ÿWPCå 7# UN %k 0(qw@™4Ùíü 0¶ 0DºU:þU:8Lr¾ 0JÆ 0T 0^d 0h 0r* 0|œ 0† 0ž 1u. 0d£ AQ ÆX 0D 0@b 0D¢ Bæ D/ B2 D3O U>‚ U*À B)ê DC AMV£êªv~”vÓ˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLlÎ(ÈhH  Z 6Times New Roman RegularX($¡¡ <U=de>?E@AEBCDÓ€P ƒ‰#¾W3|xP(f(2V$¤¤Ý ƒ!ÝÝ  ÝÔ€ôMôXXÔÔ€ ô?²ôôôMÔÓ  Óà  àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó, øð AZ‹"Arial Regular, øð AZ‹"Arial RegularC:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ !"#%Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó d'''÷ÿ dxdüÿP Pd$$$$'ÿÿdxd< Œ 9p`(&Times New Roman< Œ 9p`(Arial% Line 7 d00007Border 1dd "1Cþÿ << Gÿÿ ýÝ ƒ!ÝÔ€.ÔÝ  ÝÝ ƒ!"ÝÝ  ÝÔ€/ÔÔ€/ÔÓ  ÓÔ YYY ÔFILEDÔ€/XÔÌÌò òDecember€10,€1997ÌÌCecil€Crowson,€Jr.ÌÔ€/ôÔAppellate€Court€Clerkó ó àÝ ƒ!ÝÑ#€d#ÑÔ€.ÔÝ  ÝÝ ƒ $ÝÔ€.ôÔÔ€/ÔÓ  Óà àòòÚ  ÚÚ  ÚóóÝ  Ý€We€note€that€the€order€in€limine€to€which€the€parties€refer€is€not€contained€in€the€record€onÏappeal.€€However,€because€both€parties€agreed€upon€the€existence€and€terms€of€the€order€and€becauseÏthe€trial€court€acted€to€enforce€the€order,€we€will€consider€this€issue€on€appeal.€€€€ÌPtPtHHÚ(ÿáÿâùFG(üHHØ(d'`Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  ion-F Geneva ÒÒ  ion-F Geneva ÒÝ ƒ!ÝÔ . ÔÔ€.ÔÝ  ÝÓ  ÓÑ\R AØ'\ÑÔ€/Ô›œ›Þ ÞÌà@ àò òIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÌà@ àWESTERN€SECTION€AT€JACKSONÌÌÌTERRI€DEMILT,à àà àà àà à)€€ÌÙ€ ÙœßR€231A1-j|°` Å `€€@ÿRß›à àà àà àà àà àà à)Ìà àà àó óPlaintiff/Appellee,à àà àò ò)€€Shelby€Circuit€No.€51669€T.D.Ìà àà àà àà àà àà à)ÌVS.à àà àà àà àà àà à)€€Appeal€No.€02A01„9611„CV„00283Ìà àà àà àà àà àà à)ÌMARY€MOSS,€M.D.,à àà àà à)Ìà àà àà àà àà àà à)Ìà àà àó óDefendant/Appellant.à àò ò)ó óÌÌÌà@ àAPPEAL€FROM€THE€CIRCUIT€COURT€OF€SHELBY€COUNTYÌà@ àAT€MEMPHIS,€TENNESSEEÌà@ àTHE€HONORABLE€GEORGE€H.€BROWN,€JR.,€JUDGEÌÌÌÌÌÌÌò òJERRY€E.€MITCHELLó óÌò òJOHN€H.€DOTSONó óÌò òTHOMASON,€HENDRIX,€HARVEY,ÌJOHNSON€&€MITCHELLÌó óMemphis,€TennesseeÌAttorneys€for€AppellantÌÌÌò òAL.€H.€THOMASó óÌò òIRA€M.€THOMASó óÌò òTHOMAS€&€THOMASÌó óMemphis,€TennesseeÌAttorneys€for€AppelleeÌÌÌÌÌò òREVERSED€AND€REMANDEDÌÌÌÌÌÌÌó óà àà àà àà àà àà àà àà àà àò òALAN€E.€HIGHERS,€J.ÌÌÌÌCONCUR:ÌÌW.€FRANK€CRAWFORD,€P.J.,€W.S.ÌÌDAVID€R.€FARMER,€J.ó óà àÌÌÌÌÓÓà àThis€is€an€appeal€from€a€jury€verdict€in€a€medical€malpractice€case.€€The€juryÏentered€Ñ7€ AÑ XXdæXXdð7Ña€judgment€in€favor€of€the€plaintiff€in€the€amount€of€$250,000,€and€the€trialÏcourt€ordered€a€remittur€in€the€amount€of€$95,000.€€Defendant€appealed€the€judgmentÏciting,€òòinter€aliaóó,€errors€in€jury€instructions.€€€For€the€reasons€stated€herein,€we€reverseÏand€remand€the€cause€to€the€trial€court€for€a€new€trial.€ÌÌà@ àò òFACTSÌó óà àOn€March€31,€1992,€Terri€DeMilt€(hereinafter,€ð ðMs.€DeMiltðð€or€ð ðPlaintiffðð)€enteredÏMethodist€Hospital€North€in€Memphis,€Tennessee,€for€induction€of€labor€and€delivery€ofÏher€fourth€child.€€Dr.€Penn€Joe,€an€Ob„Gyn,€had€treated€Ms.€DeMilt€throughout€herÏpregnancy,€and€on€March€31,€Ms.€DeMilt€was€cared€for€by€both€Dr.€Joe€and€his€partner,ÏDr.€Mary€Moss€(hereinafter,€ð ðDr.€Mossðð€or€ð ðDefendantðð),€also€an€Ob„Gyn.€€Dr.€MossÏexamined€Ms.€DeMilt€throughout€the€day€as€her€dilation€increased,€and€by€5:00€P.M.,ÏMs.€DeMilt€had€reached€a€full€dilation€of€10€centimeters.€€At€6:00€P.M.,€Dr.€MossÏassessed€the€patient€and€determined€that€Ms.€DeMilt€could€deliver€the€baby€vaginally.€ÍDr.€Moss€ordered€a€ð ðsitting€upðð€epidural€for€anesthesia€and€began€the€deliveryÏprocedure€at€6:15€P.M.€€At€6:23€P.M.,€Ms.€DeMilt€delivered€a€10€pound,€4€ounce€babyÏfollowing€a€fourth€degree€episiotomy€performed€by€Dr.€Moss.€€ÌÌà àMs.€DeMilt€was€discharged€from€the€hospital€a€few€days€after€the€delivery,€andÏon€April€28,€1992,€Dr.€Joe€examined€her.€€At€that€time,€Ms.€DeMilt€complained€of€ð ðlowerÏfemale€pain,€soreness,€stomach€soreness€...€€hemorrhoids,€headaches€and€nerves.ðð€€ÏOn€June€5,€1992,€DeMilt€visited€Dr.€Vance€Shappley€for€treatment€of€a€recurringÏurinary€tract€infection€and€difficulty€voiding€her€bladder.