WPC ?7]UVm6McB@96㏀W up6(A=XՔBE[k PWO u;Hک-v vb7մKx4+* ιv-Dh 7,tӻbS.QrŐ4)A}N[@;?N党)GgMFP~yr5msc~.x|/k kE?kp ,Џ!L3 &Sbt@NrGU,qv#9ngsؘO݅k"L=V[f(ٰNؘO+̨%v] 1rp!e s&J/a=y7jV0G:[[UQؙ,S5Q[yƏ^sxaTѱ+j-4PO Db#\ % ^ # 0/ UN w 4 z  i x mz  J    0DbNUNEb 0 B 0 D3 D- 0K   ASW 0p 0D AXHP LaserJet 8000 Series PS0+s (`$.8dd8    ("  Z6Times New Roman Regular^p++00 C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt3|xU R>$      1     _Theformisentitled RequestforSurgery.Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5(#$  0  (I Z6Times New Roman Regular- -(|G2>$ !.8Nd XXd8         0  2H d(|3Qk$ !.8Nd XXd8     VVVV'dxd)!dxdx( $ Figure  1  ^_X`YE<<CLevel 1Level 2Level 3Level 4Level 5(|3Qk$ !.8Nd XXd8     ($$   1  X[Z&OLE 2.0 Box <=8C HKKKK !.8Ld d8     _  B8:|XXdd 8  @ PBINTHECOURTOFAPPEALSOFTENNESSEE  @WW$ATKNOXVILLE#BP #Ԉ &   July10,2001Session L X XB #BXX #ALVINBATESv.DR.JOSEPHMETCALF,IV,d/b/aOAKRIDGE J SURGEONS,P.C.X XB   ^ @@ AppealfromtheCircuitCourtforAndersonCounty  ^ @@No.98LA0448JamesB.Scott,Jr.,Judge  J FILEDDECEMBER3,2001 "  @@*AV) ` dE<` A   @@TTNo.E200100358COAR3CV   AV) ` dE<` A      #BX ͝#X X.BCharlesD.Susano,Jr.,J.,dissenting. x #BXX #X XB#BXX ́#X XB    IrespectfullydissentbecauseIbelievetheplaintiffwasentitledtoadirectedverdictonhis (x batteryclaim.Inmyjudgment,thereisnoprobativeevidenceintherecordthattheplaintiff d consentedtoaninternallateralsphincterotomy,thesurgicalprocedureperformedbyDr.Metcalf. P  Cf.Blanchardv.Kellum #BXX #X XB,975S.W.2d522,524(Tenn.1998).Inviewofthislackofconsent,I < wouldholdthatDr.Metcalfcommittedamedicalbatteryandthereforeisresponsibleforallthe ( consequencesofthatbattery.    Intheinstantcase,theplaintiffexecutedaconsentform.  #  1      ׀(SeeAppendix).Thepurposeof  suchaformisclear,i.e.,itsfunctionistosetforththeproceduresauthorizedbythepatient.Inthis  case,theplaintiffauthorizedDr.Metcalftodo/performan analexamandpossible t  hemorrhoidectomy.TheformacknowledgesthatDr.Metcalf hasdiscussedandexplainedto[the `!  plaintiff](a)[t]henatureandpurposeoftheoperationorprocedure[,][and]...(c)[s]ignificantrisks. L"! Inanotherpartoftheform,theplaintiffacknowledgesthat [i]thasbeenexplainedtomethat, 8#" duringthecourseoftheoperation,unforeseenconditionsmayrequireadditionalsurgery $$t# immediately.(Emphasisadded).WhileImentionthislatterprovisioninordertodemonstratethat %` $ Dr.Metcalfwasatlibertytodowhatwasmedicallynecessaryintheeventheencountered %L!%  unforeseenconditions,Ihastentoaddthatthedoctordoesnotcontendthatthecircumstances &8"& duringthesurgeryweresuchastorequirethataninternallateralsphincterotomybedone '$#'  immediately,i.e.,whiletheplaintiffwasstillunderageneralanesthetic. ($(   Certainfacts!factsthatIfindtobeverysignificant!arenotindispute.Dr.Metcalfnever, *%* atanytime,toldtheplaintiffthathemightperformaprocedureknownasaninternallateral +&+ sphincterotomy;hedidnotdescribewhatisinvolvedinsuchaprocedure;and!whatisprobably  obviousfromthefirsttwofacts!hedidnotinformhispatientabouttherisksinvolvedinsucha  procedure.    Thetrialcourtandthemajorityfindevidenceoftheplaintiffsimpliedconsentinthe ` followingfacts:Dr.Metcalftoldtheplaintiffthathispainandbleedingwereprobablyduetohis L  hemorrhoids,butthathissymptomscouldbecausedbysomethingelsesuchasan analfissure; 8  that,regardlessofthecauseofthesymptoms,he,thedoctor,toldtheplaintiffthathewoulddowhat $ t wasnecessarytofixhisproblem atthattime,i.e.,whiletheplaintiffwasalreadyunderageneral  ` anesthetic;and,finally,theundisputedfactthataninternallateralsphincterotomyisanappropriate  L  surgicalproceduretorepairananalfissure.  