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ST\  `&Times New RomanS7Z(X75+ ` hp x 5  &  d dG)1dxd<:zTop of For7J(X7    5+ ` hp x 5?U%2A`Arial?  ST\  `&Times New RomanS7Z(X75+ ` hp x 5  G)2dxd0KS.SampleKS<6X9`(Courier NewKST\  `&Times New RomanS0.Strong 8dl6TypewriterKS<6X9`(Courier NewKST\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB   !"#$%&' 35;AGMSY_11.1.1.1.1.1.1.1.(|G2V$ !.8%dXXd8         0  E<6X9`(Courier New\  `&Times New Roman%2A`Arial d(O;$0  2#  a  .3  0` (#(#(|3?$ !.8%dXXd8     VVVV)!dxdx)!dxdx( $ Figure  1  3#37=CIQYag1.a.i.(1)(a)(i)1)a)^_X`YE<<CLevel 1Level 2Level 3Level 4Level 5(|3?$ !.8%dXXd8     ($$   1  X[Z&OLE 2.0 Box <=8C HKKKK\i) estoppedarguendodispositivedystociaresuscitativeGallatindysthymicLEONORILDAGAMBOAEPIFANIODABNEY P.J. W.S.Highers encephalopathyEpifanoTennCareMuscogeeBULLETTT.C.A. GYN BainMcDaniel CSXTilleyBindra COAlicensurePerales t]hedurationalaffiantLedfordMoskowitzcaselawLeungPhythonStrattonMabonb]ecausepretermitted(b$0  0` (#(#2#   .3  0 ` (#` (#(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(;3$2#  0  .3  0  (F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#2#     )3  0p(#p(# kWefghijxGaeimquy}Bullet ListBullets Listml r RV$      1  E  _Ofcourse,theaffidavitmustalsosatisfythegeneralrequirementsofTennesseeRuleofCivilProcedure56.06,  regardingtheformofaffidavitsgenerally. SeeChurchv.Perales ,39S.W.3d149,166(Tenn.2000).  RV$      2  E  _Themorecommonproblemwithexperttestimonyoccurswhentheexpertiscertifiedinadifferentspecialty  asthedefendant,butclaimsthatheisnonethelessfamiliarwiththeapplicablestandardofcare. See,e.g.,Searlev. t Bryant ,713S.W.2d62,64(Tenn.1986)(plaintiffsexpertwasinfectiousdiseasespecialist,butdefendantwasa : surgeon); Ledfordv.Moskowitz ,742S.W.2d645,64748(Tenn.Ct.App.1987)(plaintiffsexpertwascertifiedasa P neurologistandinternalmedicinephysician,butdefendantwasapsychiatrist). !.8%dd8     _  %8BXXdd8  @ H%INTHECOURTOFAPPEALSOFTENNESSEE  @kk$ATNASHVILLE#%H #Ԉ &   August6,2003Session L XBX% #%XXB#BRANDONBRAVO,aminor,byhisnextfriendsandparents, J LEONORILDAGAMBOAandEPIFANIOBRAVOHERNANDEZ;and  ^ LEONORILDAGAMBOAand " r EPIFANIOBRAVOHERNANDEZ,individually 6  v. J  SUMNERREGIONALHEALTHSYSTEMS,INC.,d/b/aSUMNER ^  REGIONALMEDICALCENTER r  v.   ROBERTDABNEYPHILLIPS,M.D.   XBX% @@ AnAppealfromtheCircuitCourtforSumnerCounty  @@No.22181CC.L.Rogers,Judge  @@*AV) ` dE<]` A ^ @@TTNo.M200202642_COA_ԄR3CVFiledDecember23,_2003_ Y AV) ` dE<0` A 1    Thisisamedicalmalpracticecase.Theplaintiffwaspregnantandcametothehospitaltohavelabor ,| inducedfordeliveryofherbaby.Thedefendantobstetriciangynecologisthadnotpreviouslytreated h theplaintiff,butwastheattendingphysicianforthedeliveryofherbaby.Afteralengthylabor,the T defendantphysicianattemptedtodeliverthebabyvaginally.Whenproblemsdeveloped,the @ defendantphysicianimmediatelydeliveredthebabybyCesareansection.Thebabysufferedinjuries , fromthelossofoxygenduringthebirthingprocess.Theplaintiffs,thechildsmotherandfather,  individuallyandonbehalfofthechild,suedthedefendantphysician,assertingthathebreachedthe  standardofcareinunderestimatingthesizeofthebabyandinthedeliveryofthebaby.The   defendantphysicianmovedforsummaryjudgment.Inresponse,theplaintiffssubmittedtheexpert ! affidavitofanobstetriciangynecologistfromGeorgia,whosemedicalpracticehadbeenlimitedto x"  gynecologicandfertilitymattersforseveralyears.Thedefendantphysicianobjected,arguingunder d#! TennesseeCodeAnnotated2926115thattheplaintiffsprofferedexpertwasnotcompetentto P$" testifyregardingobstetricssincehehadnotpracticedinthatspecialtyforseveralyearsandthathe <% # didnotsatisfythe localityrule.Thetrialcourtfoundthattheexpertwasnotcompetentand (&x!$ grantedsummaryjudgmentinfavorofthedefendantphysician.Theplaintiffsnowappeal.We 'd"% reverseandremand,findingthattheaffidavitoftheplaintiffsexpertindicatedthathewas (P#& competenttotestifyaboutobstetricsandsatisfiedthelocalityrule. (<$' 6  *&) _yTenn.R.App.P.3AppealasofRight;JudgmentoftheCircuitCourtis  ReversedandRemanded     #%XB #XBX.%HollyM.Kirby,J.,deliveredtheopinionofthecourt,inwhichW.FrankCrawford,P.J.,W.S., t andAlanE.Highers,J.,joined. ` JamesD.Kay,Jr.,JohnJ.Griffin,andJoannaThomson,Nashville,Tennessee,fortheappellants, 8  LeonorildaGamboaandEpifanioBravoHernandez,individuallyandasnextfriendsandparentsof $ t BrandonBravo.  ` DixieW.CooperandLisaD.York,Nashville,Tennessee,fortheappellee,RobertDabneyPhillips,  8  M.D. $   OPINION #%XXB.#XBX%   #%XXB#XBX%    OnNovember1,2000,Plaintiff/AppellantLeonorildaGamboa( Mother),whowas   pregnant,wenttoSumnerRegionalMedicalCenter( SumnerMedical)inGallatin,Sumner p County,Tennesseeandhadanobstetricultrasoundtestperformed.Theultrasoundtestresults \ describedthesizeofthebaby,estimatedthegestationalageasthirtynine(39)weekstwo(2)days, H andestimatedadateofdeliverytheweekofNovember6,2000. 