€€Dr.€Shappley€diagnosed€herÏas€having€urethral€stenosis,€or€narrowing€of€the€urethra.€€In€October,€1992,€DeMilt€wasÏexamined€by€Dr.€Joseph€DeFranco,€Jr.,€because€of€her€irregular€and€lengthenedÏmenstrual€periods€and€difficulty€with€bowel€movements.€€Subsequently,€DeMilt€visitedÏDr.€Michael€Thomas€because€of€fecal€incontinence.€ò òÌó óÌà àOn€February€8,€1993,€Ms.€DeMilt€filed€this€medical€malpractice€lawsuit€againstÏMethodist€Hospital,€Dr.€Penn€Joe,€Dr.€Mary€Moss€and€Sherree€Montgomery,€R.N.€€InÏthe€complaint,€Ms.€DeMilt€alleged€that€the€professional€negligence€of€defendants€in€theÏdelivery€of€the€child€resulted€in€injuries€to€her€bladder€and€bowels.€€€On€June€14,€1994,Ïthe€trial€court€granted€the€motion€for€summary€judgment€filed€by€Methodist€HospitalÏand€Sherree€Montgomery,€and€on€May€23,€1996,€the€trial€court€entered€an€order€ofÏvoluntary€non„suit€as€to€defendant€Dr.€Penn€Joe.€€€The€cause€proceeded€to€trial€in€May,Ï1996,€and€the€jury€returned€with€a€verdict€for€Ms.€DeMilt€for€$250,000.€€The€order€onÏthe€jury€verdict€was€entered€on€June€3,€1996.€€Thereafter,€Dr.€Moss€timely€filed€aÍmotion€for€a€new€trial€or€in€the€alternative€a€motion€to€alter€or€amend€the€judgment.€€OnÏJuly€22,€1996,€the€trial€court€entered€an€order€granting€a€remittur€in€the€amount€ofÏ$95,000,€thereby€reducing€the€total€judgment€to€$155,000.€€€Dr.€Moss€timely€filed€aÏnotice€of€appeal€on€August€7,€1996,€and€the€cause€is€properly€before€this€Court€forÏconsideration.€ò òÌó óÌà àOur€review€of€a€judgment€based€upon€a€jury€verdict€is€governed€by€Rule€13(d)ÏT.R.A.P.€Findings€of€fact€by€a€jury€in€civil€actions€shall€be€set€aside€only€if€there€is€noÏmaterial€evidence€to€support€the€verdict.€€€ÌÌà@ àò òISSUESó óà àÌà àAppellant€Moss€has€raised€the€following€issues€on€appeal:ÌÓÓà8 àI.€€Whether€the€trial€court€erred€in€presenting€an€allegedly€erroneous€juryÏinstruction€regarding€the€permanency€of€Ms.€DeMiltððs€injuries;€ÌÌà8 àII.€€Whether€the€trial€court€erred€in€presenting€an€allegedly€erroneous€juryÏinstruction€regarding€the€aggravation€of€Ms.€DeMiltððs€preexistingÏcondition€or€disability;€€ÌÌà8 àIII.€€Whether€the€Court€erred€in€failing€to€charge€the€jury€on€all€of€theÏelements€the€plaintiff€must€prove€to€carry€her€burden€of€proof€under€theÏmedical€malpractice€statute;Ìà8 àÌà8 àIV.€€Whether€the€trial€court€properly€charged€the€jury€on€proximateÏcausation;ÌÌà8 àV.€€Whether€the€trial€court€erred€in€failing€to€rule€on€defendantððs€motion€forÏpartial€directed€verdict€at€the€close€of€all€proof,€or€in€the€alternative,Ïwhether€the€trial€court€erred€in€effectively€denying€defendantððs€motion€forÏpartial€directed€verdict;€€ÌÌà8 àVI.€€Whether€plaintiffððs€attorney€improperly€argued€the€plaintiffððs€demandÍto€the€jury€in€contradiction€of€the€prohibition€set€out€in€T.C.A.€ðð€29„26„117Ï(1980);€€ÌÌà8 àVII.€€Whether€the€trial€court€erred€in€denying€defendantððs€motion€for€aÏmistrial€based€upon€plaintiffððs€counselððs€argument€to€the€jury€usingÏexcluded€testimony;€and€ÌÌà8 àVIII.€€Whether€the€jury€verdict€was€excessive€and€not€supported€by€theÏevidence€and€whether€the€trial€courtððs€remittur€was€inadequate.€€ÌÌÌà àAppellee€also€has€raised€issues€on€appeal,€and€they€are:ÌÌà àI.€€Whether€the€trial€court€erred€in€granting€a€remittur€of€the€juryððs€award€in€theÏà àamount€of€$95,000;€and€ÌÌà8 àII.€€Whether€the€trial€court€erred€in€striking€questions€posed€by€plaintiffððsÏcounsel€in€deposition€testimony€of€local€expert€witnesses€whichÏdemonstrated€bias€and€reluctance€to€testify€on€the€part€of€deponents.€Ì€ÌÌà@ àò òDISCUSSION€ó óÌÌà8 àò òWhether€the€trial€court€erred€in€presenting€an€allegedlyÏerroneous€jury€instruction€regarding€the€permanency€of€Ms.ÏDeMiltððs€injuries;€and€ÌÌà8 àWhether€the€trial€court€erred€in€presenting€an€allegedlyÏerroneous€jury€instruction€regarding€the€aggravation€of€Ms.ÏDeMiltððs€preexisting€condition€or€disability:ó ó€€ò ò€€ó óÌÌÓÓà àDefendant€asserts€that€Plaintiff€failed€to€introduce€evidence€regarding€both€theÏpermanency€of€her€injuries€and€the€aggravation€caused€to€her€preexisting€conditions.