WPC, >\ծviaCgx" pi3gA ';?OߝL`4_2@] u̘8 -g6YE1s-2T1Pk㳤ym}ց TW&iԾ0xjT #02GqU[>9V PTzMy؎JήQ_DQDu*~{>\J8_Qu@o:ҙ&sЗQƠ5*$TCh|R$um#Y c`zCiW $wx&yqo8^m5=ޘ\wMksY(8G8 F&r1Ԏ[ '=o' ̈́]9kr *# LUNW % 0(w@4' 1m6U: 0 0D 0c:U: .4 U:b 0D  U : LjU:rU :- AQB 0D 0DL B D/ B D3HP LaserJet 4SiHPPCL5MS,,,,,,0nLl(9 Z 6Times New Roman RegularX($ EEDEUEEgE EEUEӀEu[%, 3|xE #,e37=CIQYag1.a.i.(1)(a)(i)1)a),cAZ"Arial Regular(f(20$ !  XNXXXXXN      0  (#$  0  (;$2,e  0  .3  0     0$XNXXXXXN      1    BlicksamendedcomplaintalsonamedPaulStampli,LPN,JeanHarris,LPN,andtheHospitalas  defendants,butthesedefendantsweresubsequentlydismissedfromthelawsuitandarenotpartiestothisappeal.#ɍ#,cAZ"Arial Regular $  /$X0XXX/XX0      3    //WedeclinetoaddressBlicksalternativeargumentthatDr.KentnegligentlysupervisedHectorin  violationofthePhysicianAssistantsAct,inasmuchasthetrialcourtapparentlyhasnotruledonthisissue.CarverPlumbingCo.v.Beck,No.01A01-9708-CV-00377,1998WL161112,at*7(Tenn.App.Apr.8,1998).#//ߍ#,cAZ"Arial Regular($$   1   ""  XNXXXNrXXN   Ad FILEDXNXNr  November13,1998CecilW.CrowsonAppellateCourtClerkdAh ,  AZ"Arial RegularC:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT,cAZ"Arial Regular"Arial Regular ##iXd#   /$X0XXX/XX0      2     //Basedontherecordbeforeus,weareunabletoconcludethatHectorsactofscrubbingthewound  toitsdepthcompliedwiththerequirementthatheprobethewound.Oneavailableauthorityindicatesthattheterms scruband probehaveverydifferentmeanings,andwenotethatHectorsuseofthesetermsinhisdepositionwasconsistentwiththisauthoritysdefinitions.MerriamWebstersMedicalDeskDictionary575, X 642(1993).#/ /ߍ#!"#&C<< CLevel 1Level 2Level 3Level 4Level 5(3$ !  (3$ !   d((' dxdP Pd$$$$'dxd !  E'X` XX'E  TR[A' Legal3'A' Legal3'T   XNXXXEE! XXX!7&}XXdXXd7EEEEEEEEEEEEEEr )<,(j 8` `@E` 8ttxP  rEEEEEEE@m m  INTHECOURTOFAPPEALSOFTENNESSEE@$ATNASHVILLEEEEEEEt )>.*jxn` `@E` 8ttxP n tߛEEJAMESMARKBLICK,   h   ) `    `     h   )   ` Plaintiff/Appellant, h   )MontgomeryCountyNo.C10329 8     `     h   )VS.   `     h   )AppealNo.01A019708CV00393  `    `     h   )STEPHENW.KENT,M.D.,etal,  )  8     `     h   )   ` Defendants/Appellees.  )    @APPEALFROMTHECIRCUITCOURTOFMONTGOMERYCOUNTY@ATCLARKSVILLE,TENNESSEE@T T THEHONORABLEJAMESE.WALTON,JUDGE MARKR.OLSON t OLSON&OLSON,PLC  ` Clarksville,TennesseeAttorneyforAppellant DANL.NOLAN !  MARIEANTOINETTEJOINERBATSON,NOLAN,BRICE,HARVEY&WILLIAMSON,PLLC Clarksville,Tennessee $# AttorneysforAppellees REVERSEDANDREMANDED *(&* ̜EEEEEE    `     h      p   ALANE.HIGHERS,J. 82-2 CONCUR:W.FRANKCRAWFORD,P.J.,W.S.HOLLYKIRBYLILLARD,J. E h E 94:   :5; 7XXdXXd7  EEE7XXdXXd7  7XXdXXd7  7XXdXXd7  7XXdXXd7  7XXdXXd7  7XXdXXd7  7XXdXXd7  EEEE7XXdXXd7  7XXdXXd7  7XXdXXd7  7XXdXXd7  EEEEE  EInthismedicalmalpracticeaction,PlaintiffJamesMarkBlickappealsthetrialcourts   finalorderenteringsummaryjudgmentinfavorofDefendants/AppelleesStephenW.Kent,M.D.,WilliamD.Shippen,M.D.,RobertDouglasDoty,M.D.,andRobertHector,P.A.Forreasonshereinafterstated,wereversethetrialcourtsjudgmentandremandforfurtherproceedings.  