(Tenn.€Ct.€App.€1982).Ð º' #. ÐÔ_ÔÔ_ÔÔ_ÔÔ_ÔÌà ` àThe€fourth€classification€includes€experts€designated€by€a€party€as€a€witness€expectedÐ Æ*&2 Ðto€testify€at€trial€but€whose€designation€is€subsequently€withdrawn.׃%è×Ý ƒ #ÃÝòòÚ  Ú10Ú  ÚóóÝ  Ý×  ×€€The€designation€ofÐ L,œ'4 Ðthese€experts€as€testifying€witnesses,€even€if€that€designation€is€subsequently€withdrawn,Ð ° Ðtakes€an€opposing€partyððs€demand€to€depose€and€use€the€expert€at€trial€out€of€theÐ 6† Ðrequirements€of€Tenn.€R.€Civ.€P.€26.02(4)(B).€€However,€the€Tenn.€R.€Civ.€P.€26.02(4)(A)Ð ¼  Ðdesignation€does€not€automatically€entitle€the€opposing€party€to€depose€or€use€another€partyððsÐ B ’ Ðexpert€at€trial.€€Rather,€the€trial€court€must€use€its€discretion,€guided€by€Tenn.€R.€Evid.€403'sÐ È  Ðbalancing€of€probative€value€against€prejudice,€to€determine€whether€the€opposing€partyÐ N ž  Ðshould€be€permitted€to€call€or€depose€or€use€the€other€partyððs€expert€at€trial.€€òòSee€House€v.Ð Ô $  ÐCombined€Ins.€Co.€of€Am.óó,€168€F.R.D.€236,€245„46€(N.D.€Iowa€1996).€€Ð Zª  ÐÌà ` àShielding€consulting€experts€from€discovery€runs€contrary€to€the€broad€policy€favoringÐ f¶  Ðthe€discovery€of€non„privileged€information;€however,€it€serves€several€other€legitimateÐ ì< Ðinterests.€€It€encourages€lawyers€to€seek€expert€advice€to€properly€evaluate€and€present€theirÐ r Ðclientððs€position.€€òòSee€Rocky€Mountain€Natððl€Gas€Co.€v.€Cooper€Indus.,€Inc.óó,€166€F.R.D.€481,Ð øH Ð482€(D.€Colo.€1996);òò€McKinnon€v.€Smockóó,€445€S.E.2d€526,€528€(Ga.€1994);òò€Tom€L.€Scott,Ð ~Î ÐInc.€v.€McIlhaneyóó,€798€S.W.2d€556,€559€(Tex.€1990).€€Without€this€protection,€parties€wouldÐ T Ðbe€reluctant€to€consult€experts€because€they€would€be€forced€to€live€or€die€based€on€theÐ ŠÚ Ðunknown€opinion€of€the€expert€consulted.€€òòSee€General€Motor€Corp.€v.€Gayleóó,€924€S.W.2dÐ `  Ð222,€230€(Tex.€App.€1996).€€It€also€prevents€the€unfairness€of€permitting€a€party€to€benefitÐ –æ" Ðfrom€the€opposing€partyððs€efforts€and€expense.€€òòSee€Durflinger€v.€Artilesóó,€727€F.2d€888,€891Ð  l$ Ð(10th€Cir.€1984).€€In€addition,€shielding€consulting€witnesses€from€discovery€helps€assure€theÐ ¢!ò& Ðavailability€of€experts€who€will€assist€with€litigated€disputes€and€minimizes€the€prejudiceÐ (#x( Ðcaused€by€revealing€the€prior€retention€of€an€expert€by€the€opposing€party.€€òòSee€Rubel€v.€EliÐ ®$þ* ÐLilly€&€Co.óó,€160€F.R.D.€458,€460€(S.D.N.Y.€1995).Ð 4&„!, ÐÌà ` àMost€of€the€reasons€in€favor€of€shielding€a€consulting€expert€from€discovery€becomeÐ @)$0 Ðattenuated€once€a€party€identifies€or€designates€an€expert€as€a€witness€expected€to€testify€atÐ Æ*&2 Ðtrial.€€Identifying€an€expert€as€a€testifying€witness€in€accordance€with€Tenn.€R.€Civ.€P.Ð L,œ'4 Ð26.02(4)(A)€has€the€practical€effect€of€waiving€the€protection€of€Tenn.€R.€Civ.€P.€26.02(4)(B),Ð ° Ðòòsee€Brown€v.€Hamidóó,€856€S.W.2d€51,€54€(Mo.€1993),€and€of€making€the€expert€available€toÐ 6† Ðbe€deposed.€€òòSee€Brown€v.€Ringstadóó,€142€F.R.D.€461,€465€(S.D.€Iowa€1992);€òòIn€re€Shell€OilÐ ¼  ÐRefineryóó,€132€F.R.D.€437,€440€(E.D.€La.€1990).€€Once€an€expert€has€been€deposed,€theÐ B ’ Ðlimitation€on€the€discovery€of€consulting€experts€has€little€or€no€application,€òòsee€Agron€v.Ð È  ÐTrustees€of€Columbia€Univ.óó,€176€F.R.D.€445,€449€(S.D.N.Y.€1997),€and€the€expert€isÐ N ž  Ðrecognized€as€presenting€part€of€the€common€body€of€discoverable€and€generally€admissibleÐ Ô $  Ðinformation€and€testimony€available€to€all€parties.€€òòSee€House€v.€Combined€Ins.€Co.€of€Am.óó,Ð Zª  Ð168€F.R.D.€at€245.Ð à0  ÐÌà ` àWhile€Dr.€Kostuik€may€once€have€been€a€consulting€expert,€the€defendants€eventuallyÐ ì< Ðdesignated€him€as€a€testifying€expert€pursuant€to€Tenn.€R.€Civ.€P.€26.02(4)(A).€€Not€only€didÐ r Ðthey€designate€him€as€a€testifying€expert,€they€voluntarily€made€him€available€for€twoÐ øH Ðdepositions€ð!ð€one€of€the€depositions€to€preserve€his€testimony€because€of€his€legalÐ ~Î Ðunavailability.€€In€addition,€the€lawyers€representing€the€defendants€participated€in€theseÐ T Ðdepositions€without€objection.€€Instead€of€attempting€to€redesignate€Dr.