€ÏDefendant€asserts€that€as€a€result€of€such€omission,€the€judgment€should€be€reversed.€ÏIn€its€instructions€to€the€jury,€the€trial€court€stated:ÌÓÓà8 àà8 àAgain€on€the€question€of€damages,€I€charge€you€that€thereÏhas€been€evidence€introduced€before€you€upon€theÏquestion€of€the€effect€upon€the€plaintiff€due€to€the€nature€andÏpermanency€of€her€injuries.€€Now€I€charge€you€that€toÏwarrant€a€recovery€for€a€permanent€injury€the€future€effect€ofÍthe€injury€must€be€shown€with€reasonable€certainty.€€It€is€notÏnecessary€that€the€evidence€show€conclusively€or€without€aÏshadow€of€a€doubt€that€the€injuries€are€permanent€or€as€toÏthe€effect€upon€the€plaintiff,€but€while€absolute€certaintyÏshould€not€be€required€as€to€the€effect€of€a€permanentÏinjury,€a€mere€conjecture€or€even€a€probability€does€notÏwarrant€the€giving€of€damages€for€future€effects€of€disabilityÏwhich€may€never€occur€„„€which€may€never€exist.€€ÌÌà8 àà8 àNow,€ladies€and€gentlemen,€there€is€nothing€so€certain€asÏdeath€and€nothing€so€uncertain€as€life.€€You€are€not€toÏpresume€from€the€offer€of€the€mortality€table€that€this€ladyÏwill€live€a€longer€or€shorter€time€than€is€shown€by€the€table.€ÏThat€proof€was€offered€to€you€as€a€guide€along€with€theÏother€evidenceÌÌà8 à€offered€and€you€should€consider€it€as€such€when€you€come€to€considerÏthis€case€after€the€court€has€concluded€the€charge.€€Ìà àà àÌà àÌÓÓà àSimilarly,€the€trial€court€charged€the€jury€in€regard€to€the€aggravation€of€Ms.ÏDeMiltððs€preexisting€condition€as€follows:ÌÓÓà8 àà8 àA€person€who€has€a€condition€or€disability€at€the€time€of€anÏinjury€is€not€entitled€to€recover€damages€therefor;€however,Ïshe€is€entitled€to€recover€damages€for€any€aggravation€ofÏsuch€preexisting€condition€or€disability€proximately€resultingÏfrom€the€injury.€€This€is€true€even€if€the€personððs€condition€orÏdisability€made€her€more€€susceptible€to€the€possibility€of€illÏeffects€than€a€normally€healthy€person€would€have€beenÏand€even€if€a€normally€healthy€person€would€not€haveÏsuffered€any€substantial€injury.€€Where€a€preexistingÏcondition€or€disability€is€so€aggravated,€the€damages€as€toÏsuch€condition€or€disability€are€limited€to€the€additionalÏinjury€or€harmed€caused€by€the€aggravation.€€However,€ifÏthe€preexisting€condition€caused€no€harm€or€disabilityÏbefore€the€accident,€the€defendant€is€responsible€for€all€ofÏthe€harm€or€disability€caused€by€the€accident€even€though€itÏis€greater€because€of€the€preexisting€condition€than€it€mightÏotherwise€have€been.€€€€€Ìà àà àò òÌó óÌÌÓÓà àUpon€review€of€the€record€before€the€Court,€we€conclude€that€the€record€isÏlacking€in€testimony€regarding€the€permanency€of€Plaintiffððs€injuries.€€While€TennesseeÏlaw€does€not€require€that€the€evidence€show€conclusively€or€beyond€a€shadow€of€aÏdoubt€that€the€injuries€are€permanent,€the€future€effect€of€an€injury€must€be€shown€withÏreasonable€certainty€to€warrant€recovery.€€òòPorter€v.€Greenóó,€745€S.W.2d€874,€878€(Tenn.ÏApp.€1987);€òòWilliams€v.€Danielsóó,€344€S.W.2d€555,€559€(Tenn.€App.€1960).€€€€€€€ÌÌà àThe€Tennessee€Supreme€Court€held€in€òòWilson€v.€Tranbargeróó,€402€S.W.2d€449,Ï461€(Tenn.€1965),€that€there€must€be€evidence€in€the€record€to€support€an€issue€of€factÏbefore€the€jury€may€be€charged€as€to€the€law€on€that€issue.€€Specifically,€the€CourtÏheld,ÌÓÓà8 àà8 àIt€has€been€held€time€and€again€that:€ððthe€instructions€givenÏby€the€judge€to€the€jury€should€be€directly€applicable€to€theÏfacts€in€evidence.€€There€must€be€testimony€tending€to€raiseÏthe€question€in€order€for€an€issue€to€be€submitted€to€the€jury.€ÏAn€instruction€which€assumes€that€there€is€evidence€tendingÏto€prove€certain€facts,€when€there€is€no€such€evidence,€isÏerroneous.ðð€€Ìà àà àòòId.óó€at€461.€(Citations€omitted).€€€Ì€ÌÌÓÓà àIt€is€well€established€that€the€determination€of€the€issue€of€permanency€of€all€butÏthe€most€obvious€injuries,€such€as€loss€of€a€member,€is€within€the€realm€of€scientificÏknowledge.