ÿWPCž/ ¶…ˆMÞË»jj/w`]£:õ1–/àÓU\Ø»oj#bÁ¡­Úøa :ÊÑÄÔ7#·Â=_­#ò° ý>b2 8sGQ­Ä„x”-¶Ù»%1ÖåsÆJ{Júµh CÌfzÀeGWøÔFŒ2Æ7ìeDž·7­ñt‰î½ŽíÉÔ tj †U‘ݺ/ª±æÄ…-Š6!^ ì1ðƒû;ð} 0Ú»…©B >…¼Ælà'¡´mɉ‘;–§Ùã[©É…T¸æŸÄ¢Ö|è·Hå3ÿlÛÁ?ÑJŠ¢]úa~Ä’Ìæ8Râ‡`XK•ÔTÕªÞþmÐFõÀOϽècEÈŸº´’ÛšïÎãÆðµý¸PpÃÀ‹¶ðú^2‘p¬/9™›¼fFÎ C>•À4KŸµË²)å'kêŒÌ͇æÂaÀL•*ŠÜÓ]çÏŸèʵÌM~r¾Iž5Ó#ã i¡=5é›8”î®^¾6NâR~¸iøý¿1â!G ¬EÕÍ>C¨U"±•<™=ú™”FäQÿÖ|}Ïé¤ôšAQÎ2½Bë‚èq™F)–Ø’{ìŒ=Pó[Ðh.Í ¼%õÅCñiQUad—Òµ¦ Oeµb#É\ %% UN+ 0ˆy UN ^ O w[ z_ ÒÙ 4« ¿ Î mÐ Æç Æ­ ÆsÆ9 0DÿNCC¬EEñšób“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“*“* 0ë›*›*›*›* B†+†+ 0¤£+ D3G, D-z, 0K§,§, ASò,ÆE- 0¤ . 0D¯. A«ó.˜\\IB01S02\CLERKJACÈÈ,,,,ÈÈ0»(ÖÃ9 Z‹6Times New Roman Regular(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman RegularŒb1Ï  ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt6hö0ê:i¢×+003|xÿU‹ÿÀÀÀLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5(#Ã$òòÚ  Ú0Ú  Úóó ¢Ý ƒR™Ñ$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô¨<ò»»ÔÝ  ÝÔ_Ôà ` àOn€April€12,€2000,€after€the€death€of€Ô_ÔSauterÔ_Ô,€a€consent€order€was€entered€substituting€Margaret€Ô_ÔSauterÔ_Ô,Ð ° Ðexecutrix€of€Ô_ÔSauterÔ_Ôððs€estate,€as€a€party€to€the€lawsuit.€ Ý ƒR™Ñ$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ô¨<ò»»ÔÝ  ÝÔ_Ôà ` àOn€August€2,€2000,€Dubois€amended€her€complaint€to€add€Super€D€Drugs€Acquisition,€Co.€(ð ðSuperÐ ° ÐDðð),€Stephen€L.€Ô_ÔLafranceÔ_Ô€Holdings,€Inc.,€Stephen€L.€Ô_ÔLafranceÔ_Ô€Pharmacy,€Inc.,€Ô_ÔSAJÔ_Ô€Distributors,€Inc.,€Ô_ÔSAJÔ_Ô€Enterprises,Ð qÁ ÐInc.,€M€&€H€Drugs€Franchising,€Inc.,€and€USA€Drugs,€Inc.€as€defendants.€€Subsequently,€the€trial€court€held€a€hearingÐ 2‚ Ðon€M€&€H€Drugððs€motion€to€dismiss€or€for€summary€judgment€and€granted€such€motion€pursuant€to€the€applicable€statuteÐ óC Ðof€repose€and€Tenn.€R.€Civ.€P.€54.02.€€Though€the€trial€court€order€dismissing€Duboisðð€complaint€stated€such€action€wasÐ ´ Ðdismissed€as€against€M€&€H€Drug,€we€presume€that€such€order€dismissed€the€action€against€all€added€defendants,€becauseÐ uÅ Ðthey€no€longer€appear€as€parties€in€the€record€and€are€not€parties€to€this€appeal.€€ üÝ ƒR™Ñ$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô¨<ò»»ÔÝ  ÝÔ_Ôà ` àSpecifically,€we€note€that€the€following€trial€exhibits€support€Brownððs€conclusion€that€Ô_ÔTegretolÔ_Ô€reducedÐ ° Ðthe€efficacy€of€the€oral€contraceptives:€Ô_ÔMicromedexÔ_Ô(R)€(stating€ð ðAdverse€Effect:€decreased€contraceptive€effectivenessðð),Ð qÁ ÐEpilepsia,€April€2002,€ð