OnAugust23,1992,BlickwastreatedforaheadlacerationbyPhysiciansAssistantRobertHectorattheClarksvilleMemorialHospitalemergencyroom.HectorwasemployedbyClarksvilleEmergencyPhysicians,apartnershipofdoctorswhich,pursuanttoacontract,providedemergencymedicalservicesattheHospital.DefendantsWilliamD.Shippen,M.D.,andRobertDouglasDoty,M.D.,werepartnersofClarksvilleEmergencyPhysicians,aswasDefendantStephenW.Kent,M.D.Dr.KentactedasthesupervisingphysicianintheemergencyroomonthedayBlickwastreated.  AftercleaningBlicksheadlacerationandinspectingitforanyforeignmatter,HectorsuturedthewoundandproceededtodischargeBlick.AlthoughDr.KentdidnotpersonallytreatBlick,Dr.KentreviewedBlickschartandauthorizedhisdischargefromtheHospital.ϜOveroneyearlater,Blicksoughttreatmentfromanotherphysicianforcontinuingproblemswithhisheadwound.AsubsequentsurgeryrevealedthepresenceofapieceofglassimbeddedinBlicksheadwhichHectorsexaminationapparentlyhadmissed.Theglasswastriangularinshapeandmeasuredapproximatelytwocentimetersonitswidestside.  InOctober1994,BlickfiledthisactionformedicalmalpracticeagainstHector,Dr.Kent,andtheotherDefendants.   #  1      כInhisamendedcomplaint,BlickallegedthatHector .T). negligentlyfailedtodiscoverthepieceofglasswhenhetreatedBlicksheadwoundinAugust1992.BlickadditionallyallegedthatDr.KentwasnegligentinfailingadequatelytosuperviseHectorinviolationofthePhysicianAssistantsAct,codifiedatTennesseeCodeAnnotatedsections63-19-101to63-19-114(1990&Supp.1992). 4506 Ї  Afterparticipatingindiscovery,theDefendantsmovedforsummaryjudgment,contendingthattheundisputedevidencefailedtosupportBlicksclaimthatHectordeviatedfromtheapplicablestandardofcareinhistreatmentofBlick.Insupportoftheirmotion,theDefendantsreliedonthedepositionsofDefendantsHectorandKent.TheDefendantsalsoreliedontheaffidavitofBlicksexpert,Dr.DavidH.Lander,andthedepositiontestimonyofDr.HarryS.Creekmore,thesurgeonwhoremovedthepieceofglassfromBlickshead.EE  IngrantingtheDefendantsmotionforsummaryjudgment,thetrialcourtmadethefollowingruling:̜EEEE8  8`    TheCourtconsidered[the]DefendantsMotionforSummaryJudgment,andtheCourtfindsthatthedepositiontestimonyofDr.KentandDr.Creekmoredo[sic]notestablishthatDefendantsviolatedthestandardofcare.TheCourtfindsthattheAffidavitofDavidH.Lander,M.D.,stateswhathebelievestobetheapplicablestandardofcare.However,hedoesnotsayorintimatethattheDefendantsviolatedthatstandard.TheCourtfindsthatthePlaintiffhasfailedtopresentevidencethattheDefendantsviolatedtheapplicablestandardofcare.Therefore,thereisnogenuineissueastoanymaterialfact,andDefendantsareentitledtojudgmentasamatteroflaw.WithoutanyexpertmedicalproofinoppositiontotheDefendantsMotionforSummaryJudgment,theCourtenterssummaryJudgmentinfavoroftheonlyremainingDefendants,StephenW.Kent,M.D.,WilliamD.Shippen,M.D.,RobertDouglasDoty,M.D.,individuallyandasgeneralpartnersofEmergencyRoomPhysicians,aPartnership,andRobertHector,P.A.,asafinaljudgmentpursuanttoRule56.04oftheTennesseeRulesofCivilProcedure.ThePlaintiffscauseagainsttheseDefendantsisherebydismissed.EE ` x` x   OurstandardofreviewofthetrialcourtsordergrantingtheDefendantsmotionforsummaryjudgmentissummarizedinCarvellv.Bottoms,900S.W.2d23(Tenn.1995): 4/3 8  8`    Sinceourinquiryinvolvespurelyaquestionoflaw,nopresumptionofcorrectnessattachestothetrialcourtsjudgment,andourtaskisconfinedtoreviewingtherecordtodeterminewhethertherequirementsofTenn.R.Civ.P.56havebeenmet.Cowdenv.SovranBank/CentralSouth,816  :p59 S.W.2d741,744(Tenn.1991).