€€òòOwens€Illinois,€Inc.€v.€Laneóó,€576€S.W.2d€348,€350€(Tenn.€1978);€€€òòSandersÏv.€Johnsonóó,€859€S.W.2d€329,€331€(Tenn.€App.€1993).€€As€the€òòSandersóó€court€noted,ÏTennessee€does€recognize€an€exception€for€ð ðobvious€injuriesðð;€however,€there€hasÏbeen€no€showing€that€Ms.€DeMiltððs€injuries€fit€within€the€ð ðobvious€injuriesðð€exception€toÏpermanency.€€ÌÌà àThe€determination€of€whether€plaintiffððs€injuries€would€be€described€asÏpermanent€should€be€made€upon€the€testimony€of€qualified€experts.€€òòSandersóó,€859ÏS.W.2d€at€332.€€DeMilt€has€demonstrated€no€evidence€in€the€record€regarding€theÏpermanency€of€her€injuries,€and€we€find€that€it€is€reversible€error€for€the€trial€court€toÏhave€charged€that€the€jury€might€find€whether€the€injuries€were€permanent€in€theÏabsence€of€such€evidence.€€òòSandersóó,€859€S.W.2d€at€332€(Tenn.€App.€1993).€€ÌÌà àWe€decline€to€find,€however,€that€the€trial€court€committed€reversible€error€inÏregard€to€its€instruction€on€aggravation€of€Ms.€DeMiltððs€preexisting€conditions.€€WeÏhave€examined€the€evidence€and€find€that€the€record€contains€competent€testimonyÏfrom€Dr.€Ray€Sexton€who€testified€that€Ms.€DeMilt€had€a€preexisting€somatizationÏdisorder€which€could€have€been€aggravated€by€the€trauma€of€the€childbirth€andÏalleged€medical€malpractice€on€March€31,€1992.€€€A€jury€may€assign€whatever€weight€itÏchooses€to€that€testimony.€€Nonetheless,€in€light€of€this,€we€conclude€that€the€trial€courtÏcorrectly€charged€the€jury€in€regard€to€the€issue€of€€aggravation€of€a€preexisting€injury.€€ÌÌà àOn€appeal,€Ms.€DeMilt€maintains€that€the€trial€court€erred€in€excludingÏdeposition€testimony€from€various€treating€physicians€and€argues€that€said€testimony€isÏrelevant€to€issues€of€permanency€and€aggravation€of€preexisting€injuries.€€Upon€reviewÏof€Ms.€DeMiltððs€arguments,€we€do€not€find€that€the€trial€court€erred€in€excluding€thisÏtestimony.€Ì€ÌÓÓà8 àò òÌÌà8 àWhether€the€Court€erred€in€failing€to€charge€the€jury€on€all€ofÏthe€elements€the€plaintiff€must€prove€to€carry€her€burden€ofÏproof€under€the€medical€malpractice€statute:ÌÌÓÓó óà àDefendant€has€raised€as€the€third€issue€the€question€of€whether€the€trial€courtÏpresented€to€the€jury€all€the€elements€that€the€plaintiff€must€prove€under€theÏmalpractice€statute,€T.C.A.€ðð€29„26„115€(1980).€€That€section€states€in€pertinent€part:ÌÓÓà8 àà8 à(a)€In€a€malpractice€action,€the€claimant€shall€have€theÏburden€of€proving€by€evidence€as€provided€by€subsectionÏ(b):ÌÌà8 àà8 à(1)€The€recognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€the€specialty€thereof,€if€any,Ïthat€the€defendant€practices€in€the€community€in€which€heÏpractices€or€in€a€similar€community€at€the€time€the€allegedÏinjury€or€wrongful€action€occurred;Ìà8 àà8 à(2)€That€the€defendant€acted€with€less€than€or€failed€to€actÏwith€ordinary€and€reasonable€care€in€accordance€with€suchÏstandard;€€andÌà8 àà8 à(3)€As€a€proximate€result€of€the€defendant's€negligent€act€orÏomission,€the€plaintiff€suffered€injuries€which€would€notÏotherwise€have€occurred.Ìà àà àT.C.A.ðð€29„26„115(a)(1980).Ìà à€ÌÓÓDr.€Moss€asserts€that€the€trial€court€charged€the€jury€on€the€elements€of€a€generalÏnegligence€claim€and€not€on€the€elements€of€a€medical€malpractice€claim€as€definedÏby€statute.€€Moss€asserts€that€under€òòStreet€v.€Calvertóó,€541€S.W.2d€576€(Tenn.€1976),Ïthe€trial€court€is€bound€to€instruct€the€jury€upon€every€issue€of€fact€and€theory€of€theÏcase€raised€by€the€pleadings€and€supported€by€the€proof.€€In€its€jury€charge,€the€trialÏcourt€stated€in€pertinent€part:ÌÓÓà8 àà8 àWhere€a€defendant€files€a€plea€of€general€denial,€as€hasÏbeen€done€in€this€case,€or€special€pleas€denying€each€andÏevery€material€allegation€of€the€plaintiffððs€case,€then€the€lawÍsteps€in€and€places€upon€the€plaintiff€the€burden€ofÏsupporting€and€making€out€her€case€upon€every€issue,Ïevery€material€issue€in€controversy€by€the€greater€weight€orÏpreponderance€of€the€evidence.