ðThe€importance€of€drug€interactions€in€epilepsy€therapyðð€(stating€ð ð[Ô_ÔantiepilepticÔ_Ô€drugs]€alsoÐ 2‚ Ðenhance€the€metabolism€of€many€other€drugs€(e.g.,€oral€contraceptives,€antidepressants,€and€warfarin)€so€that€therapeuticÐ óC Ðefficacy€of€Ô_ÔcoadministeredÔ_Ô€drugs€is€lost€unless€the€dosage€is€increasedðð),€Clinical€Ô_ÔPharmacokineticsÔ_Ô,€2002,€ð ðTreatmentÐ ´ Ðof€epilepsy€in€women€of€reproductive€age:€Ô_ÔpharmacokineticÔ_Ô€considerationsðð€(stating€ð ð[Ô_Ôd]rugÔ_Ô€interactions€betweenÐ uÅ Ðenzyme„inducing€[Ô_ÔantiepilepticÔ_Ô€drugs]€and€contraceptives€are€well€documentedðð),€Drug€Safety,€January„February€1991,Ð 6 † Ðð ðRisk„benefit€assessment€of€Ô_ÔanticonvulsantsÔ_Ô€in€women€of€child„bearing€potentialðð€(stating€ð ð[Ô_Ôa]nticonvulsantsÔ_Ô€which€areÐ ÷ G Ðliver€enzyme€inducers€(Ô_ÔphenytoinÔ_Ô,€phenobarbital,€Ô_ÔprimidoneÔ_Ô€and€Ô_ÔcarbamazepineÔ_Ô)€reduce€the€efficacy€of€the€oralÐ ¸  Ðcontraceptive€pillðð),€Advances€in€Contraception,€December€1991,€ð ðOral€contraceptive€steroidsð!ðpharmacological€issuesÐ y É  Ðof€interest€to€the€prescribing€physicianðð€(stating€ð ð[Ô_Ôe]nzymeÔ_Ô„inducing€agents€such€as€Ô_ÔrifampicinÔ_Ô,€phenobarbitone,Ð : Š  ÐÔ_ÔphenytoinÔ_Ô€and€Ô_ÔcarbamazepineÔ_Ô€reduce€blood€levels€of€the€[oral€contraceptive€steroids]€leading€to€contraceptive€failureðð),Ð û K  ÐMayo€Clinic€Proceedings,€October€1996,€ð ðEpilepsy€in€womenðð€(stating€ð ðthe€contraceptive€failure€rate€increases€fourfoldÐ ¼  Ðif€patients€are€being€treated€concurrently€with€enzyme„inducing€Ô_ÔantiepilepticÔ_Ô€drugsðð),€Clinical€Ô_ÔPharmacokineticsÔ_Ô,€JuneÐ }Í   Ð1990,€ð ðÔ_ÔPharmacokineticÔ_Ô€Drug€Interactions€with€Oral€Contraceptivesðð€(stating€ð ð[a]€number€of€Ô_ÔanticonvulsantsÔ_ÔÐ ° Ð(phenobarbital,€Ô_ÔphenytoinÔ_Ô,€Ô_ÔcarbamazepineÔ_Ô)€are€enzyme„inducing€agents€and€thereby€increase€the€clearance€of€the€oralÐ qÁ Ðcontraceptive€steroidsðð€and€ð ð[Ô_Ôt]hereÔ_Ô€are€Ô_ÔpharmacokineticÔ_Ô€drug€interactions€with€oral€contraceptives€of€definite€clinicalÐ 2‚ Ðrelevance€(Ô_ÔanticonvulsantsÔ_Ô,€Ô_ÔrifampicinÔ_Ô)€because,€in€the€majority€of€subjects€who€take€the€2€drugs,€interaction€will€occurðð),Ð óC ÐThe€Journal€of€the€American€Medical€Association,€July€11,€1986,€ð ðUse€of€Oral€Contraceptives€by€Women€WithÐ ´ ÐEpilepsyðð€(stating€ð ð[Ô_Ôf]ailureÔ_Ô€of€oral€contraceptives,€normally€0.7€per€100€woman„years,€increases€to€3.1€per€100€woman„Ð uÅ Ðyears€in€women€taking€Ô_ÔantiepilepticÔ_Ô€drugs,€which€is€equivalent€to€the€failure€rate€for€intrauterine€devicesðð),€NeurologicÐ 6 † ÐClinics:€Epilepsy,€May€2001,€ð ðTreatment€Issues€For€Women€With€Epilepsyðð€(stating€ð ð[Ô_Ôp]henobarbitalÔ_Ô,€Ô_ÔprimidoneÔ_Ô,Ð ÷ G ÐÔ_ÔphenytoinÔ_Ô,€and€Ô_ÔcarbamazepineÔ_Ô€also€induce€the€production€of€sex€hormone„binding€globulin,€further€reducing€theÐ ¸  Ðconcentration€of€unbound€(free)€progesterone€and€the€likelihood€of€suppressing€ovulationðð),€Epilepsia,€2002,€ð ðTheÐ y É  ÐImportance€of€Drug€Interactions€in€Epilepsy€Therapyðð€(stating€ð ðNumerous€[Ô_ÔantiepilepticÔ_Ô€drugs]€(for€example,Ð : Š  Ð[Ô_ÔcarbamazepineÔ_Ô],€Ô_ÔPHTÔ_Ô,€PB,€Ô_ÔFBMÔ_Ô,€Ô_ÔOXCÔ_Ô,€and€Ô_ÔTPMÔ_Ô)€increase€the€metabolism€and€clearance€of€oral€contraceptives,Ð û K  Ðreducing€their€contraceptive€efficacy,€with€the€potential€for€unwanted€pregnancyðð).- ù-(|G2™Ñ$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€˜»»dd8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ô¨<ò»»Ô d(|3>$££Ý ƒ£ª!ÝÑ€.ÑÑ8€˜»»dd8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3>$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€˜»»dd8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€˜»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼˜»»»ÔÑ8€À¯XXdé»»d8ÑÑ  Ñà@ò ò ìàÔ€XÀ¯X»¼˜ÔÔ‡îfþîXXÀ¯ÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@òò%ìàAT€JACKSONÔ#†XÀ¯Xîîfþ+#ԈРÓ# ÐÓ  ÓMAY€20,€2004€SessionÐ öF ÐÌò òSTEPHANIE€DUBOISòòóó€v.€RADWAN€HAYKAL,€M.D.,€òòet€alóó.ó óÐ È ÐÌà@@½½ìàò òDirect€Appeal€from€the€Circuit€Court€for€Shelby€CountyÐ › ë Ðà@@øøìàNo.€92035„1€T.D.€€€€€€John€R.€McCarroll,€Jr.,€JudgeÐ … Õ ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<B` AßÐ C“  ÐÌà@@TTìàNo.€W2003„01549„COA„R3„CV€„€Filed€November€2,€2004Ð <Œ  ÐÌßA€V) °°` dE<` AßÐ `  Ðó óÌÓ  ÓÔ‡X"ÂXXXÀ¯ÔThis€appeal€arises€out€of€a€grant€of€summary€judgment€in€favor€of€Appellees€in€a€medicalÐ X  Ðmalpractice€action.€€The€trial€court€held€a€preliminary€hearing,€without€a€jury,€to€determine€ifÐ ñA ÐAppellant€could€establish€the€essential€elements€of€such€an€action,€particularly€the€element€ofÐ Ú* Ðcausation.€€After€Appellant€presented€her€expertsðð€testimony€regarding€causation€for€AppellantððsÐ Ã Ðmedical€malpractice€action,€the€trial€court€granted€Appelleesðð€motions€for€summary€judgment.€Ð ¬ü ÐAppellant€filed€an€appeal€to€this€Court,€and,€for€the€following€reasons,€we€reverse€and€remand€forÐ •å Ðfurther€proceedings€consistent€with€this€opinion.Ð ~Î ÐÌÔ#†XÀ¯XXX"ÂK#ÔÌÓ?ÓÌò òTenn.