8    Idonotbelievetheevidenceissuchastolegallyraisetheissueofimpliedconsent.Inmy   judgment,aconsentformisanintegralpartofthecontractforprofessionalservicesbetweenthe   surgeonandhisorherpatient.Infact,itisthepartofthecontractthatdefinestheauthorized   procedures.Consideringthepurposeofsuchaform,Ibelievetheconsentformbeforeusmustbe   construedasastatementofwhatisauthorized,totheexclusionofallotherproceduresexceptinthe p caseof unforeseenconditions.Toholdotherwiseistoignorethepurposeoftheform;to \ substantiallydiluteitssignificanceasanauthorizationvehicle;andtorenderitsubjecttoundue H expansionbyavaguestatementsuchastheoneattributedtoDr.Metcalfinthiscase.Ifweareto 4 allowaphysiciantotestifythatheorshetoldthepatient! Iwilldowhatisnecessarytocorrect  p yourproblem!weputatrisktheefficacyofawrittenconsentformsettingforthwithspecificity  \ theproceduresauthorizedbyapatient. H   Inmyopinion,Dr.Metcalfstestimonyrunsafouloftheparolevidencerule.Itwasoffered   tovarythetermsofaspecificauthorizationbyaddinganotherprocedurethatthedoctorcould   performinanonemergencysituation.Weshouldnotconsiderthistestimonysinceitviolatesthe  parolevidencerule,aruleofsubstantivelaw.See Maddoxv.WebbConstr.Co .,562S.W.2d198,  201(Tenn.1978)( TheparolevidenceruleinTennesseeisnotaruleofevidencemerely,butisa  ruleofsubstantivelawandnoexceptionnorassignmentoferrorisnecessarytoensureits l application.);seealso TriCitiesForkliftCo.v.ConasaugaRiverLumberCo .,700S.W.2d548, X  549(Tenn.Ct.App.1985).( sinceinthisjurisdictiontheparolevidenceruleisnotmerelyarule D! ofevidencebutaruleofsubstantivelaw,weareboundbyitonappealwhethertheappellant 0"  objectedonthetrialofthecaseorfailstoraiseitasanissueonappeal). #l!   Theconsentforminthiscaseauthorizestwospecificprocedures!ananalexamandpossible $D # hemorrhoidectomy!andamoregeneralcategoryofprocedures,i.e., unforeseenconditionsmay %0!$ requireadditionalsurgeryimmediately.Idisagreewiththeconcurringopinionsconclusionthat &"% thislattergeneralcategorymeansthattheconsentformisnot acompleteandexclusivestatement '#& ofthetermsoftheagreement.Whilethisgeneralcategoryofprocedurescouldhaveresultedina (#' procedurenotexpresslyauthorized,thatdidnothappeninthiscase.AsIhavepreviouslyindicated, )$( thesurgeryperformedbyDr.Metcalfdidnothavetobeundertaken immediately.Thisfactis |*%) undisputed.Inmyjudgment,Dr.Metcalfstestimonyclearlyattemptstoexpandtheconsentform h+&* beyondthatwhichwasexpresslyandgenerallyauthorized.Itismyfurtherjudgmentthatthereis  nothingabouttheconsentformtosuggestthatitwasotherthanacompletestatementofthe  proceduresauthorizedbytheplaintiff.    Casesfromotherjurisdictionshavedeniedpatientstherighttoexpandorcontradictawritten ` consentformbyparolevidence.See,e.g., Chandlerv.Cook ,265A.2d794,795(Pa.1970); L   Thompsonv.Peters ,885P.2d686,68788(Okla.Ct.App.1994).Aphysicianshouldbesimilarly 8  restricted.Asthesayinggoes, whatsgoodforthegoose,isgoodforthegander. $ t   Ibelieveweestablishadangerousprecedentwhenweallowaphysiciantocreateadisputed  L  factbyoraltestimonyofthetypenowbeforeusinthefaceofaclearandunambiguouswritten  8  consentformauthorizingspecificprocedures. $    Anindividualhasarighttotheintegrityofhisorherbody. Churchv.Perales ,39S.W.3d   149,158(Tenn.Ct.App.2000).Thelawrecognizesthisrightinmanyways!incivillawaswell   asincriminallaw.Noonehasarighttoinvadethatrightwithouttheconsentoftheother.Ifind   nosuchconsentintheinstantcase.Accordingly,Iwouldremandfortheentryofanorderdirecting p averdictfortheplaintiffonthebatteryclaimandforfurtherconsideration,limitedtotheissueof \ damages. H   Accordingly,Irespectfullydissent.  p    `     h     ___________________________________      `     h     CHARLESD.SUSANO,JR.,JUDGE