€€ÌÌà8 àà8 àNumber€one,€that€the€defendant€was€negligent.€€Two,€thatÏthe€defendantððs€negligence€was€the€proximate€cause€of€theÏinjuries€and€damages€to€the€plaintiff.€€And,€three,€the€natureÏand€extent€of€the€injuries€claimed€to€have€been€suffered.€€Ìà àà àÌÌà àThe€trial€court€further€charged€the€jury€as€follows:ÌÌà8 àà8 àIn€performing€professional€services€for€a€patient,€aÏphysician€or€surgeon€has€the€duty€to€have€that€degree€ofÏlearning€and€skill€ordinarily€possessed€by€physicians€andÏsurgeons€of€good€standing€practicing€in€the€same€or€similarÏlocality€and€under€similar€circumstances.€€It€is€further€theÏduty€of€a€physician€or€surgeon€to€use€the€care€and€skillÏordinarily€exercised€in€like€cases€by€reputable€members€ofÏhis€or€her€profession€practicing€in€the€same€or€similarÏlocality€under€similar€circumstances€and€to€use€reasonableÏdiligence€and€oneððs€best€judgment€in€the€exercise€of€skill€inÏthe€application€of€his€or€her€learning€in€an€effort€toÏaccomplish€the€purpose€for€which€he€or€she€is€employed.€€AÏfailure€to€do€so€is€a€form€of€negligence€called€malpractice.€€ÌÌà8 àà8 àA€surgeon€who€holds€herself€out€as€a€specialist€in€aÏparticular€field€of€medical€science€or€limits€her€practice€to€aÏparticular€speciality€has€a€duty€to€possess€and€exercise€thatÏdegree€of€skill,€care,€and€learning€ordinarily€possessed€andÏexercised€in€similar€cases€by€members€of€good€standing€ofÏthe€profession€who€specialize€in€the€same€field€of€medicineÏand€practice€in€the€same€or€similar€locality.€€ÌÌà8 àà8 àA€physician€or€surgeon€is€not€negligent€simply€because€herÏefforts€prove€unsuccessful.€€It€is€possible€for€a€physician€or€aÏsurgeon€to€err€in€judgment€or€to€be€unsuccessful€in€herÏtreatment€without€being€negligent.€€By€undertakingÏtreatment€she€does€not€guarantee€a€good€result,€òòbut€she€isÏresponsible€for€an€injury€to€her€patient€resulting€from€herÏlack€of€the€requisite€knowledge€and€skill€and€for€her€failureÏto€exercise€reasonable€care€or€to€use€her€best€judgment.óó€€ÌÌà àà à.€.€.€.€.ÌÌà8 àà8 àYou€must€determine€the€standard€of€professional€learning,Ïskill,€and€care€required€of€the€defendant€only€from€theÏopinions€of€the€physicians€and€surgeons€including€theÏdefendant€who€have€testified€as€expert€witnesses€about€thatÏstanding....Ìà àà àÌÌÓÓà àT.C.A.€ðð€29„26„115(a)€requires€that€a€plaintiff€prove€(1)€the€applicable€standardÏof€acceptable€professional€practice;€(2)€that€defendant€failed€to€adhere€to€thatÏstandard;€and€(3)€that€the€plaintiff€suffered€injuries€that€would€not€otherwise€haveÏoccurred€but€for€the€defendantððs€failure.€€It€appears€to€the€Court€that€the€trial€court,€in€itsÏjury€instructions,€covered€the€necessary€factors€under€T.C.A.€ðð€29„26„115(a).€€As€notedÏby€this€Court€in€òòHurst€by€Hurst€v.€Doughertyóó,€800€S.W.2d€183€(Tenn.€App.€1990),€theÏspecific€portion€of€the€charge€complained€of€must€be€viewed€in€context,€and€althoughÏthe€charge€must€be€substantially€accurate,€it€need€not€be€perfect€in€every€detail.€€òòId.óó€atÏ186;€See€also,€òòMitchell€v.€Smithóó,€779€S.W.2d€384€(Tenn.€App.1989).€€The€juryÏinstructions,€when€fully€considered,€meet€the€requirements€of€T.C.A.€ðð€29„26„115(a).€€ÏIn€addition€to€meeting€the€requirements€of€subsection€(a),€the€jury€must€also€beÏcharged€in€regard€to€T.C.A.€ðð€29„26„115(d)€(1980)€which€expressly€states:€€ÌÓÓà8 àà8 à(d)€In€a€malpractice€action€as€described€in€subsection€(a)€ofÏthis€section,€the€jury€shall€be€instructed€that€the€claimant€hasÏthe€burden€of€proving,€by€a€preponderance€of€the€evidence,Ïthe€negligence€of€the€defendant.€€The€jury€shall€be€furtherÏinstructed€that€injury€alone€does€not€raise€a€presumption€ofÏthe€defendant's€negligence.Ìà àà àT.C.A.€ðð€29„26„115(d)€(1980).ÌÌÌà àIn€making€the€jury€charge,€the€trial€court€stated€in€relevant€part:ÌÌà8 àà8 àWhere€a€defendant€filed€a€plea€of€general€denial,€as€hasÏbeen€done€in€this€case,€or€special€pleas€denying€each€andÏevery€material€allegation€of€the€plaintiffððs€case,€then€the€lawÏsteps€in€and€òòplaces€upon€the€plaintiff€the€burden€ofÏsupporting€and€making€out€her€case€upon€every€issue,Ïevery€material€issue€in€controversy€by€the€greater€weight€orÏpreponderance€of€the€evidence.