€R.€App.€P.€3;€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Reversed€andÐ "r ÐRemandedó óÐ  \ ÐÌòòÓ  ÓAlan€E.€Highers,€J.óó,€delivered€the€opinion€of€the€court,€in€which€òòDavid€R.€Farmer,€J.,€óó€and€òòHollyÐ ß/ ÐM.€Kirby,€J.óó,€joined.Ð È ÐÌMimi€Phillips,€R.€H.€ð ðChipðð€Chockley,€Memphis,€TN,€for€AppellantÐ š ê  ÐÌMichael€E.€Keeney,€John€Dotson,€Memphis,€TN,€for€Appellee€Radwan€Haykal,€M.D.Ð l"¼" ÐÌKaren€S.€Koplon,€Virginia€M.€Patterson,€Memphis,€TN,€for€Appellee€Margaret€H.€SauterÐ >$Ž$ ÐÌR.€Douglas€Hanson,€Memphis,€TN,€for€Appellee€Walgreen€Co.Ð &`!& ÐÓ1ÓÌò òÌÌÌÌÌÌÐ ^-®(.ý ÐOPINIONó óÐ ° ÐÌò òÔ‡X"ÂXXXÀ¯ÔFacts€and€Procedural€Historyó óÐ ƒÓ ÐÌÓ  Óà  àIn€March€1996,€Stephanie€Dubois€(ð ðDuboisðð€or€ð ðAppellantðð)€entered€into€a€physician/patientÐ V¦ Ðrelationship€with€Dr.€Radwan€Haykal€(ð ðHaykalðð),€following€her€admission€for€partial€hospitalizationÐ ?  Ðto€Charter€Lakeside€Hospital.€€Haykal€treated€Dubois€for€post„traumatic€stress€disorder€and€bipolarÐ ( x Ðdisorder,€stemming€from€Duboisðð€divorce€in€the€previous€year€and€the€developmental€problemsÐ  a Ðexperienced€by€her€son,€Max,€who€was€born€with€significant€birth€defects.€€Dubois€began€takingÐ ú J ÐWellbutrin€in€March€1996€for€treatment€of€her€stress.€€She€concluded€her€treatment€with€CharterÐ ã 3  ÐLakeside€Hospital€on€April€12,€1996,€but€she€continued€to€see€Haykal€for€further€counseling.€€DuringÐ Ì   Ðthe€counseling,€Dubois€informed€Haykal€she€was€currently€in€another€monogamous€relationship€andÐ µ  Ðwas€taking€Norinyl€135,€an€oral€contraceptive.€€In€June€1996,€in€order€to€treat€Duboisðð€bipolarÐ žî  Ðdisorder,€Haykal€prescribed€for€Dubois€a€drug€called€Tegretol,€traditionally€an€anticonvulsant€withÐ ‡×  Ðan€off„label€use€to€treat€bipolar€disorder.€€Dubois€subsequently€filled€her€first€prescription€ofÐ pÀ  ÐTegretol€on€June€6,€1996,€at€a€Super€D€pharmacy.€€Additionally,€Dubois€submitted€a€prescriptionÐ Y©  Ðto€be€filled€for€one,€21„pill,€7„day€Tegretol€prescription€at€a€Walgreenððs€pharmacy€(ð ðWalgreenððsðð)Ð B’ Ðon€July€10,€1996,€and€picked€up€the€Tegretol€medication€on€July€12,€1996.€€There€is€no€record€ofÐ +{ ÐWalgreenððs€filling€any€other€Tegretol€prescription€for€Dubois,€and€she€stated€that€she€utilized€a€mailÐ d Ðorder€pharmacy€to€fill€any€further€Tegretol€and€Wellbutrin€prescriptions.