[Rule56.04]providesthatsummaryjudgmentisonlyappropriatewhere:(1)thereisnogenuineissuewithregardtothematerialfactsrelevanttotheclaimordefensecontainedinthemotion,Byrdv.Hall,847  S.W.2d208,210(Tenn.1993);and(2)themovingpartyisentitledtoajudgmentasamatteroflawontheundisputedfacts.Andersonv.StandardRegisterCo.,857S.W.2d555, P  559(Tenn.1993).Themovingpartyhastheburdenofprovingthatitsmotionsatisfiestheserequirements.Downenv. 0  AllstateIns.Co.,811S.W.2d523,524(Tenn.1991). p ` x` x 8  8`    ...Courtsmustviewtheevidenceinthelightmostfavorabletothenonmovingpartyandmustalsodrawallreasonableinferencesinthenonmovingpartysfavor.Byrd, 0  847S.W.2dat21011.Courtsshouldgrantasummaryjudgmentonlywhenboththefactsandtheconclusionstobedrawnfromthefactspermitareasonablepersontoreachonly&  oneconclusion.Id.` x` x Carvellv.Bottoms,900S.W.2dat26.'?"    Thiscourthasrecognizedthat,asageneralrule,adefendantmovingforsummaryjudgmentmayavailitselfoftwoavenues:(1)thedefendant maynegateanessentialelementofthenonmovingpartysclaim,or(2)thedefendant mayestablishanaffirmativedefense,suchasthestatuteoflimitations,thatdefeatstheclaim.AlliedSound,Inc.v. 0 Neely,909S.W.2d815,820(Tenn.App.1995)(citingByrdv.Hall,847S.W.2d208,215 ! n.5(Tenn.1993)).Inthiscase,theDefendantssoughttoobtainasummaryjudgmentbythefirstavenue,thatofnegatinganessentialelementofBlicksclaimformedicalmalpractice.  Inamedicalmalpracticeaction,theplaintiffisrequiredtoprovethreeelementsbycompetentexperttestimony:(1)theapplicablestandardofcare,(2)thedefendantsdeviationfromthatstandard,and(3)injurytotheplaintiffasaproximateresultofsuchdeviation.Roddyv.VolunteerMed.Clinic,Inc.,926S.W.2d572,578(Tenn.App.1996); 0,/ Parkerv.VanderbiltUniv.,767S.W.2d412,420(Tenn.App.1988).Inthepresentcase, 2-1 thetrialcourtruledthattheundisputedevidencefailedtoestablishthatHectordeviatedfromtheapplicablestandardofcareinhistreatmentofBlick.E(T.R.vol.I,pp.9899).EAccordingly,thetrialcourt agreedthattheDefendantshadsuccessfullynegatedanE @837 EessentialelementofBlicksclaim,andthecourtgrantedtheDefendantsmotionfor summaryjudgment.  Afterreviewingtheexperttestimonypresentedinthiscase,weconcludethat,contrarytothetrialcourtsruling,therecordrevealstheexistenceofagenuineissueofmaterialfactastowhetherHectordeviatedfromtherequiredstandardofcareandwhetherthisdeviationproximatelycausedBlicksinjury.Thiscasewassomewhatunusualinthatthepartiesessentiallyagreedontheapplicablestandardofcare.Accordingtothevariousexperts,thestandardofcarerequiredHector,priortosuturingorotherwiseclosingthewound,toexaminethewoundforthepresenceofforeignobjectsbyprobingtothedepthofthewound.HectorsrecollectionoftreatingBlickwasvague,andhereliedtoalargeextentonthenotationshehadmadeinBlickschart.HectortestifiedthathevisuallyinspectedBlickswoundtothedepthofthewoundtoensurethatnoforeignbodieswerepresent.HectoralsoscrubbedBlickswoundtoitsdepthwithBetadine.EE  Hectorstestimonyrevealed,however,thathedidnotprobethewound.DuringHectorsdeposition,thefollowingexchangetranspired:8  8`    Q.  Butnoneofyournotesreflectanyactionyou $" tookactuallyprobinginsidethewound,dothey? ` x` x 8  8`    A.  No.Ididntprobeinsidethewound.Iinspected `'"% itvisuallyandIscrubbeditout. ` x` x 8  8`    Q.  Onceagainmyquestionis:Noneofyournotes 0*%( statethatyouactuallyprobedorinvestigatedinsidethewound;correct? ` x` x 8  8`    A.  