óó€€ÌÌà8 àà8 àNumber€one,€that€the€defendant€was€negligent.€€Two,€thatÏthe€defendantððs€negligence€was€the€proximate€cause€of€theÏinjuries€and€damages€to€the€plaintiff.€€And,€three,€the€natureÏand€extent€of€the€injuries€claimed€to€have€been€suffered.€€Ìà àà à(Emphasis€Added).€€€€€€€€€€à à€€Ìà àà à.€.€.€.€.ÌÌà8 àà8 àThe€court€further€instructs€you,€ladies€and€gentlemen€of€theÏjury,€that€the€òògreater€weight€or€the€preponderance€of€theÏevidenceóó€in€the€case€is€not€alone€determined€by€the€numberÏof€witnesses€testifying€to€a€particular€fact€or€to€a€particularÏstate€of€facts€but€rather€depends€on€the€weight,€credit,€andÏvalue€of€the€total€evidence€on€either€side€of€the€issue€and€ofÏthis,€you,€jurors,€are€the€exclusive€judges.ÌÌà8 àà8 àòòThe€term€preponderance€of€the€evidence€means€theÏamount€of€factual€information€presented€to€you€in€this€trialÏwhich€is€sufficient€to€cause€you€to€believe€that€the€allegationÏis€probably€true.€€In€order€to€preponderate,€the€evidenceÏmust€have€the€greater€convincing€effect€in€the€formation€ofÏyour€beliefóó....Ìà àà à(Emphasis€Added).€€ÌÌÌÓÓà àIt€appears€to€the€Court€that€the€trial€court€correctly€instructed€the€jury€in€regard€toÏthe€first€part€of€subsection€(d),€requiring€that€the€jury€be€instructed€that€the€plaintiff€mustÏprove€the€defendantððs€negligence€by€a€preponderance€of€the€evidence.€However,€weÏfind€that€the€trial€court€incorrectly€instructed€the€jury€in€regard€to€the€second€part€ofÏsubsection€(d),€which€requires€that€the€jury€be€charged€that€the€injury€does€not€raise€aÏpresumption€of€negligence.€€The€Court€stated:ÌÓÓà8 àà8 àA€physician€or€surgeon€is€not€negligent€simply€because€herÏefforts€prove€unsuccessful.€€It€is€possible€for€a€physician€or€aÏsurgeon€to€err€in€judgment€or€to€be€unsuccessful€in€herÏtreatment€without€being€negligent.€€By€undertakingÏtreatment€she€does€not€guarantee€a€good€result,€but€she€isÏresponsible€for€an€injury€to€her€patient€resulting€from€herÏlack€of€the€requisite€knowledge€and€skill€and€for€her€failureÏto€exercise€reasonable€care€or€to€use€her€best€judgment.€€Ìà àà àÌÌÓÓà àWhile€the€instruction€might€suggest€to€one€that€a€physician€is€not€negligentÏsimply€because€there€is€an€injury,€we€do€not€find€that€the€instruction€meets€the€expressÏrequirements€of€the€statute€which€requires€that€the€jury€be€instructed€that€they€are€notÏto€presume€negligence€simply€because€of€the€existence€of€an€injury.€€In€light€of€theÏforegoing,€we€are€forced€to€conclude€that€the€trial€courtððs€jury€instructions€were€in€error.€€ÌÌÓÓà8 àò òWhether€the€trial€court€properly€charged€the€jury€on€proximateÏcausation:ó óÌÌÓÓà àDefendant€asserts€that€the€trial€court€erred€in€its€charge€to€the€jury€in€regard€toÏproximate€causation.€€During€a€break€in€the€proceedings,€Defendantððs€attorneyÏinformed€the€trial€court€that€it€had€not€given€the€proper€charge€on€proximate€causation.€ÏThe€Court€then€gave€the€following€instruction:ÌÓÓà8 àà8 àThe€law€in€Tennessee€sets€out€two€requirements€toÏdetermine€whether€an€act€or€omission€was€a€proximateÏcause€of€an€injury€or€damage.€€Number€one,€the€conductÏmust€have€been€a€substantial€factor€in€bringing€about€theÏharm€being€complained€of.€€And,€number€two,€the€harmÏgiving€rise€to€the€action€could€have€been€reasonablyÏforeseen€and€anticipated.€€To€be€a€proximate€cause€of€anÏinjury€there€is€no€requirement€that€the€cause€be€the€onlyÏcause,€the€last€act€or€the€one€nearest€to€the€injury€so€long€asÏit€is€a€substantial€factor€in€producing€the€injury€or€damage.€€Ìà àà àÌÓÓUpon€examination€of€the€definition€we€find€that€the€trial€court€committed€no€error€in€itsÏcharge€to€the€jury€on€the€definition€of€proximate€causation.€€As€the€TennesseeÏSupreme€Court€held€in€òòMcClenahan€v.€Cooleyóó,€806€S.W.2d€767,€775€(Tenn.