€€Dubois€additionally€filledÐ ýM Ðher€prescriptions€for€oral€contraceptives€with€Walgreenððs€on€May€20€and€August€27,€1996,€and€thereÐ æ6 Ðis€no€record€of€Walgreenððs€filling€any€other€oral€contraceptive€prescription€for€Dubois€during€theÐ Ï Ðtime€frame€at€issue€in€this€case.€Ð ¸ ÐÌà  àOn€July€11,€1996,€Dubois€began€a€gynecologist/patient€relationship€with€Dr.€Robert€SauterÐ ŠÚ Ð(ð ðSauterðð€or,€collectively€with€Walgreenððs€and€Haykal,€the€ð ðAppelleesðð).€€Previously,€DuboisððÐ sà Ðgynecologist€was€Dr.€Sharfman,€an€internist,€who€had€been€prescribing€Dubois€her€oralÐ \¬ Ðcontraceptive,€Norinyl€135.€€However,€because€of€problems€related€to€Duboisðð€menstrual€cycle,Ð E• ÐSauter€changed€Duboisðð€oral€contraceptive€prescription€to€Ortho„Tricyclen.€€Dubois€discovered€onÐ .~ ÐDecember€18,€1996,€after€missing€her€period,€that€she€was€pregnant,€despite€her€consistent€use€ofÐ g Ðoral€contraceptives.€€This€was€confirmed€when€she€was€tested€by€another€gynecologist,€Dr.€JohnÐ  P ÐAustin€(ð ðAustinðð).€€Austin€reviewed€Duboisðð€medications€and€informed€her€that€Tegretol€couldÐ é 9 Ðcause€birth€defects€if€used€during€the€pregnancy.€€On€December€28,€1996,€Dubois€had€an€abortion,Ð Ò!"  Ðprimarily€to€avoid€having€another€child€with€birth€defects.€€Employees€at€the€abortion€clinic€furtherÐ »" ! Ðinformed€Dubois€that€Tegretol€has€been€known€to€negatively€impact€the€effectiveness€of€oralÐ ¤#ô" Ðcontraceptives.€€Ð $Ý# Ðà  àOn€December€18,€1997,€Dubois€filed€the€instant€action€in€the€Shelby€County€Circuit€CourtÐ v%Æ $ Ðâ âagainst€Haykal,€Sauter,׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€and€Walgreenððs,€alleging€medical€malpractice€on€the€basis€that€suchÐ _&¯!% Ðdefendants€failed€to€warn€Dubois€of€the€interaction€between€Tegretol€and€her€oral€contraceptive.׃×Ý ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ׀Р° Ðâ âSubsequently,€after€taking€discovery,€Haykal,€Sauterððs€estate,€and€Walgreenððs€each€filed€a€motionÐ ™é Ðfor€summary€judgment.€€€On€May€27,€2003,€after€reviewing€the€record€and€taking€testimony€fromÐ ‚Ò Ðtwo€of€Duboisðð€expert€witnesses,€the€trial€court€entered€an€order€granting€each€defendantððs€motionÐ k» Ðfor€summary€judgment€on€the€basis€that€Dubois€failed€to€establish€the€element€of€causation€as€to€anyÐ T¤ Ðdefendant.€€From€the€record,€it€appears€the€trial€court€determined€that€Duboisðð€expert€witnessesððÐ =  Ðtestimony€on€the€element€of€causation€was€unreliable€and,€therefore,€inadmissible,€making€a€grantÐ & v Ðof€summary€judgment€in€favor€of€Appellees€appropriate.