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A. a.(1)(a) i) a)S !"($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)x?t2PleadingHeader for Numbered Pleading Paper % z &(  &XXXXX6G''*d66G''*d6HH1HH2HH3HH4HH5HH6HH7HH8HH910111213141516171819202122232425262728  .+((3$ FT!   p4Heading 2Underlined Heading Flush LeftV4Heading 1Centered Heading@..  b* 8Bullet ListIndented Bullet List0..0` ..` B& $1Document Style0..8` ..` B $2Document Style.. . 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X/&24Technical Document Style.. 23  Ԁ.   CRight ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3|xb <6X9`(*Courier 12pt10cpiXXx6X@JQX@( T$   dw#%$(G.29$ FT!   XX     0  MARVINBERKELESLIEMcWILLIAMS($   0   VANNLASLEYPINCHAKMcDONALDLUFKINFRIERSONROSENBALMDannenholdBellomyVanderbiltGeldmeier  I9$  XX     2    _ `  T  TheoriginalcomplaintalsoincludedasDefendantsMs.Geldmeier `  andFortSandersRegionalMedicalCenter,Inc.AnonsuitwastakenastoMs.GeldmeierandtheclaimagainstFortSanderswassettled.#  Tگ#HP LaserJet 4SiHPPCL5MS,,,,,,0nL U DANNENHOLDHENSLEYROSENBALMBELLOMYDannenholdBellomyGeldmeier$cytotechnologist&cytotechnologistsprimetimeRussomTenn.Ct.App CLIAHOLLARS<09Z .Courier New Regular<( 9Z &Courier Regular Y DZ [ U\ e] E^ _ Ӏ` a {b (hH  Z6Times New Roman Regular  I9$  XX     1    _ ` Ms.Dannenholddiedaftersuitwasfiledandasubstitute `  complaintwasfiledbyherExecutrix.((3$ FT!   ((3$ FT!     I$  XX     3    _T ` Dr.Cooperwasnotamemberofthepathologygroupwhenthe `  readingsweremadein1991and1993.Hedid,however,examinetheslidesin1994afteraquestionastotheiraccuracywasraised.#TЄ# 7 I$  XX     5    _ ` Mrs.DannenholddidinfactdieinAugustof1997,andher `  substitutedcomplainthasbeenfiledtoallowherExecutrixtoproceedwiththisaction. iXXXXi:XiX Ad   FILEDi&i:   November17,1998  CecilCrowson,Jr.AppellateCourtClerk GGGG'dxd(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.gtuvwxyz#,37=CIQYag1.a.i.(1)(a)(i)1)a)(;s$2,  0  .3  0    I$  XX     4    _  ` The3yearreposeprovisionof_Tenn.Code_ԀAnn.2926116(a)had `  alreadypassedonthe1991slidebeforeMrs.Dannenholdlearnedthatshehadcancer,whichultimatelyledtoherdiscoveryofthedefendantsnegligenceinreportingherpreviouspapsmearsasnegative.Thecytotechnologistwhoreadthe1991slideandthepathologistwhoissuedthenegativereportonthe1991slideswerenotnamedasdefendantstothisaction,andnoattempthasbeenmadebytheplaintifftoassertaclaimforrecoveryofdamagesforthenegligencethattookplacein1991.Theeventsof1991arestillrelevantevidence,however,inconnectionwithplaintiffsallegationsregardingtheindependentnegligenceofthedefendantsintheoperationandmanagementofthislaboratory,andthefailuretoidentifyandremedyanobviousdeficiencyintheproficiencyofthetechnicianstowhomthesedefendantseredelegatingthetaskofreadingslides.# ӄ#,cAZ"Arial Regular((3$ FT!   (O{$0  2,  a  .3  0` (#(#(bD$0  0` (#(#2,   .3  0 ` (#` (#(x$0  0` (#(#0 ` (#` (#2,(  0  )3  0 (# (#(Ƃ$0  0` (#(#0 ` (#` (#0 (# (#2,(  a  )3  0h(#(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2,(   )3  0h(#h(#(4$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2,  0  )3  0(#(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2,  a  )3  0p(#(#XC<< CLevel 1Level 2Level 3Level 4Level 5($$   1  ' dxdP Pd FT!   _  7OXXdd7`   XTXOXXXTR[A' Legal3'A' Legal3'T_ l\]6&"h 8 `Ef tt06H` l HH(#(#_ 0  @ |H(#INTHECOURTOFAPPEALS `  @ |ATKNOXVILLE@||#|   ` ESTATEOFSHIRLEYJ.DANNENHOLD,@@@#|@@*)  KNOXCOUNTY   x byherExecutrix,MARGARET  )  03A019710CV @  (#(#HH00443HENSLEY@*) 0    @*)  PlaintiffAppellant@*) `  @*)   (    v. `  @*)  HON.WHEELERROSENBALM,  P      @*)  JUDGE   KNOXVILLEPATHOLOGYGROUP,P.C.,@*)   CARTERMILLER,JR.,M.D.and@*) H  BRUCEBELLOMY,M.D.