4   Approximatelyfourweekslater,wellaftertheestimatedduedate,theSumnerCountyHealth  \ DepartmentscheduledMotherforaninduceddeliveryatSumnerMedical.Onthemorningof H December1,2000,MotherarrivedatSumnerMedicalforthescheduledlaborinduction. 4 Defendant/AppelleeRobertDabneyPhillips,M.D.( Dr.Phillips),wasoncallforhismedicalgroup   atSumnerMedical,andconsequentlybecameMothersattendingphysician.Priortothatdate,Dr.   PhillipshadneithertreatedMothernorbeeninvolvedinherprenatalcare.    Atapproximately8:30a.m.,Dr.PhillipsmetwithMother.Shehadreportedleaking  amnioticfluid,withahistoryofdeliveringaninepoundbabyin1995.Motherwasunsureofher l lastmenstrualcycle.#%XXB<#XBX%Dr.PhillipsobtainedtheNovember1,2000ultrasoundreportshowing X  pertinentfetalmeasurementsandanestimatedgestationalageatthattimeofthirtynine(39)weeks D! two(2)days.Fromtheinformationintheultrasoundreport,Dr.Phillipsestimatedthefetalweight 0"  tobeabout4000to4500grams,orapproximately8.8to9.9pounds.Nofurtherteststoestimatethe #l! sizeofthebabyweredone.Dr.Phillipsanticipatedvaginaldeliveryofthebaby. $X"   PitocinwasadministeredtoMotherandlaborprogressedslowly.Around5:45p.m.,Mother %0!$ beganpushing.Thiscontinuedforaboutoneandahalfhours.Atapproximately7:39p.m.,Dr. &"% Phillipsattemptedavacuumextractionofthebaby,andthebabysheadwasdeliveredatabout7:41 '#& p.m.Withashoulderdystocia(alsocalled stuckshoulders) identified,thebabysheadwasput (#' backintothevagina.ACesareansectionwasperformedatapproximately7:54p.m.Thechild, )$( Plaintiff/AppellantBrandonBravo( child),wasdeliveredatapproximately8:10p.m.,weighing |*%) thirteenpoundssevenounces.Thechildwashypoxic,orlackingoxygen, andwasimmediately h+&* handedovertothepediatricianforresuscitativemeasures.Hewassubsequentlytransportedto  VanderbiltMedicalCenter,andwasdiagnosedashavingexperiencedprolongedasphyxiawith  hypoxicischemicencephalopathy,orbraindamageduetolackofbloodflow.     OnOctober4,2001,Motherandthechildsfather,EpifanoBravoHernandez( Father), ` individuallyandonbehalfofthechild(collectively, plaintiffs),filedthislawsuitagainstSumner L  MedicalandDr.Phillipsformedicalmalpractice,seekingdamagesfortheinjuriesthechild 8  sustainedduringthebirthprocess.ThecomplaintallegedthatDr.Phillipsdeviatedfromthe $ t applicablestandardofcareinfailing totreat,observe,detect,test,diagnose,reportandmonitorthe  ` riskfactorsandmedicalconditionswhich[Mother]exhibitedpriortodelivery,andalsoinfailing  L   toexamine[Mother]andperformorcausetobeperformedsuchprocedures,examinations,tests  8  andtreatmentsas[Mothers]conditionwouldhavedictatedtoareasonablycarefulandcompetent $  medicalprofessional.     OnDecember10,2001,Dr.Phillipsfiledananswer,denyingtheplaintiffsallegationsof   negligence.Discoveryensued.OnFebruary14,2002,inresponsetointerrogatories,theplaintiffs   identifiedJoelS.Engel,M.D.( Dr.Engel),asanexpertexpectedtogivetestimonyattrialin p supportoftheirposition. \   OnApril29,2002,thetrialcourtenteredaschedulingorder.February1,2003,was 4 establishedasthedeadlinefortheplaintiffstodesignatetheirexpertwitnessesfortrial,andthetrial  p wassetforSeptember1,2003.  \   OnJuly18,2002,Dr.Phillipsmovedforsummaryjudgment.Insupportofhismotion,he 4 submittedhisownaffidavit,statingthathismedicaltreatmentofMotherconformedtotherequired   standardofcare.OnAugust23,2002,theplaintiffsfiledaresponseinoppositiontoDr.Phillips   motionforsummaryjudgment.TheplaintiffsresponsewassupportedbytheaffidavitofDr.Engel.    Dr.EngelsaffidavitstatedthathewaslicensedtopracticemedicineinGeorgiain1969,and  thathehadbeencertifiedbytheAmericanBoardofObstetricsandGynecologysince1974.Further, l hestatedthathepracticedinobstetricsandgynecologyinGeorgiafrom1972to1993.In1993, X  however,Dr.Engeleliminatedobstetricsfromhispracticeandfocusedongynecologyandinfertility. D!   TodemonstratethathewasqualifiedtotestifyaboutDr.PhillipsobstetriccareofMother, #l! Dr.Engelstatedthathewas familiarwiththerecognizedstandardofcareapplicabletoobstetricians $X" duringNovemberandDecember2000inGallatinandincommunitiessimilarinsizetoGallatin. $D # Inadditiontohisprivatepractice,Dr.Engelstated,since1999,hehadservedontheStateof %0!$ TennesseeBureauofTennCare,MedicalServiceAppealsBoard( TennCareBoard).Hesaidthat &"% hewasagynecologyobstetricsexpertforTennCare.AspartofhisserviceontheTennCareBoard, '#& Dr.EngelreviewedgynecologicalobstetricmedicalrecordsfromsmallerTennesseecommunities (#' nearmajorregionalmedicalcenters,communitiesthataresimilarinsizetoGallatin.Throughhis )$( serviceontheTennCareBoard,Dr.Engelasserted,hehadbecomefamiliarwiththemedical |*%) resourcesavailabletoobstetriciansincommunitiessimilarinsizetoGallatin.Hemaintainedthat h+&* hehadreviewedobstetriccasesfromTennesseecommunitiessimilartoGallatin,andthathewas  familiarwiththetreatment,care,andskillofpractitionersincommunitiessimilartoGallatin.    Dr.EngelalsosaidthathehadreviewedrelevantmaterialsonGallatin,andthathewas t familiarwiththeapplicablestandardofcareforobstetricsandgynecologyinGallatinandsimilar ` communities: L  Ѐ8  ...Ihavereviewedgeographicaldata,statisticaldataandliteratureconcerning $ t Gallatin...andSumnerRegionalMedicalCenter.Iknowthatin2000,Gallatin,  ` Tennesseehadapopulationofapproximately23,230andthatSumnerCountyhad  L  apopulationofapproximately130,449.IknowthatSumnerRegionalMedical  8  Centerisanotforprofitfacilitywith155bedcapacitywithover700staffemployees $  andover100physicians.SumnerRegionalMedicalCenterdeliveredapproximately   756babiesin2001andtreatsover25,000patientsperyearintheir24houraday   EmergencyRoom.Further,SumnerRegionalMedicalCenteris32milesor   approximatelya45minutedrivefromVanderbiltUniversityMedicalCenter,a   leadingmedicalcomplexandteachinghospital.SumnerCounty,Tennesseehasthree p (3)generalmedicalsurgicalhospitals.Basedonthisandotherinformation,Iam \ familiarwiththemedicalresourcesavailabletothemedicalcommunityinGallatin, H SumnerCounty,Tennessee.Iamfamiliarwiththestandardproceduresandpractices 4 ofobstetriciansincommunitiessimilarinsizetoGallatin,SumnerCounty,  p Tennessee. \   8  ...Thirdly,IreceivereferralsfromsmallcommunitiesnearAtlanta,Georgiathatare 4 similarinsizetoGallatin,SumnerCounty,Tennessee.Forexample,Ireceive   referralsfromRome,FloydCounty,Georgiawhichis65milesfromAtlanta.Floyd   Countyhasapopulationof91,183peopleandhastwo(2)generalmedicalsurgical  hospitals.ThecityofRomehasapopulationofapproximately31,000people.Iam  familiarwiththestandardofcareforobstetricsandgynecologyin2000inRome,  FloydCounty,Georgia.Asanotherexample,IreceivereferralsfromColumbus, l MuscogeeCountywhichis109milesfromAtlanta.MuscogeeCountyhasa X  populationof184,134peoplewithfour(4)generalmedicalsurgicalhospitals.Iam D! familiarwiththestandardofcareforobstetricsandgynecologyinColumbus, 0"  MuscogeeCounty,Georgia.ThemedicalcommunitiesinFloydCounty,Georgiaand #l! MuscogeeCounty,GeorgiaaresimilartothemedicalcommunityinSumnerCounty, $X" Tennessee.BecauseofthereferralsIreceivefromMuscogeeCountyandFloyd $D # County,Iamfamiliarwiththestandardproceduresandpracticesofobstetriciansin %0!$ GeorgiacommunitiessimilartoGallatin,SumnerCounty,Tennessee.&"%   8  ...Lastly,IhavevisitedhospitalsinacommunitysimilartoGallatin,Sumner (#' County,Tennessee.Ihavereviewedmedicalrecordsfromthehospitalsina )$( communitysimilartoGallatin,SumnerCounty,Tennessee.IhaveattendedObstetric |*%) andGynecologyseminars/conferenceswhereIfurtherbecamefamiliarwiththe h+&* standardofcareapplicabletoobstetriciansincommunitiessimilartoGallatin,  SumnerCounty,Tennessee.     Dr.EngelthengavehisopinionregardingDr.Phillipsmedicalcareinthiscase.Hestated t thathehadreviewedallofMothersrecords,andoutlinedtherelevantinformationfromthem.From ` hisreviewoftherecords,Dr.Engelstatedthefollowingopinions: L   XBXXXB mkWefghijl(x3\"k3"  8  k3@23  0`     Theobstetricpracticeinthiscasewaswellbelowthestandardofcare.k3@@݌$ t` `  Ќ  "k3"  8  k3A23  0`     Therewassufficientdataindicatingthatthiswasgoingtobeaverylargefor  ` gestationalageinfantifallowedtoproceedtoterm.k3AA݌ L ` `  Ќ  "k3"  8  k3C23  0`     Theprenatalfundalheightmeasurementswereallconsistentwith  8  macrosomia.k3CXC݌$ ` `  Ќ  "k3"  8  k3ID23  0`     TheultrasoundperformedonNovember1,2000,somefourweekspriorto   induction,wassupportiveofmacrosomiawithsomeoftheparameters   measuredbeingoffthescale.k3IDD݌ ` `  Ќ  "k3"  8  k3E23  0`     Thestandardofcarerequiredthatasecondultrasoundbeperformedpriorto   theinductionattermtoconfirmthesize.k3EF݌p` `  Ќ  "k3"  8  k38G23  0`     Thephysiciansestimateoftheinfantssizeas4,000to4,500gramswas \ totallyunrealistic,andfallsbelowthestandardofcare,inviewofthedate H andreasonableevaluationoffetalsizeatthetimeofinduction.k38GqG݌4` `  Ќ  "k3"  8  k3 I23  0`     Tomissthesizebysome3.5poundswasunacceptableandwellbelowthe  p standardofcare.k3 ICI݌ \` `  Ќ  "k3"  8  k3AJ23  0`     Therearesafelimitsastothesizeofinfantsthatshouldbeinduced.k3AJzJ݌H` `  Ќ  "k3"  8  k3RK23  0`     Theusualmaximumweightis10pounds.k3RKK݌4` `  Ќ  "k3 "  8  k3BL23  0`     Theattempttodelivervaginallywiththevacuumextractorasopposedto   proceedingdirectlytoacesareansectionwasbelowthestandardofcare.k3BL{L݌ ` `  Ќ  "k3 "  8  k3M23  0`     Thispatientshouldnothavebeeninduced,butshouldhavehadaprimary  cesareansection.Toinduceunderthesecircumstancesfallsbelowthe  standardofcare.k3MM݌` `  Ќ  "k3 "  8  k3EO23  0`     Therewasnorecordingoftheestimationofthesizeofthefetusinrelation l tothesizeofthemotherspelvisinthiscase.Failuretorecordsuchvital X  informationfallsbelowthestandardofcare.k3EO~O݌D!