€Kostuik€as€aÐ ŠÚ Ðconsulting€expert€following€his€depositions,€the€defendants€repeatedly€reinforced€Dr.Ð `  ÐKostuikððs€status€as€a€testifying€expert€by€including€him€on€their€list€of€potential€trialÐ –æ" Ðwitnesses€and€alluding€to€his€expected€appearance€in€court€to€testify€in€person.€€Ð  l$ ÐÌà ` àBased€on€these€facts,€we€find€that€Tenn.€R.€Civ.€P.€26.02(4)(B)€is€inapplicable€to€theÐ (#x( Ðdefendantsðð€motion€in€limine€for€two€reasons.€€First,€Tenn.€R.€Civ.€P.€26.02(4)(B)€governsÐ ®$þ* Ðlimitations€on€discovery,€not€on€the€admissibility€of€properly€discovered€evidence.€€Second,Ð 4&„!, Ðthis€record€contains€no€evidence€that€the€Whites€abused€the€discovery€process€or€that€theyÐ º' #. Ðlearned€of€Dr.€Kostuikððs€identity€or€opinions€through€any€means€inconsistent€with€either€theÐ @)$0 Ðletter€or€the€spirit€of€the€discovery€rules.€€Because€Tenn.€R.€Civ.€P.€26.02(4)(B)€isÐ Æ*&2 Ðinapplicable,€all€that€is€left€for€the€court€to€do€is€to€determine€the€admissibility€of€Dr.Ð L,œ'4 ÐKostuikððs€depositions€under€the€applicable€provisions€of€the€Tennessee€Rules€of€CivilÐ Ò-")6 ÐProcedure€and€the€Tennessee€Rules€of€Evidence.€€òòSee€Argon€v.€Trustees€of€Columbia€Univ.óó,Ð X/¨*8 Ð176€F.R.D.€at€449„50;òò€Rubel€v.€Eli€Lilly€&€Co.óó,€160€F.R.D.€at€460„61€(both€cases€finding€thatÐ Þ0.,: Ðin€the€absence€of€discovery€abuse,€the€admissibility€of€expert€testimony€is€governed€by€Fed.Ð d2´-< ÐR.€Evid.€403).€€Ð ê3:/> ÐÌÌÌÐ :R5F Ðà@ÛÛ.Dàò òD.ó óˆÐ ° Ðà@” ” Dàòòò òThe€Admissibility€of€Dr.€Kostuikððs€Testimony€at€Trialó óóóˆÐ 6† ÐÌà ` àThe€Whitesðð€request€to€read€portions€of€Dr.€Kostuikððs€depositions€into€evidence€andÐ B ’ Ðto€use€the€depositions€to€cross„examine€the€defendantsðð€experts€triggers€the€consideration€ofÐ È  Ðthree€issues.€€First,€we€must€determine€whether,€under€the€facts€of€this€case,€Tenn.€R.€Civ.€P.Ð N ž  Ð32€permitted€the€use€of€deposition€testimony€at€trial.€€Second,€we€must€decide€whether€theÐ Ô $  Ðportions€of€Dr.€Kostuikððs€testimony€that€the€Whitesðð€desired€to€use€were€relevant.€€Third,€weÐ Zª  Ðmust€determine€whether€the€probative€value€of€the€portions€of€the€depositions€the€WhitesÐ à0  Ðproposed€to€use€outweighs€the€possible€prejudice€to€the€defendants.€€We€decide€each€of€theseÐ f¶  Ðquestions€in€the€Whitesðð€favor.Ð ì< ÐÌà@óó.Dàò ò1.ó óˆÐ øH Ðà@ØØDàòòò òUse€of€Dr.€Kostuikððs€Depositionsó óóóˆÐ ~Î ÐÌà ` àWe€turn€first€to€the€question€of€whether€the€Whites€could€have€used€Dr.€KostuikððsÐ ŠÚ Ðdeposition€at€trial.€€Tenn.€R.€Civ.€P.€32.01(3)€provides€that€the€deposition€of€a€witness€mayÐ `  Ðbe€used€at€trial€for€any€purpose€if€the€court€finds€that€the€witness€is€either€at€a€greater€distanceÐ –æ" Ðthan€one€hundred€miles€from€the€place€of€the€trial€or€that€the€witness€is€out€of€the€state.€€Dr.Ð  l$ ÐKostuik€meets€both€criteria€because€he€resides€and€works€in€Baltimore,€Maryland.€Ð ¢!ò& ÐAccordingly,€because€there€is€no€evidence€that€the€Whites€procured€his€absence,€Dr.Ð (#x( ÐÔ_ÔKostuikÔ_Ôððs€status€as€a€witness€satisfies€the€distance€and€geographic€requirements€in€Tenn.€R.Ð ®$þ* ÐCiv.€P.€32.01(3).Ð 4&„!, ÐÌà ` àTenn.€R.€Civ.€P.€32.01(3)€also€provides€that€depositions€of€experts€taken€pursuant€toÐ @)$0 Ðthe€provisions€of€Tenn.€R.€Civ.€P.€26.02(4)€may€only€be€used€at€trial€to€impeach€theÐ Æ*&2 Ðtestimony€of€the€deponent.€€The€comments€to€Tenn.€R.€Civ.€P.€32.01€make€clear€that€thisÐ L,œ'4 Ðrestriction€applies€only€to€discovery€depositions€of€an€adversaryððs€expert.€€òòSeeóó€Tenn.€R.€Civ.Ð Ò-")6 ÐP.€32.01€advisory€commission€cmt.€to€1986€amendment.€€Dr.€Kostuikððs€videotapedÐ X/¨*8 Ðdeposition€of€August€29,€1996€was€not€a€discovery€deposition€taken€by€the€Whites€but€ratherÐ Þ0.,: Ðwas€a€deposition€taken€at€the€defendantsðð€insistence€to€preserve€Dr.€Kostuikððs€testimony.€Ð d2´-< ÐAccordingly,€this€deposition€meets€the€requirements€of€Tenn.€R.€Civ.€P.€32.01(3).€€Dr.Ð ê3:/> ÐKostuikððs€telephone€deposition€of€August€21,€1996€was€a€discovery€deposition€taken€by€theÐ p5À0@ ÐWhites.€€Rather€than€being€completely€inadmissible,€however,€it€can€be€used€to€impeach€Dr.