€€Dubois€filed€an€appeal€with€this€Court€andÐ  _ Ðpresents€the€following€issue€for€our€review:€whether€the€trial€court€erred€when€it€determined€thatÐ ø H ÐDuboisðð€expert€witnessesðð€testimony€on€the€element€of€causation€was€unreliable€and€grantedÐ á 1  ÐAppellees€motions€for€summary€judgment.€€For€the€following€reasons,€we€reverse€and€remand€forÐ Ê   Ðfurther€proceedings€consistent€with€this€opinion.Ð ³  ÐÌÓ  Óò òStandard€of€Reviewó óÐ …Õ  ÐÌÓ  Óà  àAlthough€this€case€comes€to€this€Court€with€the€final€order€granting€summary€judgment,€weÐ X¨  Ðmust€analyze€this€action€under€an€abuse€of€discretion€standard€of€review.€€In€this€instance,€the€trialÐ A‘ Ðcourt€held€a€òòDaubert/McDanielóó€hearing€to€determine€the€basis€for€Appellantððs€expert€witnessesððÐ *z Ðopinions€and€the€reliability€of€the€research€and€data€upon€which€they€based€their€opinions.€€AfterÐ c Ðsuch€hearing,€the€trial€court€determined€that€Appellantððs€expert€witnessesðð€opinions€wereÐ üL Ðinadmissible,€and,€therefore,€granting€Appellees€summary€judgment€would€be€appropriate€for€a€lackÐ å5 Ðof€proof€of€causation.€€Therefore,€we€address€a€question€regarding€the€admissibility,€qualifications,Ð Î Ðrelevancy€and€competency€of€expert€testimony,€which€is€left€to€the€discretion€of€the€trial€court.€Ð · ÐòòMcDaniel€v.€CSX€Trans.,€Inc.óó,€955€S.W.2d€257,€263€(Tenn.€1997)€(citing€òòState€v.€Ballardóó,€855Ð  ð ÐS.W.2d€557,€562€(Tenn.€1993)).€€As€such,€ð ð[t]he€trial€courtððs€ruling€in€this€regard€may€only€beÐ ‰Ù Ðoverturned€if€the€discretion€is€arbitrarily€exercised€or€abused.ðð€€òòIdóó.€(citing€òòBallardóó,€855€S.W.2d€atÐ r Ð562).€€Ð [« ÐÌÓ  Óò òLaw€and€Analysisó óÐ -} ÐÌÓ  Óà  àAppellant€argues€that€the€testimony€and€depositions€of€Dr.€Donald€Block€(ð ðBlockðð),€anÐ  P ÐOB/GYN,€and€Dr.€Richard€Brown€(ð ðBrownðð),€a€clinical€pharmacist,€sufficiently€establish€theÐ é 9 Ðelement€of€causation€and€that€such€expert€opinions€were€based€on€trustworthy€facts€and€data.€Ð Ò!"  ÐTennessee€Rules€of€Evidence€702€and€703€govern€the€admissibility€of€scientific€proof€for€TennesseeÐ »" ! Ðâ âcourts.€€Tennessee€Rule€of€Evidence€702€provides:Ð ¤#ô" ÐÓ XÓà0  àIf€scientific,€technical,€or€other€specialized€knowledge€will€substantially€assist€theÐ ° Ðâ âtrier€of€fact€to€understand€the€evidence€or€to€determine€a€fact€in€issue,€a€witnessÐ ™é Ðqualified€as€an€expert€by€knowledge,€skill,€experience,€training,€or€education€mayÐ ‚Ò Ðtestify€in€the€form€of€an€opinion€or€otherwise.