` `  Ќ  "k3 "  8  k3Q23  0`     Theprolongedasphyxiaaswellasthetraumainflictedinattemptingto 0"  delivervaginallywasbelowthestandardofcare.#XBXXXB?##%XXBt#XBX% k3Q=Q݌#l!` `  Ќ  8       Dr.Engelassertedthattheavailableinformationindicatedthatthebabywouldbetoolargetosafely $D # delivervaginally,andforDr.Phillipsto missthefetalsizebysome3.5poundsisunacceptableand %0!$ wellbelowthestandardofcare.HestatedthatDr.Phillipsattempttodeliverthebabyvaginally &"% ratherthanproceedingdirectlytoaCesareansectiondepartedfromtheapplicablestandardofcare '#& anddirectlyresultedinBrandonsprofoundinjuries. (#'   OnAugust30,2002,thetrialcourtheardargumentsonDr.Phillipsmotionforsummary |*%) judgment,andonSeptember9,2002,thetrialcourtissueditsmemorandumopinion.Thetrialcourt h+&* notedthatDr.Engeladmittedthatthehadnotpracticedobstetricssince1993,butlimitedhispractice  togynecologyandinfertility.Itdistinguishedbetweenobstetricsandgynecology: Thespeciality  ofobstetrics...dealswiththecareofwomenduringpregnancy,laborandthepostlaborperiod.  Thespecialityofgynecology...[deals]withthediagnosisandtreatmentofdiseasesaffectingthe t organspeculiartowomen.Thetrialcourtheld: ` 8  T.C.A.2926115requiresanypersonattemptingtotestifyastotheacceptable 8  standardofcaremustnotonlybelicensedinthespecialtybutmusthavepracticed $ t thespecialtyduringtheyearprecedingthedateofoccurrence.TheAffidavit  ` establishesthelicenserequirement,butnotthepracticerequirement.Plaintiff,[sic]  L  reliesuponDr.EngelreviewingTennCarerecordsregardingOBGYNandDr.  8  EngelisavisitingassociateatEmoryUniversity,DepartmentofGynecologyand $  Obstetrics.Noadditionalexplanationorsupportisprovidedtodemonstrateactual   practiceofobstetricssince1993.Inlightoftheadmissionofnonpracticesince   1993,theCourtcannotfindthePlaintiffsofferedexperttobequalifiedpursuantto   thepracticerequirementofT.C.A.2926115.    ThusthetrialcourtheldthatDr.EngelwasnotqualifiedtotestifyunderTennesseeCodeAnnotated \ 2926115becausehehadnotpracticedobstetricsduringtheyearprecedingtheoccurrence. H   OnSeptember11,2002,theplaintiffsvoluntarilydismissedSumnerMedical.OnOctober  p 3,2002,thetrialcourtenteredafinalordergrantingDr.Phillipsmotionforsummaryjudgmentand  \ incorporatingintheorderitsSeptember9,2002memorandumopinion.Fromthatorder,the H plaintiffsappeal. 4   Onappeal,theplaintiffsarguethatthetrialcourterredindisqualifyingDr.Engelonthebasis   thathehadnotpracticedobstetricsduringtheyearprecedingtheinjury.Rather,theplaintiffsargue,  TennesseeCodeAnnotated2926115requiresonlythattheexperthavepracticedinaspecialty  thatwouldmakehistestimonyrelevanttotheissuesinthecase.Theyclaimthat,becauseDr.  Engelsfieldofspecializationisobstetricsandgynecology,andhispracticeingynecologyisrelevant l totheissuesinthecase,thenhisaffidavitissufficient.Inthealternative,theplaintiffsarguethat X  thetrialcourtsgrantofsummaryjudgmenttoDr.Phillipswaspremature,becausethetrialcourts D! schedulingorderallowedthemuntilFebruary2003toidentifytheirexpertwitnesses,andbecause 0"  theydidnothavetimetoconductsufficientdiscovery.  #l!    XBXXXBThetrialcourtsgrantofsummaryjudgmentisrevieweddenovowithnopresumptionof $D # correctness. Warrenv.EstateofKirk ,954S.W.2d722,723(Tenn.1997).Summaryjudgmentis %0!$ appropriatewhere thepleadings,depositions,answerstointerrogatories,andadmissionsonfile, &"% togetherwiththeaffidavits,ifany,showthatthereisnogenuineissueastoanymaterialfactandthat '#& themovingpartyisentitledtoajudgmentasamatteroflaw.Tenn.R.Civ.P.56.04.Theappellate (#' courtmustviewtheevidenceinalightmostfavorabletothenonmovingparty,givingthatpartythe )$( benefitofallreasonableinferences. Warren ,954S.W.2dat723(quoting Bainv.Wells ,936S.W.2d |*%) 618,622(Tenn.1997))#XBXX XBc# XBXXXB.#XBXX XBf#ԀOncethemovingpartydemonstratesthattherearenogenuineissuesof h+&* materialfact,thenonmovingpartymustdemonstrate,byaffidavitsorotherwise,thatadisputed  issueofmaterialfactexistsfortrial. Byrdv.Hall ,847S.W.2d208,211(Tenn.1993).Inaddition,  thedeterminationofthetrialcourtregardingthe admissibility,qualifications,relevancyand  competencyofexperttestimony,willbeupheldabsentanabuseofdiscretion. SeeMcDanielv. t CSXTransp.,Inc. ,955S.W.2d257,263(Tenn.1997); seealsoTilleyv.Bindra ,No.W2001 ` 01157COAR3CV,2002WL1000196,at*4(Tenn.Ct.App.May13,2002). Atrialabusesits L  discretionwhenitappliesthewronglegalstandard. SeeMcEvoyv.Brewer ,No.M200102054 8  COAR3CV,2003WL22794521,at*6(Tenn.Ct.App.Nov.25,2003). $ t  #%XXB^R#XBX%  First,theplaintiffsarguethatthetrialcourterredindisqualify#%XXBrk#XBX%ingDr.Engelonthebasisthat  L  hehadnotpracticedinobstetricswithintheyearprecedingtheinjury.Theplaintiffsnotethatthere  8  isnostatutoryrequirementthattheexpertpracticeinthesamespecialtyasthedefendant,onlythat $  theexpertpracticeinaspecialtythatwouldmakehistestimonyrelevanttotheissuesinthecase.    