Ð ö6F2B ÐKostuikððs€testimony€in€his€August€29,€1996€deposition.Ð |8Ì3D ÐÐ :R5F Ðà ` àHaving€determined€that€Dr.€Kostuikððs€depositions€satisfy€the€conditions€for€use€at€trialÐ ° Ðin€Tenn.€R.€Civ.€P.€32.01,€we€must€still€determine€whether€the€deposition€testimony€wouldÐ 6† Ðbe€admissible€under€the€applicable€rules€of€evidence€if€Dr.€Kostuik€were€to€have€given€theÐ ¼  Ðsame€testimony€live€in€the€courtroom.׃×Ý ƒ #ÃÝòòÚ  Ú11Ú  ÚóóÝ  Ý×  ×€€The€answer€to€this€question€requires€us€to€considerÐ B ’ Ðtwo€rules€of€evidence€ð!ð€Tenn.€R.€Evid.€401€and€403.€€Ð È  ÐÌÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_Ôà@óó.Dàò ò2.ó óˆÐ Ô $  Ðà@Ï Ï Dàòòò òThe€Relevance€of€Dr.€Kostuikððs€Testimonyó óóóˆÐ Zª  ÐÌà ` àThis€is€a€medical€malpractice€action.€€To€prevail,€the€Whites€had€to€present€expertÐ f¶  Ðevidence€(1)€establishing€the€applicable€standard€of€care,€(2)€demonstrating€that€theÐ ì< Ðdefendantsðð€conduct€fell€below€that€standard€of€care,€and€(3)€that€the€defendantsðð€conduct€wasÐ r Ðthe€proximate€cause€of€injuries€that€would€not€otherwise€have€occurred.€€òòSeeóó€Tenn.€CodeÐ øH ÐAnn.€ðð€29„26„115(a)€(1980);€òòMoon€v.€Saint€Thomas€Hosp.óó,€983€S.W.2d€225,€229€(Tenn.Ð ~Î Ð1998);€òòHurst€v.€Doughertyóó,€800€S.W.2d€183,€185€(Tenn.€Ct.€App.€1990).׃!€×Ý ƒ #ÃÝòòÚ  Ú12Ú  ÚóóÝ  Ý×  ×€€Accordingly,€itÐ T Ðwas€incumbent€on€the€Whites€to€present€expert€testimony€€regarding€the€standard€of€care€ofÐ ŠÚ Ðthe€nurse€and€the€four€physicians€treating€Ms.€White€on€October€27€and€28,€1991€andÐ `  Ðwhether€the€conduct€of€these€health€care€providers€at€that€time€fell€below€the€applicableÐ –æ" Ðstandard€of€care€and€caused€Ms.€White€to€sustain€injuries€that€she€would€not€otherwise€haveÐ  l$ Ðsuffered.Ð ¢!ò& ÐÌà ` àIn€light€of€the€Whitesðð€burden€of€proof,€there€is€little€need€for€a€prolonged€discussionÐ ®$þ* Ðconcerning€whether€Dr.€Kostuikððs€testimony€is€relevant€to€their€case.€€Tenn.€R.€Evid.€401Ð 4&„!, Ðdefines€relevant€evidence€as€ð ðevidence€having€any€tendency€to€make€the€existence€of€any€factÐ º' #. Ðthat€is€of€consequence€to€the€determination€of€the€action€more€probable€or€less€probable€thanÐ @)$0 Ðit€would€be€without€the€evidence.ðð€€Dr.€Kostuikððs€testimony€relates€to€the€issues€of€theÐ Æ*&2 Ðapplicable€standard€of€care€for€the€health€care€providers€treating€Ms.€White,€as€well€as€to€theÐ L,œ'4 Ðissues€of€breach€of€this€standard€of€care€and€causation.€€Because€each€of€these€issues€wasÐ Ò-")6 Ðhotly€contested,€there€is€no€question€that€Dr.€Kostuikððs€testimony€was€relevant€to€the€issuesÐ X/¨*8 Ðat€trial.Ð Þ0.,: Їà@óó.Dàò ò3.ó óˆÐ ° Ðà@iiDàòòò òBalancing€Under€Tenn.€R.€Evid.€403ó óóóˆÐ 6† ÐÌà ` àWe€now€turn€to€the€balancing€of€the€probative€value€of€Dr.€Kostuikððs€testimonyÐ B ’ Ðagainst€the€countervailing€factors€identified€in€Tenn.€R.€Evid.€403.€€This€balancing€processÐ È  Ðhas€several€general€ground€rules.€€It€begins€by€recognizing€that€the€rules€of€evidence€favorÐ N ž  Ðthe€admissibility€of€relevant€evidence,òò€seeóó€10€James€W.€Moore€et€al.,€òòMooreððs€FederalÐ Ô $  ÐPracticeóó€ðð€403.02[3]€(2d€ed.€1995),€and€that€relevant€evidence€is€admissible€unless€otherwiseÐ Zª  Ðprovided.€€òòSeeóó€Tenn.€R.€Evid.€402;€òòPhillips€v.€F.W.€Woolworth€Co.óó,€867€S.W.2d€316,€318Ð à0  Ð(Tenn.€Ct.€App.€1992).€€Thus,€excluding€relevant€evidence€under€Tenn.€R.€Evid.€403€is€anÐ f¶  Ðextraordinary€remedy€that€should€be€used€sparingly,€òòseeóó€òòUnited€States€v.€Rodriguezóó,€192€F.3dÐ ì< Ð946,€949€(10th€Cir.€1999);€òòCaparotta€v.€Entergy€Corp.óó,€168€F.3d€754,€758€(5th€Cir.€1999);Ð r ÐòòWestcott€v.€Crinklawóó,€68€F.3d€1073,€1077„78€(8th€Cir.€1995);€òòTrevino€v.€Texas€Depððt€ofÐ øH ÐProtective€&€Regulatory€Servs.óó,€893€S.W.2d€243,€248€(Tex.€App.€1995);€òòTowner€v.€Stateóó,€685Ð ~Î ÐP.2d€45,€49€(Wyo.€1984),€and€persons€seeking€to€exclude€otherwise€admissible€and€relevantÐ T Ðevidence€have€a€significant€burden€of€persuasion.€€òòSeeóó€Neil€P.€Cohen€et€al.,òò€Tennessee€LawÐ ŠÚ Ðof€Evidenceóó€ðð€403.3,€at€152€(3d€ed.€1995)€(ð ðTennessee€Law€of€Evidenceðð).€€Ð `  ÐÌà ` àEach€Tenn.€R.