€1991),Ïð ð[T]here€is€no€requirement€that€a€cause,€to€be€regarded€as€the€proximate€cause€of€anÏinjury,€be€the€sole€cause,€the€last€act,€or€the€one€nearest€to€the€injury,€provided€it€is€aÏsubstantial€factor€in€producing€the€end€result.ðð€€òòId.óó€at€775.€€While€the€trial€courtððsÏdefinition€of€proximate€causation€was€not€that€propounded€by€the€Tennessee€PatternÏJury€Instructions€as€Defendant€asserts€it€should€have€been,€it€appears€to€this€Court€thatÏthe€definition€of€ÌÌproximate€causation€is€that€approved€by€our€Supreme€Court.€€Accordingly,€we€find€noÏerror€in€this€regard.€ÌÌÓÓà8 àò òWhether€plaintiffððs€attorney€improperly€argued€the€plaintiffððsÏdemand€to€the€jury€in€contradiction€of€the€prohibition€set€outÏin€T.C.A.€ðð€29„26„117;€and€ó ó€€€€ÌÌò òà8 àWhether€the€trial€court€erred€in€denying€defendantððs€motionÏfor€a€mistrial€upon€plaintiffððs€counselððs€argument€to€the€juryÏusing€excluded€testimony:€€ó óà àÌÌÓÓà àDr.€Moss€asserts€that€Ms.€DeMiltððs€counsel€committed€reversible€error€in€hisÏclosing€argument€to€the€jury€when€he€referred€to€the€demand.€€Specifically,€counselÏstated:ÌÓÓà8 àà8 àSo€then,€you€have€to€decide,€you€have€to€decide€what€isÏsomething€like€this€worth.€€And€there€is€nobody€you€can€goÏto.€€Ìà8 àà8 àWell,€number€one,€you€start€out€with€it€has€been€four€yearsÏsince€this€happened€to€her€and€so€you€can€decide,€well€forÍthose€four€years€I€think€she€ought€to€have€$50,000.00€aÏyear.€€You€may€pick€more,€you€may€pick€less....Ìà àà àÌÌÓÓà àT.C.A.€ðð€29„26„117€(1980),€sets€forth€the€parameters€regarding€the€admissibilityÏof€a€plaintiffððs€demands.€€That€section€states:ÌÓÓà8 àà8 àIn€a€medical€malpractice€action€the€pleading€filed€by€theÏplaintiff€may€state€a€demand€for€a€specific€sum,€but€suchÏdemand€shall€not€be€disclosed€to€the€jury€during€a€trial€ofÏthe€case;€notwithstanding€the€provisions€of€ðð€20„9„302€toÏthe€contrary.Ìà àà àT.C.A.€ðð€29„26„117€(1980).à àÌÌÓÓà àIn€the€ad€damnum€section€of€her€complaint,€Ms.€DeMilt€made€the€followingÏprayer€for€relief:ÌÓÓà8 àà8 àWHEREFORE€PLAINTIFF€demands€judgment€forÏcompensatory€damages€against€the€Defendants€in€theÏamounts€as€follows:Ìà8 àà8 à1.à àCompensatory€damages€for€pain€and€suffering€„€bothÏphysical€and€mental€„€and€medical€expenses€as€to€PlaintiffÏTerri€DeMilt€in€the€amount€of€TEN€MILLION€DOLLARSÏ($10,000.000.00).€€€Ìà àà àÌÌÓÓà àReview€of€the€record€on€appeal€reveals€that€Ms.€DeMiltððs€counsel€stated€in€hisÏclosing€argument€to€the€jury:ÌÓÓà8 àà8 àNow,€this€being€a€medical€malpractice€action,€ourÏlegislature€some€years€ago€passed€a€rule€that€in€a€medicalÏmalpracticeÌÌà8 à€case€the€lawyer€canððt€tell€you€how€much€he€is€suing€for,€so€I€canððt€tell€youÏhow€much€we€are€suing€for.€€Ìà àà àÌÌÓÓà àThe€lawyer€then€went€on€to€present€the€argument€cited€above€which€containedÏthe€reference€to€an€award€of€$50,000€annually.€€In€òòGuess€v.€Mauryóó,€726€S.W.2d€906Í(Tenn.€App.€1986),€this€Court€addressed€a€similar€situation€to€that€in€the€instant€case.€ÏIn€that€case,€the€attorneyððs€reference€to€the€action€as€a€ð ðmulti„million€dollarðð€case€wasÏin€direct€contravention€of€the€trial€courtððs€order€to€the€contrary,€and€this€Court€held€thatÏsuch€action€was,€òòinter€aliaóó,€grounds€for€a€new€trial.€€òòId.óó€at€920.€€As€in€òòGuessóó,€theÏattorneyððs€reference€to€a€dollar€figure€in€his€closing€argument€in€this€case€likely€had€itsÏeffect€upon€the€jury€because€the€suggestion€of€$50,000€annually€in€damages€for€theÏprevious€four€years€is€quite€close€to€the€$250,000€amount€of€damages€that€the€juryÏactually€awarded.€€Obviously,€DeMiltððs€attorney€did€not€violate€the€letter€of€the€law€byÏstating€the€exact€figure€contained€in€the€ad€damnum€clause.€€However,€uponÏconsideration€of€the€foregoing,€we€conclude€that€this€is€a€further€reason€for€a€new€trial.ÌÌà àDr.€Moss€submits€that€DeMiltððs€counsel€compounded€his€misconduct€by€usingÏexcluded€testimony€when€making€his€closing€argument€to€the€jury€and€that€the€trialÏcourt€erred€in€denying€a€mistrial€upon€said€basis.