Ididntprobethewound,no,notwithan -@), instrument. ` x` x 8  8`    Q.  Andtheresnothingelseinyournotesherethat 0,/ reflectthattherewasanykindofprobingorinvestigationinsidethewound. ` x` x   8  8`    A.  Thewoundwasvisuallyinspectedjustbythefact 4/3 thatInotedthesizeandlocationandtheconditionofthewound.EE ` x` x InasmuchasHectorsowntestimonyindicatesthathefailedtoprobethewoundasrequiredbytheapplicablestandardofcareattestedtobythepartiesexperts,weconclude  :p59 thatthetrialcourtimproperlygrantedsummaryjudgmentonthisissue.   Withoutcitationtotherecord,theDefendantsassertthatHectortestifiedinhisdeposition thathedidprobetothedepthofthewound.EEAfterreviewingHectorsdeposition,wecanonlysurmisethattheDefendantsarereferringtoHectorstestimonywherebyhestatedthathevisuallyinspectedthewoundforforeigndebrisandthathescrubbedthewoundtoitsdepth.EEAstheabovequotedportionsofHectorsdepositionreveal,however,Hectorspecificallytestifiedthathedidnotprobethewound.  #  2      כEE    Inurgingthiscourttoaffirmthetrialcourtsentryofsummaryjudgmentintheirfavor,theDefendantscontendthatthetestimonyofBlicksexpertsfailedtorevealanydeviationfromtherequiredstandardofcarebyHector.ItistruethatDr.LanderdeferredtoDr.CreekmoreontheissueofwhetherHectorsfailuretodiscovertheglassconstitutednegligence.Italsoistruethat,whenaskedhisopinionontheissue,Dr.CreekmoredeclinedtocharacterizeHectorsfailuretofindthepieceofglassasnegligence.Dr.Creekmoretestifiedthat, IcannotsaythatMr.Hectorwasguiltyofnegligence.Imean,itispossibleforsomeonetotrytofindsomethingandnotfindit.Dr.Creekmoreagreedthat,justbecauseapieceofglasswasmissedinanexamination,itdidnotnecessarilyfollowthattheexaminingphysicianorphysiciansassistantfailedtofollowtheapplicablestandardofcare.EEDr.Creekmoreexplainedthat thereareconceivablysomeoccasionswhenapieceoftissuecanoverlapandmakeonethinkoneisatthebottomofawoundwhenoneisnotand,therefore,onecanmakeanerroneousjudgmentthere.EEInthismanner,apieceoftissuecouldobscureanunderlyingpieceofglass.Dr.Creekmorealsoexplainedthataforeignbody,suchasapieceofglass,couldmigratetowardthesurface 3.2 oftheskinoveraperiodoftimeand,thus,notbediscovereduntilaftersometimehadpassed.EEDr.CreekmorebelievedthathewouldhavefoundthepieceofglassduringtheinitialexaminationofBlickswound,buthedidnotnecessarilybelieveHectorwasnegligentforfailingtofindit.EE  Despitethistestimony,weconcludethatthesummaryjudgmententeredinfavoroftheDefendantsmustbereversed.Dr.Creekmorestestimonyrevealedthat,evenintheexerciseofduecare,HectorstillcouldhavefailedtodetectthepresenceoftheglassinBlickswound.Dr.Creekmorestestimony,however,waspredicatedontheassumptionthatHectorhad,infact,compliedwiththeapplicablestandardofcarebyprobingthewoundtoitsdepth.InlightofHectorsownadmissionthathedidnotprobethewound,thecitedtestimonyfailstonegateBlicksclaimthatHectordeviatedfromtheapplicablestandardofcareinhistreatmentofBlickswound.  #  3       0   Thejudgmentofthetrialcourtisherebyreversed,andthiscauseisremandedforfurtherproceedingsconsistentwiththisopinion.CostsonappealaretaxedtotheDefendants,forwhichexecutionmayissueifnecessary.EE   `     h      p 򀀀 p&!$    `     h      p HIGHERS,J. `'"% CONCUR:򀀀 -P(+ CRAWFORD,P.J.,W.S.E񀀀EE 0,/ LILLARD,J.EEEEE̛