See Tenn.CodeAnn.2926115(b).TheypointoutthatDr.Engelis,infact,boardcertifiedinthe   samespecialtyasDr.Phillips,obstetricsandgynecology,whichisonespecialty,nottwo.Assuch,   theplaintiffsallege,Dr.Engelreceivedthesameeducation,training,andcertificationasDr.Phillips.   Inaddition,theplaintiffsarguethatthepracticeofgynecologyisclearlyrelevanttothepracticeof p obstetrics,particularlyinlightofDr.Engelsextensiveexperience,knowledge,andqualifications \ thatsupporthisstatementthatheisfamiliarwiththeapplicablestandardofobstetriccareduringthe H pertinenttime. 4   Inresponse,Dr.PhillipsarguesthatthetrialcourtwascorrectindeterminingthatDr.Engels  \ affidavitdidnotmeetthespecialtyrequirementofTennesseeCodeAnnotated2926115(b).Dr. H PhillipsnotesthatDr.Engelpracticedonlygynecology,notobstetrics,withintheyearpriortothe 4 plaintiffsinjuries,andarguesthatissuesrelatedtogynecologyandfertilityarenotrelevanttothe   deliveryofababy.Inaddition,Dr.Phillipsargues,Dr.Engelsaffidavitdidnotsatisfythe locality   rule,i.e.,itdidnotshowthatDr.Engelwasfamiliarwiththerecognizedstandardofacceptable  professionalpracticeinGallatin,SumnerCounty,Tennesseeatthepertinenttime.ThoughDr.Engel  claimedtobefamiliarwiththeappropriatestandard,Dr.Phillipsargues,theaffidavitindicatesthat  Dr.EngelneverpracticedobstetricsinGallatinorsimilarcommunities,onlythathereceived l referralsasafertilityspecialistfromthosecommunities. X    TherequirementsforaplaintiffinamedicalmalpracticecaseissetoutinTennesseeCode 0"  Annotated2926115,whichstatesinpertinentpart: #l!  8  (a)Inamalpracticeaction,theclaimantshallhavetheburdenofprovingbyevidence $D # asprovidedbysubsection(b):%0!$   8  8`   (1)Therecognizedstandardofacceptableprofessionalpracticeinthe '#& professionandthespecialtythereof,ifany,thatthedefendant (#' practicesinthecommunityinwhichthedefendantpracticesorina )$( similarcommunityatthetimetheallegedinjuryorwrongfulaction |*%) occurred....h+&*` x` x y TRX3'Avery 5161 AddressX3' Letter3'Avery 5160 Addressijl(x3'LetterT   8  (b)Nopersoninahealthcareprofessionrequiringlicensureunderthelawsofthis  stateshallbecompetenttotestifyinanycourtoflawtoestablishthefactsrequired  tobeestablishedbysubsection(a),unlessthepersonwaslicensedtopracticeinthe t stateoracontiguousborderingstateaprofessionorspecialtywhichwouldmakethe ` personsexperttestimonyrelevanttotheissuesinthecaseandhadpracticedthis L  professionorspecialtyinone(1)ofthesestatesduringtheyearprecedingthedate 8  thattheallegedinjuryorwrongfulactoccurred....$ t    Tenn.CodeAnn.2926115(a),(b)(Supp.2003).Fromtheplainlanguageofthestatute,the  L  TennesseeSupremeCourthasidentifiedfiverequirements:s #  1      ׀  8  8  [First,][t]heaffiantmustdemonstratethatheorshemeetsthegeographicand   durationalresidenceandpracticerequirements.Second,theaffiantmustdemonstrate   thatheorshepracticesinaprofessionorspecialtythatmakestheaffiantsopinion   relevanttotheissuesinthecase.Third,theaffiantmustdemonstratethatfamiliarity   withtherecognizedstandardofprofessionalpracticeinthecommunitywherethe p defendantpracticesorinsimilarcommunities.Fourth,theaffiantmustgivean \ opinionconcerningwhetherthedefendantphysicianmetorfailedtomeetthe H relevantstandardofprofessionalpractice.Finally,theaffiantmustopinewhetherthe 4 defendantphysiciansnegligencemorelikelythannotcausedthepatientinjuriesthat  p heorshewouldnototherwisehavesuffered. \    Churchv.Perales ,39S.W.3d149,166(Tenn.2000). 4   Clearly,then,thetrialcourtsstatementofthestandardinthiscasewaserroneous;itisnot   necessaryfortheprofferedexperttohavepracticedthesamespecialtyasthedefendantduringthe  yearprecedingthedateoftheoccurrence.Rather,itisrequiredthathepracticeinaprofessionor  specialty whichwouldmakethepersonsexperttestimonyrelevanttotheissuesinthecaseduring  theyearprecedingtheoccurrence.Tenn.CodeAnn.2926115(b); SeeLedfordv.Moskowitz ,742 l S.W.2d645,647(Tenn.Ct.App.1987).Whilethetrialcourtsdecisiononthecompetencyofan X  expertwitnessisreviewedunderanabuseofdiscretionstandard,applicationofthewronglegal D! standardconstitutesanabuseofdiscretion.Ontheseundisputedfacts,then,wecandetermine 0"   whether,inanyevent,Dr.Engelsaffidavitsatisfiesthepracticerequirementunderthestatute. #l!   Thefactsinthiscasepresentanunusualsituation.u #  2      ׀Dr.Engelislicensedinthesame   specialtyasDr.Phillips,thatis, obstetricsandgynecology,whichsatisfiesthestatutory  requirementthattheexpertbe licensedtopracticein...aprofessionorspecialtythatwouldmake  histestimonyrelevanttotheissuesinthecase.However,thestatutealsorequiresthatDr.Engel t practiceintherelevantspecialtyintheyearprecedingtheallegedmalpractice.Inthiscase,itis ` undisputedthatitisnecessarytolookbeyondthenomenclatureofhisfieldofspecialty,sinceDr. L  Engellimitedhispracticetogynecologyafter1993andhasnotengagedinthepracticeofobstetrics 8  sincethattime.TheissuesonwhichDr.Engeliscalledtotestifyrelateonlytoobstetrics,namely, $ t Dr.PhillipsmedicaltreatmentofMotherduringchildbirth.