@*)   p @*)0  AFFIRMEDINPART;VACATED8(#(#   DefendantsAppellees@*)0  INPARTandREMANDED(#(# DONNAKEENEHOLTOFKNOXVILLEFORAPPELLANTEDWARDG.WHITE,II,andAMYV.HOLLARSOFKNOXVILLEFORAPPELLEES   `    OPINION #"    `     h      p   Goddard,P.J. 'x'    ` InthiscauseShirleyJ.DannenholdW K   1      ׀suesKnoxville +`", PathologyGroup,CarterMiller,Jr.,M.D.,andBruceBellomy,M.D.,formedicalmalpracticeincidenttothemisreadingofa1993papsmearbyLouiseGeldmeier,whoinaccuratelyissuedanegativereportratherthanapositiveone.M  K   2       2(4   30*6     ` ThecomplaintastotheDefendantsinthisappealwas predicatedupontwotheories.First,thedoctrineofloanedservant,itbeingthecontentionofthePlaintiffthatMs.Geldmeier,althoughemployedbyFortSanders,wasloanedtotheDefendants.ThesecondwastheindependentnegligenceoftheDefendantsinfailingtoadequatelytrainandsupervisethoseinterpretingthespecimenssubmittedforexamination.   ` TheTrialJudgesgrantofsummaryjudgmentwaspredicateduponhisdetermination"thattherecordfailstodemonstrateagenuineissueofmaterialfactregardingadeviationfromrecognizedstandardsofacceptableprofessionalpracticeonthepartofthemovingDefendantsoragenuineissueofmaterialfactregardingcausationofaninjurythatwouldnothaveotherwiseoccurredasaresultoftheactionsofthemovingDefendants."ThePlaintifffiledamotiontoalterandamend,specificallycallingtotheTrialCourtsattentionitsloanedservanttheory.TheTrialCourtdeniedthismotionwithoutcommentastothattheory.̀ 4 +.    ` Asalreadynoted,theTrialCourtsustainedtheDefendants'motionforsummaryjudgment,resultinginthisappealwhereinthreeissuesareraised:I. ` Woulditbeadenialofdueprocessifthetrial  courtrefusedtoapplytherecognizedstandardofreviewforamotionforsummaryjudgmentinanevenhandedmanner.II.Weretheredisputedissuesoffactpresentedastothedefendants'responsibilityforthenegligenceofanagentandtheindependentnegligenceofthesedefendants.A. @ Wasthecytotechnologistwhomisreadthe @ papsmearslidesubmittedonShirleyDannenholdtheagentand/orborrowedservantofDefendantCarterMiller,thepathologistwhoissuedthenegativereportashisdiagnosiswhenitisundisputedthatthereportofpapsmearresultsisamedicalopinionthatmustbeissuedbythepathologist,andfurtherevidencedemonstratesthatthecytotechnologistwasengagedinthebusinessofandwasunderthesupervisionofthepathologistatthetimesheperformedtheprescreenreadingoftheslide.B. @ Wasthereagenuineissueofmaterialfact p& presentedastotheindependentnegligenceofthedefendantswhenplaintiffpresentedaffidavitsfromaqualifiedpathologistthatdisputedthedefendants'interpretationoftheirdutyintheoperationofthislaboratoryandparticularizedseveralspecificdeviationsfromthestandardsofacceptableprofessionalpracticebythedefendants.III.WasthereagenuineissueofmaterialfactpresentedastowhetherthenegligenceofthedefendantscausedinjurytoShirleyDannenholdwhenplaintiffofferedexperttestimonyastohowthespecificdeviationsfromthestandardsofacceptablepracticecausedtheerroneousreporttobeissuedwithoutapathologists'sreview,anditisundisputedthatifapathologisthadreviewedtheslidethecancerwouldhavebeenreported,anditisfurtherundisputedthatthedelayindiagnosiscausedahighlycurable, noninvasivecancertoprogresstoaninvasive,terminal 09/3 cancerthathassinceclaimedthelifeofShirleyDannenhold.    ` ThefirstissueisdependentuponamotioninthisCourttosupplementtherecordwithproceedingsinanothercase.AmotiontomakethematerialapartoftherecordonappealwasdeniedbytheTrialCourt.ThemotionwaspredicateduponanunrelatedcasethatthePlaintiffperceivestobeaninconsistentrulingbythesametrialjudgeasinthiscase,whichfavoredthedefendantsinasummaryjudgmentmotionbytheplaintiffs,asdistinguishedfromgrantingtheDefendantsmotioninthiscase.   ` Inlightofourdispositionofthefirstpointunderissuetwoandourindependentreviewoftheremainingissues,wealsodenythemotion.   ` OurstandardforreviewofsummaryjudgmentissetoutinByrdv.Hall,847S.W.2d208,214(Tenn.1993),theleading P(! casebytheSupremeCourtonthesubject:   `  ` Rule56comesintoplayonlywhenthereisnogenuineissueastoanymaterialfactandthemovingpartyisentitledtoajudgmentasamatteroflaw.Thus,theissuesthatlieattheheartofevaluatingasummaryjudgmentmotionare:(1)whetherafactual 1P(+ disputeexists;(2)whetherthedisputedfactismaterialtotheoutcomeofthecase;and(3)whether 30*- thedisputedfactcreatesagenuineissuefortrial. 4 +.    ` TheforegoingauthoritymandatesthatnotwithstandingthecontraryproofplacedintherecordbytheDefendants,we  :04 adoptasthefactsnecessaryfordispositionofthisappealthefactscontainedintherecordandsetoutinthePlaintiff'sbrief,whichwehavecheckedforaccuracy.Wehave,however,editedthePlaintiffsstatementsofthefactsslightly,todeleteassertionsofundisputedproofastovariousfacts,andtodeletereferencetohearsaytestimonyofDr.GaryCooper,whichwedonotbelievewouldbeadmissibleastoasubstantiveissueattrial.Z K   3      ׀Footnotesintheportionofthebriefwequoteare   includedinthistext:   ` KnoxvillePathologyGroup,P.C.hasanexclusivecontractwithFortSandersRegionalMedicalCenter(hereinafterreferredtoas Hospital)toprovidemanagementservicesandphysiciancoverageforthepathologyandlaboratorydepartmentsofthehospital.Atalltimesmaterialtothisaction,Dr.BruceBellomyservedasthemedicaldirectorofthehospitalsonsitelaboratory.Thecytologydepartmentisthedepartmentofthelaboratorythatprocessespapsmearssubmittedtothehospitallaboratoryforexaminationanddiagnosis. ` TherewerethreecytotechnologistsemployedinthecytologydepartmentandthepathologistswhoweremembersofKnoxvillePathologyGroup,P.C.rotatedonadailybasisthedutyofthetechnicalsupervisorforcytology,whichisthemanagementpositionthatdirectlysupervisedthecytotechnologists,andthispathologistwouldalsorendertheopinionsonthediagnosticresultsofallpapsmearspecimenssubmittedforexaminationthatday.ThecytotechnologistswerepaidemployeesoftheHospital,butalargeportionoftheirtimewasspenteachdayperformingprescreenreadingsonslides,thereportsforwhichwouldbeissuedbymembersoftheKnoxvillePathologyGroup,P.C.astheirdiagnosticopinionsfortheslidessubmitted. p5,/ _ ` In1991andin1993papsmearslidesonShirleyDannenholdweresubmittedbyhergynecologisttothedefendantsforinterpretationinconnectionwithherroutinephysicalexaminations.Onbothoccasionstheslideswerereportedasnegativeforanycancercells.Subsequentreviewoftheseslidesdemonstratedthatbothslidesinfactdidshowadenocarcinomainsituthatshouldhavebeendetectedandreported. ` Mrs.Dannenholdsoughttreatmentfromadifferentphysicianinearly1994andherpapsmearsamplewassubmittedtoadifferentlaboratory,andhercancerdiagnosiswasreportedinJanuary1994.Treatmentensued,butatthetimeofdiagnosisthecancerhadalreadybecomeinvasive.InMayof1994Mrs.Dannenholdsawasegmentonthetelevisionnewsshow Primetimethatreportedlaboratorypracticesthathadcausedpositivepapsmearstobereportedasnegative.Shecontactedherformergynecologistandaskedwhetherherpreviousslidescouldbereviewedandherphysicianmadetherequesttodefendantsthatthisbedone.AtthetimeofthisrequestDr.GaryCooperhadjoinedthedefendantpathologygroupandafterhepulledMrs.Dannenholdsslidesfrom1991and1993heissuedasupplementalreportoftheamendeddiagnosistotheeffectthatboththe1991and1993slideswerepositiveforadenocarcinomainsituofthecervix. ` Thepathologistswhoissuedthe1991and1993reportsdidnotactuallyvieweitheroftheslides,butonbothoccasionsissuedthenegativediagnosisbyrelyingontheprescreenreadinggiventheslidesbyacytotechnologist.h