€Evid.€403€question€must€be€decided€on€its€own€facts,€òòseeóó€TennesseeÐ  l$ ÐLaw€of€Evidence€ðð€403.7,€at€156,€and€the€trial€court€must€be€careful€not€to€usurp€the€functionÐ ¢!ò& Ðof€the€jury€in€the€process.€€òòSeeóó€22€Charles€A.€Wright€&€Kenneth€W.€Graham,€Jr.,€òòFederalÐ (#x( ÐPractice€and€Procedureóó€ðð€5220,€at€306€(1978)€(ð ðWright€&€Grahamðð).€€The€balancing€processÐ ®$þ* Ðunder€Tenn.€R.€Evid.€403€is€a€two„step€process.€€The€trial€court€must€first€balance€theÐ 4&„!, Ðprobative€value€of€the€evidence€sought€to€be€excluded€against€the€countervailing€factors.€Ð º' #. ÐAfter€the€court€has€engaged€in€the€balancing€analysis,€it€may€then€exercise€its€discretion€toÐ @)$0 Ðdetermine€whether€the€evidence€should€be€excluded€if€the€prejudice€substantially€outweighsÐ Æ*&2 Ðthe€probative€value€of€the€evidence.€€òòSeeóó€Wright€&€Graham€ðð€5214,€at€264.Ð L,œ'4 ÐÌà ` àDuring€the€first€phase€of€the€analysis,€the€court€must€determine€whether€theÐ X/¨*8 Ðcountervailing€factors€in€Tenn.€R.€Evid.€403€ð ðsubstantially€outweighðð€the€probative€value€ofÐ Þ0.,: Ðthe€evidence.€€The€trial€court€has€no€discretion€to€exclude€evidence€under€Tenn.€R.€Evid.€403Ð d2´-< Ðunless€it€concludes€that€the€probative€worth€of€the€evidence€is€substantially€outweighed€byÐ ê3:/> Ðone€or€more€of€the€countervailing€factors.€€òòSeeóó€Wright€&€Graham€ðð€5214,€at€263.€€Thus,€aÐ p5À0@ Ðtrial€court€should€not€exclude€evidence€under€Tenn.€R.€Evid.€403€when€the€balance€betweenÐ ö6F2B Ðthe€probative€worth€of€the€evidence€and€the€countervailing€factors€is€fairly€debatable.€€òòSeeóóÐ |8Ì3D ÐWright€&€Graham€ðð€5221,€at€309.Ð :R5F Їà ` àThe€trial€courtððs€decision€to€exclude€Dr.€Kostuikððs€deposition€must€be€viewed€in€lightÐ ° Ðof€the€circumstances€at€the€trial.€€When€the€trial€began,€the€Whites€had€indicated€that€theirÐ 6† Ðcase€would€rest€on€the€expert€testimony€of€a€Knoxville€neurosurgeon,€a€nurse€from€Jackson,Ð ¼  Ðand€portions€of€Dr.€Kostuikððs€depositions.׃×Ý ƒ #ÃÝòòÚ  Ú13Ú  ÚóóÝ  Ý×  ×€€At€the€same€time,€the€defendant€physicians€andÐ B ’ Ðthe€hospital€had€signaled€their€intention€to€call€three€out„of„state€physicians,€including€Dr.Ð È  ÐKostuik,€and€three€nurses€to€testify€about€the€standard€of€care€and€causation€issues.€€InÐ N ž  Ðaddition€to€these€experts,€each€of€the€defendants€intended€to€give€their€expert€opinion€thatÐ Ô $  Ðthey€were€not€negligent€and€that€their€actions€or€inactions€did€not€cause€Ms.€White€to€sufferÐ Zª  Ðan€injury€she€would€not€otherwise€have€suffered.Ð à0  ÐÌà ` àThe€probative€value€of€Dr.€Kostuikððs€opinions€regarding€the€actions€of€Ms.€Baun,€Dr.Ð ì< ÐWyrsch,€Dr.€Jones,€and€Dr.€Spengler€is€significant€because€it€is€consistent€with€the€expertÐ r Ðopinion€of€the€only€neurosurgeon€testifying€for€the€Whites.€€Dr.€Kostuik€questioned€Ms.Ð øH ÐBaunððs€and€Dr.€Wyrschððs€failure€to€examine€Ms.€White€when€she€reported€the€new€pain€inÐ ~Î Ðher€legs.€€He€also€observed€that€Dr.€Jonesððs€two„hour€delay€in€examining€Ms.€White€wasÐ T Ðð ðprobablyðð€not€prompt€and€that€Dr.€Spengler€could€have€proceeded€to€perform€the€emergencyÐ ŠÚ Ðsurgery€without€the€myelogram.Ð `  ÐÌà ` àThe€value€of€this€evidence€must€now€be€weighed€against€the€six€countervailing€factorsÐ  l$ Ðin€Tenn.€R.€Evid.€403.€€Three€of€these,€undue€delay,€waste€of€time,€and€the€needlessÐ ¢!ò& Ðpresentation€of€cumulative€evidence,€can€be€quickly€discounted.€€Permitting€the€Whites€toÐ (#x( Ðuse€Dr.€Kostuikððs€depositions€would€not€have€delayed€the€trial€or€wasted€time.€€The€WhitesÐ ®$þ* Ðalready€had€the€depositions€in€hand€€and€reading€the€relevant€portions€into€the€record€wouldÐ 4&„!, Ðnot€have€taken€an€appreciable€amount€of€time.€€Likewise,€Dr.€Kostuikððs€deposition€testimonyÐ º' #. Ðwould€not€have€been€cumulative.€€The€trial€court€had€earlier€concluded,€at€the€defendantsððÐ @)$0 Ðinsistence,€that€Dr.€Kostuikððs€testimony€was€not€cumulative€when€it€declined€to€grant€theÐ Æ*&2 ÐWhitesðð€motion€at€the€beginning€of€the€trial€to€require€the€defendants€to€limit€the€number€ofÐ L,œ'4 Ðtheir€expert€witnesses.€€Just€as€Dr.