Ðk»Ð Ð  ÐÌÓ X5(ÓTenn.€R.€Evid.€702€(2004).€€Tennessee€Rule€of€Evidence€703€states:Ð =  ÐÌÓ XÓà0  àThe€facts€or€data€in€the€particular€case€upon€which€an€expert€bases€an€opinion€orÐ  _ Ðinference€may€be€those€perceived€by€or€made€known€to€the€expert€at€or€before€theÐ ø H Ðhearing.€€If€of€a€type€reasonably€relied€upon€by€experts€in€the€particular€field€inÐ á 1  Ðforming€opinions€or€inferences€upon€the€subject,€the€facts€or€data€need€not€beÐ Ê   Ðadmissible€in€evidence.€€The€court€shall€disallow€testimony€in€the€form€of€an€opinionÐ ³  Ðor€inference€if€the€underlying€facts€or€data€indicate€lack€of€trustworthiness.Мì Ð Ð  ÐÌÓ XL*ÓTenn.€R.€Evid.€703€(2004).€€Ð n¾  ÐÌà  àWhen€performing€its€ð ðgatekeepingðð€function€of€determining€whether€an€expertððs€opinion€isÐ @ Ðbased€upon€trustworthy€underlying€facts€or€data,€Ð )y ÐÌÓ XÓà0  àA€Tennessee€court€may€consider€in€determining€reliability:€(1)€whether€scientificÐ ûK Ðevidence€has€been€tested€and€the€methodology€with€which€it€has€been€tested;€(2)Ð ä4 Ðwhether€the€evidence€has€been€subjected€to€peer€review€or€publication;€(3)€whetherÐ Í Ða€potential€rate€of€error€is€known;€(4)€whether,€as€formerly€required€by€òòFryeóó€[òòv.Ð ¶ ÐUnited€Statesóó,€293€F.€1013€(D.C.€Cir.€1923)],€the€evidence€is€generally€accepted€inÐ Ÿï Ðthe€scientific€community;€and€(5)€whether€the€expertððs€research€in€the€field€has€beenÐ ˆØ Ðconducted€independent€of€litigation.ÐqÁÐ Ð  ÐÌÓ Xá-ÓòòMcDanielóó,€955€S.W.2d€at€265.€€We€note€that€Tennessee€courts€are€not€required€to€consider€theseÐ C“ Ðfactors€and€such€factors€are€not€exclusive.€€òòIdóó.;€òòBrown€v.€Crown€Equip.€Corp.óó,€No.€W2002„02228„Ð ,| ÐCOA„R3„CV,€2004€Tenn.€App.€LEXIS€114,€at€*10€(Tenn.€Ct.€App.€Feb.€25,€2004).€€If€the€scientificÐ e Ðevidence€is€invalid,€it€will€neither€substantially€assist€the€trier€of€fact€nor€will€its€underlying€facts€andÐ þN Ðdata€appear€to€be€trustworthy.€€òòMcDanielóó,€955€S.W.2d€at€265.€€However,€we€are€mindful€that€thereÐ ç 7 Ðis€no€requirement€that€scientific€evidence€be€generally€accepted.€€òòIdóó.€€A€trial€court€does€not€need€toÐ Ð!   Ðweigh€or€choose€between€two€legitimate€but€conflicting€scientific€opinions,€rather€it€must€assureÐ ¹" ! Ðitself€that€ð ðthe€opinions€are€based€on€relevant€scientific€methods,€processes,€and€data,€and€not€uponÐ ¢#ò" Ðan€expertððs€mere€speculation.ðð€€òòIdóó.€(citing€òòJoiner€v.€Gen.€Elec.€Co.óó,€78€F.3d€524,€530€(11th€Cir.Ð ‹$Û# Ð1996)).