#%XXBl#XBX%TheissuebecomeswhetherDr.Engels  ` licenseinobstetricsandgynecology,togetherwiththeparametersofhisrecentpractice, would  L  make[his]experttestimonyrelevanttotheobstetricissuesinthiscase.Tenn.CodeAnn.2926  8  115(b).Consequently,wewillreviewpertinentcaselaw. $    In Searlev.Bryant ,713S.W.2d62(Tenn.1986),thedefendantphysicianperformed   emergencysurgeryontheabdomenoftheplaintiffminor.Theplaintiffsubsequentlydevelopedan   infectioninthesurgicalwoundthatlastedforseveraldays.Theplaintiffsuedthephysician,alleging   thathenegligentlycausedherinfection,negligentlytreatedherinfection,andthathisnegligence p causedhertohaveanunnecessarilyunattractivescarfromthesurgery. Searle ,713S.W.2dat63. \ Attrial,theplaintiffsubmittedthetestimonyofaninfectiousdiseasespecialist/clinical H microbiologistwhoworkedasthedirectoroftheclinicalmicrobiologylaboratoryatVanderbilt 4 UniversityMedicalCenter.Theexperttestifiedthathedidnottreatprivatepatientsanddidnot  p performsurgery.However,hemaintainedthathehadbecomefamiliarwiththeapplicablestandard  \ ofcareforsurgeonsbyconsultingwithphysiciansoninfectiousdiseasesandbyvisitinghospitals H inhisroleasaneducator.Thetrialcourtfoundthattheplaintiffsexpertwasincompetenttotestify 4 andstruckhistestimony.Theappellatecourtreversed,findingthattheexpertsopinionregarding   thepreventionandtreatmentofsurgicalwoundinfectionswasadmissibleinlightofhisexperience.   Theappellatecourtconcludedthatthefactthattheexpertdidnottreatpatientsinprivatepractice   goestotheweightofthetestimonyratherthanitsadmissibility. Id .at64.    In Stokesv.Leung ,651S.W.2d704(Tenn.Ct.App.1982),theplaintiffwasadmittedtothe l hospitalforacutedepression,hallucinations,andothermentalconditions.Thenextday,shejumped X  fromthewindowofherhospitalroom,sustainingsevereinjuries. Stokes ,651S.W.2dat707.The D! plaintiffsuedhertreatingphysician,aspecialistininternalmedicineandcardiology.Theplaintiff 0"  offeredtheexperttestimonyofapsychiatrist,whosoughttotestifythatthedefendantphysician #l! breachedthestandardofcarebygivingtheplaintiffthewrongmedicationandputtingherinan $X" insecureroom.Thedefendantobjectedtotheexpertstestimony,arguingthathewasnotqualified $D # togiveanopinionastothestandardofcareinthemedicalfieldofthedefendantphysician.During %0!$ voirdireoftheexpertregardinghisqualifications,hestatedthathewasfamiliarwiththestandards &"% ofpracticewithregardtopsychiatricpatientsingeneralmedicinebecausehetaughtclassesonthe  subjectattheUniversityofTennesseeMedicalSchool. Id. at706.Thetrialcourtadmittedthe  expertstestimony.Theappellatecourtaffirmed,notingthatthefactthattheexpertdidnotpractice  inthesamemedicalfieldasthedefendantphysicianwent moretotheweightoftheevidencerather t thanitsadmissibility. Id.  `   In Ledfordv.Moskowitz ,742S.W.2d645(Tenn.Ct.App.1987),thedefendantpsychiatrist 8  admittedtheplaintiffintothehospitalfordysthymicdisorder.Uponherreleasefromthehospital, $ t thedefendantprescribedantipsychoticmedications.Themedicationsresultedinsideeffects.  `  Ledford ,742S.W.2dat646.ShewaslateradmittedintoahospitalinAtlanta,Georgia,andwas  L  diagnosedashavingdruginducedneurologicalproblems.Inthehospital,shewastreatedbya  8  neurologist,whodiscontinuedtheantipsychoticmedications.Theplaintiffsuedthedefendant $  psychiatrist,claimingthathenegligentlyprescribedandsupervisedtheadministrationofanti   psychoticdrugs. Id .at647.Thedefendantpsychiatristfiledamotionforsummaryjudgment.In   response,theplaintifffiledtheaffidavitanddepositionoftheneurologistwhotreatedheratthe   hospitalinAtlanta.Thedefendantpsychiatristarguedthattheneurologistwasnotqualifiedtotestify   becausehedidnotpracticeinthesamespecialtyorlocationasthedefendant.Thetrialcourtagreed, p findingthattheproposedexpertmust practicethespecialtyofthemedicaldoctorbeingsued. Id.  \ (quotingopinionofthetrialcourt).Accordingly,thetrialcourtgrantedsummaryjudgmenttothe H defendantpsychiatrist.Theappellatecourtreversed,statingthatthetrialcourt incorrectlystates 4 therequirementsofthestatute,andthat[the]proofsufficientlymeetsthestandardssetoutinthe  p statute.... Id. Theappellatecourtnotedthattheplaintiffsexpertneednotpracticeinthesame  \ specialtyasthedefendant.Furthermore,thecourtfounditsignificantthattheplaintiffsexpertwas H boardcertifiedinneurologyandpsychiatry,andthathefrequentlysawpatientswithpsychiatric 4 problemsandreferredthem.Theexpertalsostatedthathekeptupwiththeapplicablestandardof   carethroughliteratureandtraininginpsychiatry,andthathewasfamiliarwithantipsychotic   medications. Id. at64748.Inlightofthatevidence,theappellatecourtheldthatthecircumstances  madetheexpertstestimony relevanttotheissuesinthecase.Thegrantofsummaryjudgment  wasthereforereversedandthecausewasremandedfortrial. Id. at648.