€Kostuikððs€testimony€would€not€have€been€cumulative€hadÐ Ò-")6 Ðit€been€used€by€the€defendants,€it€would€not€have€been€cumulative€if€used€by€the€Whites.Ð X/¨*8 ÐÌà ` àTwo€of€the€remaining€Tenn.€R.€Evid.€403€countervailing€factors€are€confusion€of€theÐ d2´-< Ðissues€and€misleading€the€jury.€€Dr.€Kostuikððs€testimony€does€not€run€afoul€of€these€factorsÐ ê3:/> Ðeither.€€His€testimony€concerning€the€applicable€standard€of€care€and€causation€is€focused€andÐ p5À0@ Ðdirectly€on€point.€€His€answers€are€responsive€to€the€questions€and€are€couched€in€terms€thatÐ ° Ðcan€be€easily€understood€by€the€lay€persons€on€the€jury.€€Considering€both€his€testimony€asÐ 6† Ða€whole,€as€well€as€the€portions€of€the€testimony€the€Whites€sought€to€use€at€trial,€we€find€thatÐ ¼  ÐDr.€Kostuikððs€testimony€would€have€materially€assisted€the€trier€of€fact.Ð B ’ ÐÌà ` àThe€final€countervailing€factor€in€Tenn.€R.€Evid.€403€is€the€danger€of€unfair€prejudice.€Ð N ž  ÐAt€the€outset,€we€find€that€the€substance€of€much€of€Dr.€Kostuikððs€deposition€testimony€doesÐ Ô $  Ðnot€create€a€danger€of€unfair€prejudice€to€the€defendants.€€This€is€certainly€the€case€withÐ Zª  Ðregard€to€his€testimony€concerning€the€standard€of€care€and€causation€issues.€€However,€theÐ à0  ÐWhites€argue€in€their€brief€that€in€addition€to€presenting€Dr.€Kostuikððs€opinions€regarding€theÐ f¶  Ðmatters€at€issue€in€the€case,€they€should€have€been€permitted€to€disclose€to€the€jury€that€Dr.Ð ì< ÐKostuik€had€originally€been€retained€by€the€defendants.€€That€information€raises€substantialÐ r Ðfairness€concerns.Ð øH ÐÌà ` àInforming€the€jury€that€an€expert€witness€was€originally€retained€by€the€opposing€partyÐ T Ðcreates€a€danger€that€the€jury€will€draw€two€unwarranted€conclusions.€First,€it€could€createÐ ŠÚ Ðthe€unwarranted€impression€that€the€opposing€party€is€suppressing€evidence€that€it€had€anÐ `  Ðobligation€to€present.€€òòSee€Granger€v.€Wisneróó,€656€P.2d€1238,€1242„43€(Ariz.€1982);€8Ð –æ" ÐCharles€A.€Wright€et€al.,€òòFederal€Practice€and€Procedureóó€ðð€2032,€at€447€(2d€ed.€1994)Ð  l$ Ð(characterizing€this€information€as€ð ðexplosiveðð).€€Second,€it€could€induce€the€jury€to€believeÐ ¢!ò& Ðthat€the€expert€is€somehow€more€credible€than€the€other€experts.€€Accordingly,€we€have€heldÐ (#x( Ðthat€the€information€concerning€who€originally€hired€an€expert€witness€is€irrelevant.€€òòSeeÐ ®$þ* ÐState€v.€Wilkinson„Snowden„McGehee,€Inc.óó,€571€S.W.2d€842,€843€(Tenn.€Ct.€App.€1978).€Ð 4&„!, ÐA€majority€of€jurisdictions€considering€the€question€have€held€that€it€is€improper€to€elicit€onÐ º' #. Ðdirect€examination€of€an€expert€witness€that€the€expert€was€originally€retained€by€theÐ @)$0 Ðopposing€party.€€òòSee€Peterson€v.€Willieóó,€81€F.3d€1033,€1037„38€(11th€Cir.€1996);€òòHouse€v.Ð Æ*&2 ÐCombined€Ins.€Co.€of€Am.óó,€168€F.R.D.€at€248;€òòRubel€v.€Eli€Lilly€&€Co.óó,€160€F.R.D.€at€460;Ð L,œ'4 ÐòòGranger€v.€Wisneróó,€656€P.2d€at€1242;€òòGeneral€Motors€Corp.€v.€Jacksonóó,€636€So.€2d€at€314„Ð Ò-")6 Ð15;€òòSeeber€v.€Howletteóó,€586€N.W.2d€445,€451€(Neb.€1998).׃'×Ý ƒ #ÃÝòòÚ  Ú14Ú  ÚóóÝ  Ý×  ×Ð X/¨*8 ÐÌà ` àWe€have€determined€that€the€majority€rule€that€disfavors€informing€the€jury€that€anÐ d2´-< Ðexpert€witness€was€originally€retained€by€an€opposing€party€is€most€consistent€with€theÐ ê3:/> Ðbalancing€requirements€of€Tenn.€R.€Evid.€403.€€Accordingly,€the€trial€court€should€haveÐ p5À0@ Ðpermitted€the€Whites€to€use€Dr.€Kostuikððs€deposition€at€trial€but€should€have€required€themÐ ° Ðto€edit€the€portions€of€the€deposition€they€planned€to€use€to€remove€any€reference€to€the€factÐ 6† Ðthat€Dr.€Kostuik€had€been€initially€consulted€by€the€defendants.€€Removal€of€references€toÐ ¼  Ðthis€information€eliminates€any€real€risk€of€danger€of€unfair€prejudice€to€the€defendants€byÐ B ’ Ðpermitting€the€Whites€to€use€Dr.€Kostuikððs€depositions€at€trial.׃)×Ý ƒ #ÃÝòòÚ  Ú15Ú  ÚóóÝ  Ý×  ×Ð È  ÐÌà ` àUnder€the€facts€of€this€case,€we€find€that€the€possible€harm€to€the€defendants€fromÐ Ô $  Ðpermitting€the€Whites€to€use€Dr.