K   4      ׀Thediagnosisofthepapsmearis `'  issuedonlyinthenameofthepathologistandthepatientischargedthesameforthepapsmeardiagnosis,regardlessofwhethertheslidewasactuallyreadbythepathologistorreportedbasedonlyontheprescreenreadinggivenbythecytotechnologist.Thecytotechnologistsshouldhaverecognizedtheslidestobeabnormalin1991andin1993andshouldhave -$' identifiedthemforfurtherreviewbythesupervisingpathologistwhowouldbeissuingthereportsforthatday.IfLouiseGeldmeierhadsimplynotedthepresenceof reactivechangeontheslide,theslideshouldhavebeendesignatedforreviewbyapathologist.Ifapathologisthadreadtheslidesoneitheroccasion,thediagnosisshouldhavebeenmadeandreportedtoMrs.Dannenholdsgynecologist.Ifthediagnosishadbeenmadeevenaslateas1993,whilethecancerwasstillastage1adenocarcinomaofthecervix,Mrs.Dannenholdwouldhaveexpectedacurerateof8590percent.Thedelayindiagnosisthatresultedfromtheerroneouspapsmearreportof1993causedMrs.Dannenholdshighlycurablecancertoprogresstoaninvasiveandterminalcancerthatwasexpectedtoclaimherlife.[ K   5            ` Astotheissueofloanedservantpresentedinthefirstpartofissuetwo,wefindthatofallthecasescitedbytheparties,thecaseofParkerv.VanderbiltUniversity,767  S.W.2d412,416(Tenn.App.1988),isthecasemorenearlyinpointfactuallytothecaseatbar.Inthatcase,atthetimeoftheallegednegligence,thesurgicalstaffatNashvilleGeneralHospital wasfurnishedbyVanderbiltUniversityunderacontractwithMetropolitanGovernmentofNashvilleandDavidsonCounty.OurCourtspecificallyaddressedtheloanedservantquestionasfollows: ` Anemployeeofoneemployermaybecometheservantofanotherandshifttheliabilityforhisnegligentactstothesecondemployer.SeeRichardsonv.Russom 0`'* CraneRentalCo.,543S.W.2d590(Tenn.Ct.App.1975). 1P(+ ThetesttodeterminewhetheranemployeeisaloanedservantofanotheremployerhasbeensetoutinGaston 30*- v.Sharpe,179Tenn.609,168S.W.2d784(1943).In 4 +. Gaston,thecourtsaid: p5,/  `6-0 Ҁ[A]servantataparticulartimemayremainunderthecontrolofhisgeneralemployerforsomepurposesandyetbeunderthecontrolofaspecialemployerforothers.Likewiseitsometimeshappensthataparticularworkinwhichtheservantisengagedmaybeproperlyconsideredastheworkorbusinessofboththegeneralemployerandthespecialemployer. Thequestionisdifficult.ItisconsideredatsomelengthinRestatementofAgency,!V Xh XXTX@!#TX@X XVXh:#Ԁ227.Wetake p  thefollowingfromRestatementasasatisfactoryrule: Sincethequestionofliabilityisalwaysraisedbecauseofsomespecificactdone,theimportantquestionisnotwhetherornotheremainstheservantofthegeneralemployerastomattersgenerally,butwhetherornot,astotheactinquestion,` heisacting` a ` ` a ` i` b nthebusinessofandunderb thedirectionofoneortheother.Itisnotconclusivethatinpracticehewouldbelikelytoobeythedirectionsofthegeneralemployerincaseofconflictoforders.Thequestionisastowhetheritisunderstoodbetweenhimandhisemployersthatheistoremainintheallegianceofthefirstastoaspecificact,oristobeemployedinthebusinessofandsubjecttothedirectionofthetemporaryemployerastothedetailsofsuchact.Thisisaquestionoffactineachcase.179Tenn.at614,168S.W.2dat786.   ` InthatcasetheCourtconcludedthat,althoughthequestionwhetheraservantofoneemployerhasbecometheservantofanotherisgenerallyaquestionoffactforthejury,theunambiguousagreementbetweenthepartiesmadeitaquestionoflaw,andthereafteropinedasfollows(atpage417): ` TheagreementbetweenVanderbiltandGeneralprovidesthattheresidents,asmembersofthemedicalstaff,wereaccountablesolelytoGeneral;GeneralhadtherighttoapprovetheassignmentofallmedicalstaffpersonnelandallresidentsweretobesupervisedbyandaccountabletoGeneral. ` .... 4:04  ` Inlightoftheundisputedtermsofthewrittenagreement,weholdthattheVanderbiltdoctorsweretheloanedservantsofGeneralatthetimeoftheoperationonMr.Parker.Therefore,anynegligenceonthepartofthesurgicalteamcouldnotbeimputedtoVanderbilt.   ` InthecaseatbarthecontractbetweenFortSandersandtheRadiologyGroupcontainednosuchspecificlanguage.   ` WealsonotethattheDefendantsweretheonesthatprovidedtheinstructionstothosetestingthepapsmearsastohowtheyweretobepreparedandweretoberead.   ` WeconcludeinlightofthefactthatthecontractbetweenFortSandersandKnoxvilleRadiologyGroupdidnotcontaintheunambiguousprovisionsaswerepresentinParker, "P thiscaseisdistinguishableandaquestionoffactispresentedastowhetherMs.GeldmeierwasaservantloanedbyFortSanderstotheDefendants.   ` Finallyastothisquestion,wepointoutthatundercertaincircumstancesanemployeemaybetheservantofageneralemployerandalsoaspecialemployer.Parker,supra. /p&)    ` Astothesecondpartofthesecondissue,itisundisputedthattheDefendantscompliedwiththeFederalClinicalLaboratoryImprovementAct,whichthePlaintiffsexperttestifiedwasmerelyacodificationofpriorlaw,andalthough 09/3 thisexpertalsotestifiedastoadeviationfromacceptedpracticeregardingreviewbyapathologist,hewaspredicatinghistestimonyonaninferencehedrewfromafactheassumed(cytotechnologistsmarkingsmadebythecytotechnologistwhenthe1993slidewasexamined),whichtherecordshowswithoutdisputewasnottrue.   ` Astothesecondsubsectionofissuetwo,theproofshowsthatunderregulationspromulgatedundertheCLIA,theDefendantshadadutytoadequatelysupervisethecytotechnologists,andtothisendtheregulationsrequirethatapathologistreviewarandomselectionoftenpercentofallslidesfoundbythetechnicianstobenegative.TheundisputedproofsupportstheDefendants'contentionthatthisrequirementwashonored.   ` ThePlaintiffsexpertalsofoundfaultwiththemethodusedbytheDefendantsinselectingthosenegativeslideswhichweretobereviewedbythepathologist.Theproofshowedthatthosethathadsomeindicationofabnormalitywereusedinthe10percentselectedratherthanthosethatunquestionablyappearednegative.TheexpertapparentlyreasonsthatMrs.Dannenhold'spapsmearwouldhavebeendrawnhadthemethodhesuggestedbeenemployed.WefindthatsuchaconclusionwouldbepurespeculationandthattheTrialCourtwascorrectinsustainingtheDefendantsmotionforsummaryjudgmentastothispoint.  :04    ` ThethirdissueattacksthefindingoftheCourtthatthereisno genuineissueofmaterialfactregardingcausationofaninjurythatwouldnothaveotherwiseoccurredasaresultoftheactionsofthemovingDefendants.ThetestimonyofDr.MatthewKohler,oneofthePlaintiffsexpertwitnesses,establishesthathadaproperdiagnosisbeenmadeasX toX Y aY Z theZ 1993papsmear,Mrs.Dannenholdhadanexcellentchanceofrecoveryandthathercureratewasintherangeof85to90percent.   ` FortheforegoingreasonsthejudgmentoftheTrialCourtisvacatedinsofarasitaddressestheloanedservanttheoryandremandedtotheTrialCourtforfurtherproceedingsnotinconsistentwiththisopinion.ThejudgmentoftheTrialCourtisaffirmedastoothertheoriesadvanced.CostsofappealareadjudgedonehalfagainstthePlaintiffandonehalfagainsttheDefendants.   `     h   _______________________________   `     h   HoustonM.Goddard,P.J.CONCUR:________________________________HerschelP.Franks,J.________________________________DonT.McMurray,J.SX?j XXTX `6-0 #TXX XSX?jR#^ [ [ ^ ] \ November\ \ 10,\ \ 1998\ ]