#%XXB#XBX%    Ineachofthesecases,thetestimonyofanexpertphysicianspecializingandpracticingin X  anotherfieldwasacceptedascompetentproofonthestandardofcare,solongastheexperthada D! sufficientbasisonwhichtoestablishfamiliaritywiththedefendantsfieldofpracticeandthe 0"  standardofcarerequiredindealingwiththemedicalcareatissue. SeeGoodmanv.Phythyon ,803 #l! S.W.2d697,70102(Tenn.Ct.App.1990)(analyzingcases).Intheinstantcase,theplaintiffsargue $X" thatthefollowingfactsinDr.Engelsaffidavitsupportafindingthathistestimonywouldbe $D # relevanttotheissuesinthecase: %0!$  mkWefghijl(yx mkWefghijl"k3"  8  k3R23  0`     Dr.Engelisaboardcertifiedobstetriciangynecologistwhohastrainingin '#& obstetrics;hecompletedapreceptorshipinUltrasonographyattheUniversity (#'  ofColorado;k3R݌)$(` `  Ќ  "k3"  8  k3 23  0`     Hereceivesreferrals(ingynecologyandfertility)fromobstetriciansinsmall  communitiesandisfamiliarwiththestandardproceduresandpracticesof  thoseobstetricians;8h` ` k3 B݌hh   "k3"  8  k3ǭ23  0`     HecontinueshiseducationbyattendingObstetricandGynecologyseminars t andconferences;k3ǭ݌`` `  Ќ  "k3"  8  k323  0`     HeworksasanexpertontheTennCareBoardreviewingobstetricrecordsto L  determinewhethercertainproceduresareinsured,andheis,therefore, 8  familiarwiththestandardofcareforobstetriciansinTennesseeandin $ t communitiessimilartoGallatin;k38݌ `` `  Ќ  "k3"  8  k323  0`     ThroughhisserviceontheTennCareReviewBoard,heisfamiliarwiththe  L  medicalresourcesavailabletoobstetriciansincommunitiessimilarinsizeto  8  Gallatin;k3;݌$ ` `  Ќ  "k3"  8  k323  0`     HeteachesasaclinicalvisitingassociateatEmoryUniversity,Department   ofGynecologyandObstetrics;k3ϲ݌ ` `  Ќ  "k3"  8  k3ݳ23  0`     Hepracticedasanobstetricianfrom1974through1993;8@2` ` k3ݳ݌   Ќ  "k3"  8  k323  0`     Since1993,hehascontinuedtopracticemedicineintheareasofgeneralk3"݌ ` `  Ќ     ` gynecologyandfertility; p "k3"  8  k3D23  0`     HehasservedasagynecologyobstetricsexpertontheTennCareMedical \ AppealsBoardsince1999.k3D}݌H` `  Ќ  Dr.Phillipsarguesthatthesefactsarenotsufficient,becausetestimonygivenbyDr.Engelinother  p casesconfirmsthat,since1993,hehasonlytreatedfirsttrimesterandpostdeliverypatients,andthat  \ hehasmadeaconcertedefforttodevotehispracticeexclusivelytogynecology.Dr.Phillipsalso H maintainsthatDr.EngelsTennCareexperiencedoesnotestablishanyfamiliaritywiththestandard 4 ofcareinobstetrics,becauseDr.EngelsonlyrolewithTennCareistoreviewclaimstodetermine   whethertheyshouldbepaid.     Thiscasepresentsaverycloseissue.Onthesefacts,however,weconcludethatthereis  sufficientinformationtoestablishDr.Engelscompetencetotestifyontheissuesinthiscase.Itis  significantthatDr.Engelislicensedinthesamespecialtyasthedefendant,andthathepracticedin l obstetricsforovertwentyyears.AlthoughthefocusofDr.Engelspracticehasshiftedawayfrom X  obstetricstogynecology,heassertsthathemaintainshisknowledgeaboutthestandardofcarein D! obstetricsthrough,amongotherthings,teachingclassesatEmoryUniversityandattendingseminars 0"  andconferencesonobstetricsandgynecology. SeeSearle ,713S.W.2dat64(notingthatthereis #l! norequirementthattheexpertsknowledgeoftheapplicablestandardofcare havebeengainedby $X" treatingpatientsinprivatepractice); Ledford ,742S.W.2dat647(notingthatplaintiffsexpertwas $D # boardcertifiedindefendantsspecialtyandthattheexpert keptupwithliteraturerelatedtothat %0!$ specialty).Therefore,inourview,thefactthatDr.Engeldidnotactuallydeliverbabiesin2000goes &"% totheweightofhistestimony,notitsadmissibility. SeeSearle ,713S.W.2dat64( Thefactthat '#& Dr.Strattondoesnotseepatientsinprivatepracticegoestotheweightofthetestimonyratherthan (#' itsadmissibility.); Stokes ,651S.W.2dat706(statingthatthedefendantsobjectionstotheexperts )$(  testimony mustgomoretotheweightoftheevidenceratherthanitsadmissibility).Thus,because |*%) the proofsufficientlymeetsthestandardssetoutinthestatute,wereversethetrialcourts  conclusionthatDr.Engelisincompetentbasedonthe practicerequirementofthestatute. Seeid.      Dr.PhillipsalsoarguedtothetrialcourtthatDr.Engeldidnotmeettherequirementsofthe t statutebecausehedidnotshowthathewasfamiliarwiththestandardofcareinthesameorsimilar ` communityasGallatin,wheretheallegedmalpracticeoccurred.Inotherwords,Dr.Engelsaffidavit L  didnotsatisfythe localityrule. SeeHowellv.BaptistHosp. ,No.M200102388COAR3CV, 8  2003WL112762,at*5(Tenn.Ct.App.Jan.14,2003); Mabonv.JacksonMadisonCountyGen. $ t Hosp. ,968S.W.2d826,831(Tenn.Ct.App.1997); seealsoTilley ,2002WL1000196,at*6.  `  Withoutthisrequisitethresholdevidenceofthestandardofcareinthelocality,aplaintiffcannot  L  demonstrateabreachofduty. Mabon ,968S.W.2dat831.  