€Kostuikððs€deposition€at€trial€does€not€substantially€outweighÐ Zª  Ðthe€probative€value€of€the€evidence.€€The€defendants€designated€Dr.€Kostuik€as€a€testifyingÐ à0  Ðexpert€witness€in€accordance€with€Tenn.€R.€Civ.€P.€26.02(4)(A)€and€never€withdrew€thisÐ f¶  Ðdesignation.€€The€manner€in€which€the€Whites€obtained€Dr.€Kostuikððs€deposition€compliedÐ ì< Ðwith€the€letter€and€the€spirit€of€the€discovery€rules.€€Accordingly,€the€trial€court€erred€byÐ r Ðrefusing€to€allow€them€to€rely€on€Dr.€Kostuikððs€deposition€at€trial.Ð øH ÐÌà ` àFinally,€we€must€determine€whether€the€trial€courtððs€error€in€excluding€Dr.€KostuikððsÐ T Ðdeposition€has€harmless.€€Under€the€facts€of€this€case,€the€trial€courtððs€decision€worked€anÐ ŠÚ Ðinjustice€on€the€Whites€by€preventing€them€from€introducing€relevant€evidence€to€supportÐ `  Ðtheir€medical€malpractice€claim.€€Given€the€closeness€of€the€case€and€the€weight€of€the€expertÐ –æ" Ðproof€against€their€claim,€we€conclude€that€the€trial€courtððs€error,€more€probably€than€not,Ð  l$ Ðaffected€the€outcome€of€the€case.€€Therefore,€we€decline€to€find€that€the€trial€courtððs€wrongfulÐ ¢!ò& Ðexclusion€of€Dr.€Kostuikððs€testimony€was€harmless€error.׃,À ×Ý ƒ #ÃÝòòÚ  Ú16Ú  ÚóóÝ  Ý×  ×Ð (#x( ÐÐ ®$þ* ЇÔ_ÔÔ_Ôà@««-Dàò òIII.ó óˆÐ ° Ðà@88Dàò òòòDr.€Thomas€Whitesidesððs€Testimonyóóó óˆÐ 6† ÐÌà ` àThe€Whites€also€argue€that€the€trial€court€should€have€stricken€Dr.€ThomasÐ B ’ ÐWhitesidesððs€testimony€because€he€did€not€demonstrate€sufficient€knowledge€andÐ È  Ðunderstanding€of€the€key€facts€of€the€case.€€Decisions€regarding€the€admission€or€exclusionÐ N ž  Ðof€expert€testimony€are€discretionary.€€òòSee€McDaniel€v.€CSX€Transp.,€Inc.óó,€955€S.W.2d€257,Ð Ô $  Ð263€(Tenn.€1997);€òòLazy€Seven€Coal€Sales,€Inc.€v.€Stone€&€Hinds,€P.C.óó,€813€S.W.2d€400,€406„Ð Zª  Ð07€(Tenn.€1991);€òòSmith€County€v.€Eatherlyóó,€820€S.W.2d€366,€368€(Tenn.€Ct.€App.€1991).€Ð à0  ÐAccordingly,€we€will€not€overturn€a€trial€courtððs€decision€either€to€admit€or€to€exclude€expertÐ f¶  Ðtestimony€unless€it€was€arbitrary€or€an€abuse€of€discretion.€€òòSee€Buchanan€v.€Harrisóó,€902Ð ì< ÐS.W.2d€941,€945€(Tenn.€Ct.€App.€1995);€òòThomas€v.€Harperóó,€53€Tenn.€App.€549,€561,€385Ð r ÐS.W.2d€130,€136€(1964).Ð øH ÐÌà ` àAn€expert€witness€qualified€by€ð ðknowledge,€skill,€experience,€training,€or€educationððÐ T Ðmay€testify€to€scientific,€technical,€or€other€specialized€knowledge€if€it€ð ðwill€substantiallyÐ ŠÚ Ðassist€the€trier€of€fact€to€understand€the€evidence€or€to€determine€a€fact€in€issue.ðð€òòSeeóó€Tenn.Ð `  ÐR.€Evid.€702.€€A€trial€court€may€disallow€expert€testimony€if€the€underlying€facts€or€dataÐ –æ" Ðshow€a€lack€of€trustworthiness.€€òòSeeóó€Tenn.€R.€Evid.€703.€€Though€there€is€little€TennesseeÐ  l$ Ðcase€law€interpreting€Tenn.€R.€Evid.€703,€one€panel€of€this€court€has€suggested€that€an€expertÐ ¢!ò& Ðopinion€with€a€weak€factual€foundation€may€be€excluded€if€there€is€a€danger€that€the€juryÐ (#x( Ðmight€give€the€opinion€more€weight€than€it€deserves.€€òòSee€Knight€v.€Hospital€Corp.€Of€Am.óó,Ð ®$þ* ÐNo.€01A01„9509„CV„00408,€1997€WL€5161,€at€*6€(Tenn.€Ct.€App.€Jan.€8,€1997)€(No€Tenn.Ð 4&„!, ÐR.€App.€P.€11€application€filed).€€Another€panel€has€stated€that€ð ðthe€obvious€meaning€of€theÐ º' #. Ðrule€is€that€an€opinion€may€be€excluded€if€it€is€based€upon€facts€which€are€not€adequatelyÐ @)$0 Ðshown€to€be€true.ðð€€òòSeffernick€v.€Saint€Thomas€Hospitalóó,€No.€01A01„9606„CV„00282,€1996Ð Æ*&2 ÐWL€724914,€at€*3€(Tenn.€Ct.€App.€Dec.€18,€1996),€òòrevððd€on€other€groundsóó,€969€S.W.2d€391Ð L,œ'4 Ð(Tenn.€1998).Ð Ò-")6 ÐÌà ` àWe€are€convinced€that€Dr.€Whitesidesððs€testimony,€taken€as€a€whole,€meets€theÐ Þ0.,: Ðthreshold€requirements€of€admissibility.€€Though€Dr.€Whitesides€stated€on€several€occasionsÐ d2´-< Ðthat€he€did€not€remember€specific€facts,€his€testimony€indicates€he€was€merely€attempting€toÐ ê3:/> Ðbe€careful€in€rendering€his€opinion.€€Dr.€Whitesidesððs€statements€and€questions€show€that€heÐ p5À0@ Ðwanted€to€ensure€that€his€testimony€was€not€taken€out€of€context.€€In€no€way€does€the€recordÐ ö6F2B Ðâ âreflect€a€lack€of€knowledge€and€understanding€of€the€facts€such€that€his€testimony€should€beÐ |8Ì3D Ðstricken.