€€Prior€to€the€trial,€the€trial€court€hadÏordered€that€certain€evidence€be€excluded€from€evidence,€including€a€part€of€Dr.ÏJoseph€DeFrancoððs€deposition€dealing€with€Ms.€DeMiltððs€diabetes.€€Plaintiffððs€counselÏread€from€the€transcript€of€Dr.€DeFrancoððs€excluded€testimony€during€the€rebuttal€onÏclosing€argument€.€€In€reading€the€excluded€testimony€to€the€jury,€Plaintiffððs€counselÏallegedly€violated€the€order€in€limine× ƒ4 ××  ×.€€Following€closing€arguments,€the€trial€courtÏinstructed€the€jury€not€to€consider€the€part€of€the€deposition€testimony€read€to€them€byÏPlaintiffððs€counsel.€€Dr.€Moss€asserts€that€said€instruction€was€insufficient€to€cure€theÍharm€done€when€the€excluded€testimony€was€read€to€the€jury.€€We€disagree.€€ÌÌà àWhile€it€was€error€for€Plaintiffððs€counsel€to€read€from€the€excluded€testimony,€weÏdecline€to€find€that€the€error€was€of€such€magnitude€to€warrant€granting€a€mistrial.€ÏUpon€review€of€the€entire€record,€we€find€that€during€closing€argument,€it€was€Dr.€MossððÏcounsel€who€first€broached€the€subject€of€Ms.€DeMiltððs€diabetes€by€reading€from€Dr.ÏThomasðð€deposition€testimony.€€Plaintiffððs€counsel€merely€sought€to€rebut€saidÏargument.€€We€find€that€the€inadvertent€introduction€of€six€lines€of€excluded€testimonyÏfrom€Dr.€DeFranco€was€harmless€and€was€cured€by€the€trial€courtððs€subsequentÏinstruction€to€the€jury.€€Accordingly,€we€find€that€the€trial€court€did€not€err€in€denying€Dr.ÏMossðð€motion€for€a€mistrial.€€€€€€€€€€€€ÌÓÓÌà8 àò òWhether€the€trial€court€erred€in€striking€questions€posed€byÏplaintiffððs€counsel€in€deposition€testimony€of€local€expertÏwitnesses€which€demonstrated€bias€and€reluctance€to€testifyÏon€the€part€of€deponents:ó óÌÌÓÓà àOn€appeal,€Ms.€DeMilt€has€raised€as€an€issue€the€question€of€whether€the€trialÏcourt€erred€in€striking€questions€posed€by€her€attorney€to€Dr.€Mossðð€expert€witnessesÏwhich€DeMilt€claims€show€bias€on€the€part€of€the€deponents.€€Specifically,€Ms.€DeMiltÏargues€that€she€should€have€the€opportunity€to€demonstrate€to€the€jury€that€a€physicianÏwitness€may€be€biased€because€he€or€she€is€insured€by€the€same€carrier€as€theÏdefendant.€€Evidently,€Dr.€Moss€and€four€of€her€expert€witnesses€are€insured€by€theÏsame€company.€€Ìà àThis€Court€has€addressed€this€issue€on€numerous€occasions€and€hasÏconcluded€that€it€is€not€error€for€a€trial€court€to€exclude€testimony€on€the€issue€ofÍinsurance€coverage.€€òòPatton€v.€Roseóó,€892€S.W.2d€410€(Tenn.€App.€1994);€òòRoberson€v.ÏNethertonóó,€No.€01A01„9310„CV„00470€(Tenn.€App.€May€4,€1994).€€Plaintiff€asserts€thatÏshe€should€have€been€allowed€to€introduce€this€evidence€to€show€bias€or€prejudice€onÏthe€part€of€the€witness€testifying€in€favor€of€the€defendants.€€Admissibility€of€evidenceÏrests€within€the€sound€discretion€of€the€trial€court€and€will€not€be€disturbed€on€appeal€inÏthe€absence€of€an€abuse€of€that€discretion.€€From€our€examination€of€this€record,€weÏcannot€say€that€the€trial€court€abused€its€discretion€by€excluding€the€evidence.€€òòPattonÏv.€Roseóó,€892€S.W.2d€410,€414„15€(Tenn.€App.€1994).€€Trial€courts€have€broadÏdiscretion€in€ruling€on€evidentiary€matters,€and€in€the€absence€of€a€clear€abuse€ofÏdiscretion,€the€trial€courtððs€decision€will€not€be€overturned€on€appeal.€Ì€€€€€Ìà àIn€light€of€the€foregoing€disposition€of€the€issues€in€this€cause,€we€do€not€find€itÏnecessary€to€address€the€remaining€issues€raised€by€the€parties€because€such€issuesÏhave€been€pretermitted.€€The€judgment€of€the€trial€court€is€reversed,€and€the€cause€isÏremanded€to€the€trial€court€for€a€new€trial.€€€œCosts€are€adjudged€against€theÏplaintiff/appellee,€for€which€execution€may€issue,€if€necessary.›€ÌÌÓÓà àà àà àà àà àà àà àà àà àòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ïóóà àà àà àà àà àà àà àà àà àHIGHERS,€J.ÌÌÌÌCONCUR:ÌÌÌÌòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÌóóCRAWFORD,€P.J.,€W.S.ÌÌÌÌòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÌFARMER,€J.Ì