8    Thetrialcourtbelowdidnotaddressthisissue.Dr.Engelsaffidavit,however,setsout   sufficientevidencetoshowthathewasfamiliarwiththestandardofcareeitherinGallatinorina   similarcommunity.Inhisaffidavit,Dr.Engelstatesthat,throughhisserviceontheTennCare   reviewboard,hehas becomefamiliarwiththemedicalresourcesavailabletoobstetriciansin   communitiessimilarinsizetoGallatin,andheis familiarwiththetreatment,careandskillof p practitionersincommunitiessimilartoGallatin.Further,hestatesthathehasreviewedliterature \ anddataregardingGallatin,andhecomparesitwithcommunitiesheclaimsaresimilarinsize, H namelyRome,FloydCounty,Georgia,andColumbus,MuscogeeCounty,Georgia.Heassertsthat, 4  [b]ecauseofthereferralsIreceivefromMuscogeeCountyandFloydCounty,Iamfamiliarwith  p thestandardproceduresandpracticesofobstetriciansinGeorgiacommunitiessimilarto  \ Gallatin....Healsostatesthatheis familiarwiththestandardofcareforobstetricsand H gynecologyin2000inRome,FloydCounty,Georgia,andthatheis familiarwiththestandardof 4 careforobstetricsandgynecologyin2000inColumbus,MuscogeeCounty,Georgia.Finally,Dr.   EngelstatesthathehasvisitedhospitalsincommunitiessimilartoGallatin,andhehasattended   seminarswherehefurtherbecamefamiliarwiththestandardofcareforobstetriciansincommunities  similartoGallatin.    In Mabon ,thedefendantphysicianpracticedinJackson,Tennessee.Toestablishthe l requisitestandardofcareunderthestatute,theplaintiffsexpertstatedinhisaffidavitthathewas X   familiarwiththerecognizedstandardofacceptablemedicalpractice...inanareasuchasJackson, D! Tennessee,andthat thestandardofcareinJackson...wouldbecomparabletothecitiesand 0"  facilitiesatwhichhehadpracticedmedicine. Mabon ,968S.W.2dat828.Fromtheexperts #l! depositiontestimony,however,itbecameapparentthathehadnoknowledgeaboutJacksons $X" medicalcommunity,nordidhehaveanyevidenceonwhichtobasehisopinionthatthestandardof $D # careinJacksonwasthesamenationwide. Id. at83031.Theappellatecourtemphasizedthatthe %0!$ plaintiffhastheburdenofestablishingtherequisitestandardofcareinamedicalmalpracticeaction: &"% 8  Itistheplaintiffwhoischargedwiththeburdenofproofastothestandardofcare (#' inthecommunityinwhichthedefendantpracticesorinasimilarcommunity.... )$( Aplaintiffwhochoosestoprovethestandardofcareinasimilarcommunity |*%) necessarilymustprovethatcommunityissimilartotheoneinwhichthedefendant h+&* practices.Toshiftthisburdentothedefendantdirectlycontradictstheplainlanguage  ofthestatuteandwouldrenderthestatuteanullity.Undertheprinciplesofsummary  judgment,once[thedefendant]movedforsummaryjudgmentandsubmittedan  affidavitstatingthathecompliedwiththestandardofcareinJackson,theburden t thenshiftedto[theplaintiff]tosetforthspecificfactsthat[thedefendant]failedto ` meetthestandardofcareinJacksonorasimilarcommunity.L     Id. at831(citationomitted).Becausetheplaintiffsexpertdidnotsetforthspecificfactsshowing $ t thathewasfamiliarwiththestandardofcareinJackson,orthatthestandardwithwhichhewas  ` familiarpertainedtoacommunitysimilartoJackson,thecourtupheldthegrantofsummary  L  judgmentinfavorofthedefendant. Id. at831.  8    Inthiscase,Dr.Engelsaffidavitcontainsinformationthatwaslackingintheaffidavit   scrutinizedin Mabon .First,Dr.EngelsetsforthstatisticalinformationaboutGallatinandcompares   GallatintoRomeandColumbus,Georgia,anddescribesinformationindicatingthatthose   communitiesaresimilartoGallatin.Hethensetsoutthebasisforhisfamiliaritywiththestandard   ofcareinthosecommunities,statingthathereceivesgynecologicalandfertilityreferralsfrom p physiciansinthosecommunities,thathehasreviewedmedicalrecordsfromhospitalsfromthose \ communities,andthathehasattendedseminarsandconferencesthathavefamiliarizedhimwiththe H applicablestandardofcareinthosecommunities.Thus,Dr.Engelhascitedto trustworthyfacts 4 ordatasufficienttoprovideabasisforhisopinion. Tilleyv.Bindra ,No.W200101157COAR3  p CV,2002WL1000196,at*6(Tenn.Ct.App.May13,2002)(quoting Church ,2000WL1183074,  \ at*13)#%XXB#XBX%; seeSearle ,712S.W.2dat6465(findinglocalityrulesatisfiedwhenexpertindicated H familiaritywiththestandardofcarethroughhisvisitstohospitalsinsimilarcommunitiesinhis 4 capacityasaneducator).FromtherecordbeforethisCourt,Dr.Engelsaffidavit,viewedinalight   mostfavorabletothePlaintiffs,satisfiesthe localityrulerequirementsofthestatute.Accordingly,   wereversethetrialcourtsgrantofsummaryjudgmentinfavorofDr.Phillips.#%XXB#XBX%Otherissuesraised  inthisappealarepretermitted.    Thedecisionofthetrialcourtisreversedandthecauseisremandedforfurtherproceedings l notinconsistentwiththisOpinion.CostsaretobetaxedtoAppelleeRobertDabneyPhillips,M.D., X  forwhichexecutionmayissue,ifnecessary. D! Ѐ#%XXB#XBX% #l! #%XXBj#T%%TXBXT%    `  #XBXXTXB#   h     ___________________________________ &"%    `     h     HOLLYM.KIRBY,JUDGE#%XXB#