€€An€inability€to€remember€specific€facts€goes€to€the€weight€of€the€evidence€and€notÐ ° Ðto€its€admissibility.Ð 6† Ðâ âò òÌà@±±.DàIV.ˆÐ B ’ Ðòòà@¬ ¬ DàThe€Directed€Verdicts€for€Drs.€Spengler€and€Wyrschóóó óˆÐ È  ÐÌà ` àIn€their€final€issue,€the€Whites€assert€that€the€trial€court€erred€by€granting€directedÐ Ô $  Ðverdicts€for€Drs.€Spengler€and€Wyrsch€at€the€close€of€the€plaintiffsðð€proof.€€The€outcome€ofÐ Zª  Ðthis€issue€is€inextricably€linked€to€the€trial€courtððs€decision€to€exclude€Dr.€KostuikððsÐ à0  Ðdeposition.€€We€have€determined€that€Drs.€Spengler€and€Wyrsch€would€not€have€beenÐ f¶  Ðentitled€to€a€directed€verdict€had€Dr.€Kostuikððs€deposition€been€considered.Ð ì< ÐÌà ` àA€motion€for€directed€verdict€requires€the€trial€court€to€determine€whether,€as€a€matterÐ øH Ðof€law,€the€evidence€is€sufficient€to€create€an€issue€for€the€jury€to€decide.€€òòSee€Underwood€v.Ð ~Î ÐWaterslides€of€Mid„America,€Inc.óó,€823€S.W.2d€171,€176€(Tenn.€Ct.€App.€1991).€€When€facedÐ T Ðwith€a€motion€for€directed€verdict,€a€trial€court€€must€take€the€strongest€legitimate€view€of€theÐ ŠÚ Ðevidence€and€allow€all€reasonable€inferences€in€favor€of€the€non„moving€party,€whileÐ `  Ðdiscarding€all€evidence€to€the€contrary.€€òòSee€Conatser€v.€Clarksville€Coca„Cola€Bottling€Coóó.,Ð –æ" Ð920€S.W.2d€646,€647€(Tenn.€1995);€òòDobson€v.€Shorttóó,€929€S.W.2d€347,€349„50€(Tenn.€Ct.Ð  l$ ÐApp.€1996).€€Directed€verdicts€are€proper€only€when€reasonable€minds,€after€considering€theÐ ¢!ò& Ðevidence,€could€reach€only€one€conclusion.€€òòSee€Eaton€v.€McClainóó,€891€S.W.2d€587,€590Ð (#x( Ð(Tenn.€1994);€òòWilliams€v.€Brownóó,€860€S.W.2d€854,€857€(Tenn.€1993).€€Thus,€if€there€is€anyÐ ®$þ* Ðdispute€as€to€material€determinative€evidence€or€any€doubt€as€to€conclusions€to€be€drawnÐ 4&„!, Ðfrom€the€evidence,€the€motion€must€be€denied.€€òòSee€Hurley€v.€Tennessee€Farmers€Mut.€Ins.Ð º' #. ÐCo.óó,€922€S.W.2d€887,€891€(Tenn.€Ct.€App.€1995);€òòSouter€v.€Cracker€Barrel€Old€CountryÐ @)$0 ÐStore,€Incóó.,€895€S.W.2d€681,€683€(Tenn.€Ct.€App.€1994).€Ð Æ*&2 ÐÌà ` àReviewing€courts€do€not€weigh€the€evidence,€òòsee€Conatser€v.€Clarksville€Coca„ColaÐ Ò-")6 ÐBottling€Co.óó,€920€S.W.2d€at€647;€òòBenton€v.€Snyderóó,€825€S.W.2d€409,€413€(Tenn.€1992),€orÐ X/¨*8 Ðevaluate€the€credibility€of€the€witnesses.€€òòSee€Benson€v.€Tennessee€Valley€Elec.€Coopóó.,€868Ð Þ0.,: ÐS.W.2d€630,€638„39€(Tenn.€Ct.€App.€1993).€€Instead,€they€review€the€evidence€mostÐ d2´-< Ðfavorably€to€the€party€against€whom€the€motion€is€made,€give€that€party€the€benefit€of€allÐ ê3:/> Ðreasonable€inferences€from€the€evidence,€and€also€disregard€all€evidence€contrary€to€thatÐ p5À0@ Ðpartyððs€position.€€òòSee€Eaton€v.€McClainóó,€891€S.W.2d€at€590;€òòGann€v.€International€HarvesterÐ ö6F2B ÐCo.óó,€712€S.W.2d€100,€105€(Tenn.€1986).Ð |8Ì3D ÐÐ :R5F Ðà ` àThe€combined€testimony€of€Drs.€Kostuik€and€Natelson€is€sufficient€to€enable€theÐ ° ÐWhitesðð€claims€against€Drs.€Spengler€and€Wyrsch€to€survive€a€directed€verdict€motion.€€Dr.Ð 6† ÐKostuik€is€a€recognized€authority€on€cauda€equina€syndrome€and€is€also€one€of€the€fewÐ ¼  Ðexperts€who€has€conducted€research€regarding€the€effect€of€the€timing€of€decompressiveÐ B ’ Ðsurgery€on€a€patientððs€outcome.€€He€testified€that€Dr.€Wyrsch€violated€the€applicable€standardÐ È  Ðof€care€when€he€did€not€examine€Ms.€White€after€Ms.€Baun€described€her€new€symptoms€toÐ N ž  Ðhim.€€He€also€testified€that€ordering€a€confirmatory€myelogram€was€not€necessarily€indicatedÐ Ô $  Ðand€that€Dr.€Spenglerððs€decision€to€do€so€delayed€Ms.€Whiteððs€corrective€surgery.Ð Zª  ÐÌà ` àDr.€Natelson€testified€that€Dr.€Wyrsch€violated€the€applicable€standard€of€care€byÐ f¶  Ðfailing€to€inquire€about€Ms.€Whiteððs€neurovascular€status€when€Ms.€Baun€informed€Dr.Ð ì< ÐWyrsch€of€her€complaints€about€pain.€€He€also€testified€that€Dr.€Wyrschððs€oversight€causedÐ r ÐMs.€White€to€suffer€damages€that€she€would€not€otherwise€have€suffered.€€In€addition,€Dr.Ð øH ÐNatelson€testified€that€Dr.€Spengler€fell€below€the€applicable€standard€of€care€by€contributingÐ ~Î Ðto€the€delay€in€Ms.€Whiteððs€treatment€and€caused€her€to€suffer€damages€because€of€hisÐ T Ðactions.Ð ŠÚ ÐÌà ` àConstruing€the€testimony€of€Drs.€Kostuik€and€Natelson€in€a€light€most€favorable€toÐ –æ" Ðthe€Whites,€we€cannot€say€that€the€only€conclusion€that€a€reasonable€person€can€draw€is€thatÐ  l$ ÐDrs.€Spengler€and€Wyrsch€were€not€negligent€and€that€their€conduct€did€not€cause€Ms.€WhiteÐ ¢!ò& Ðto€suffer€damages€that€she€would€not€otherwise€have€suffered.€€Accordingly,€we€reverse€theÐ (#x( Ðdirected€verdicts€in€favor€of€Drs.€Spengler€and€Wyrsch.Ð ®$þ* ÐÌà@ÛÛ.Dàò òV.ó óˆÐ º' #. Ðà@%%Dàòòò òThe€Adequacy€of€the€Proof€of€Causationó óóóˆÐ @)$0 ÐÌà ` àThe€defendant€physicians€and€Vanderbilt€University€Medical€Center€argue€that€theÐ L,œ'4 ÐWhites€should€not€be€entitled€to€a€new€trial€because€they€failed€to€prove€that€any€of€their€actsÐ Ò-")6 Ðor€omissions€were€a€cause„in„fact€of€Ms.€Whiteððs€injuries.€€Specifically,€they€assert€that€theÐ X/¨*8 ÐWhites€failed€to€prove€with€expert€testimony€exactly€which€injuries€were€caused€by€theirÐ Þ0.,: Ðdelay€in€performing€the€decompressive€surgery€rather€than€by€the€causa€equina€itself.Ð d2´-< ÐÌà ` àA€plaintiff€in€a€medical€malpractice€action€must€prove€that€he€or€she€suffered€injuriesÐ p5À0@ Ðthat€would€not€otherwise€have€occurred€as€a€result€of€the€defendantððs€negligent€act€orÐ ö6F2B Ðomission.€€òòSee€óóTenn.€Code€Ann.€ðð€29„26„115(a)(3)€(1980).€€A€plaintiff€must€show€that€theÐ |8Ì3D Ðnegligent€act€or€omission€ð ðmore€likely€than€not€was€the€cause€in€fact€of€the€harm.ðð€€òòKilpatrickÐ :R5F Ðv.€Bryantóó,€868€S.W.2d€594,€602€(Tenn.€1993).€€Causation€in€fact€is€a€matter€of€probability€andÐ ° Ðnot€possibility,€and€must€be€shown€to€a€reasonable€degree€of€medical€certainty.€€òòSee€Volz€v.Ð 6† ÐLedesóó,€895€S.W.2d€677,€679€(Tenn.€1995);€òòWhite€v.€Methodist€Hosp.€S.óó,€844€S.W.2d€642,Ð ¼  Ð648„49€(Tenn.€Ct.€App.€1992).€Once€cause„in„fact€is€proven,€the€focus€shifts€to€proximateÐ B ’ Ðcause€„„€whether€the€law,€as€a€matter€of€policy,€will€hold€the€defendant€responsible€for€theÐ È  Ðnegligent€conduct€and€its€consequences.€€òòSee€Kilpatrick€v.€Bryantóó,€868€S.W.2d€at€598.Ð N ž  ЀÌà ` àDr.€Natelson,€the€Whitesðð€medical€expert,€testified€that€it€is€more€likely€than€not€thatÐ Zª  Ðthe€defendantsðð€negligence€caused€Ms.€White€to€suffer€injuries€that€she€would€not€haveÐ à0  Ðotherwise€suffered.€€He€also€stated€that€the€defendants€could€have€diagnosed€and€evacuatedÐ f¶  Ðthe€hematoma€before€Ms.€White€developed€cauda€equina€syndrome€and€that€ð ð[i]tððs€moreÐ ì< Ðlikely€than€not€that€the€sooner€that€the€blood€clot€was€removed,€the€better€off€the€patientÐ r Ðwould€end€up.ðð€€This€testimony€is€sufficient€evidence€of€causation€to€overcome€a€directedÐ øH Ðverdict.€€Dr.€Natelson€testified€to€a€reasonable€degree€of€medical€certainty€that€Ms.€WhiteÐ ~Î Ðsuffered€damages€because€of€the€defendantsðð€negligence.€€The€law€does€not€require€the€levelÐ T Ðof€specificity€and€certainty€that€the€defendants€advocate,€but€instead€dictates€that€the€plaintiffÐ ŠÚ Ðproduce€evidence€showing€that€it€is€more€likely€than€not€that€the€defendantððs€negligenceÐ `  Ðcaused€his€or€her€injuries.€Ð –æ" ÐÌò òà@±±.DàVI.ˆÐ ¢!ò& ÐÌà ` àó óWe€reverse€the€directed€verdicts€for€Drs.€Spengler€and€Wyrsch€and€the€judgment€forÐ ®$þ* ÐDr.€Jones€and€Vanderbilt€University€Medical€Center€and€remand€the€case€to€the€trial€courtÐ 4&„!, Ðfor€a€new€trial€consistent€with€this€opinion.€€We€also€tax€the€costs€of€this€appeal,€jointly€andÐ º' #. Ðseverally€to€Vanderbilt€University€Medical€Center,€Dan€M.€Spengler,€Clement€K.€Jones,€andÐ @)$0 ÐRobert€Bradley€Wyrsch,€for€which€execution,€if€necessary,€may€issue.€€Ð Æ*&2 Ðà ` àÌÓ€Óà ` àà ¸ àà  àà h àà À àà  àà œ à______________________________Ð Ò-")6 Ðà ` àà ¸ àà  àà h àà À àà  àà œ àWILLIAM€C.€KOCH,€JR.,€JUDGEÐ Ö.&*7 ÐÌÌCONCUR:Ð â12-: ÐÌÌ_______________________________Ð î4>0= ÐBEN€H.€CANTRELL,€JUDGE€Ð ò5B1> ÐÌÌÌ_______________________________Ð :R5B ÐWALTER€W.€BUSSART,€JUDGE€