€€Ð t%Ä $ ÐÌà  àIn€order€to€maintain€an€action€in€tort€for€medical€malpractice,€a€claimant€has€the€burden€ofÐ F'–"& Ðproving:€(1)€the€standard€of€acceptable€professional€practice€in€the€profession€that€the€defendantÐ /(#' Ðpractices€in€the€defendantððs€community€or€a€similar€community€at€the€time€of€the€alleged€wrongfulÐ )h$( Ðaction;€(2)€the€defendant€acted€with€less€than,€or€failed€to€act€with,€ordinary€and€reasonable€care€inÐ *Q%) Ðaccordance€with€such€standard;€and€(3)€the€claimantððs€injuries€suffered€are€the€proximate€result€ofÐ ê*:&* Ðthe€defendantððs€negligent€act€or€omission.€€Tenn.€Code€Ann.€ðð€29„26„115(a)€(2000).€€The€TennesseeÐ Ó+#'+ ÐCode€codifies€the€five€common€law€elements€of€negligence:€duty,€breach€of€duty,€causation,Ð ° Ðproximate€cause,€and€damages.€€òòKilpatrick€v.€Bryantóó,€868€S.W.2d€594,€598€(Tenn.€1993)€(citingÐ ™é ÐòòCardwell€v.€Bechtolóó,€724€S.W.2d€739,€753€(Tenn.€1987);€òòDolan€v.€Cunninghamóó,€648€S.W.2d€652,Ð ‚Ò Ð654€(Tenn.€Ct.€App.€1982)).€€Without€any€one€of€these€elements,€Appellantððs€claim€for€medicalÐ k» Ðmalpractice€cannot€succeed.€€òòIdóó.€(citing€òòBradshaw€v.€Danielóó,€854€S.W.2d€865,€869€(Tenn.€1993)).€Ð T¤ ÐFinally,€with€regard€to€causation,€the€Tennessee€Supreme€Court€has€stated€the€following:Ð =  ÐÌÓ XÓà0  à[P]roof€of€causation€equating€to€a€ð ðpossibility,ðð€a€ð ðmight€have,ðð€ð ðmay€have,ðð€ð ðcouldÐ  _ Ðhave,ðð€is€not€sufficient,€as€a€matter€of€law,€to€establish€the€required€nexus€betweenÐ ø H Ðthe€plaintiffððs€injury€and€the€defendantððs€tortious€conduct€by€a€preponderance€of€theÐ á 1  Ðevidence€in€a€medical€malpractice€case.€€Causation€in€fact€is€a€matter€of€probability,Ð Ê   Ðnot€possibility,€and€in€a€medical€malpractice€case,€such€must€be€shown€to€aÐ ³  Ðreasonable€degree€of€medical€certainty.Мì Ð Ð  ÐÌÓ  ÓÓ XÓòòIdóó.€at€602€(citing€òòWhite€v.€Methodist€Hosp.€S.óó,€844€S.W.2d€642,€648„49€(Tenn.€Ct.€App.€1992)).€€Ð n¾  ÐÓ  Óà  àIn€this€case,€the€trial€court€granted€summary€judgment€in€favor€of€the€Appellees€becauseÐ W§  ÐAppellant€failed€to€establish,€after€admittedly€presenting€all€her€evidence€of€causation,€that€theÐ @ ÐTegretol€prescription€reduced€the€efficacy€of€Appellantððs€oral€contraceptives.€€After€our€review€ofÐ )y Ðthe€record€and€for€the€reasons€below,€we€disagree€with€the€grant€of€summary€judgment.Ð b ÐÌà  àAppellant€presented€two€expert€witnesses€to€demonstrate€the€causal€nexus€between€her€injuryÐ ä4 Ðand€Appelleesðð€failure€to€warn€her€of€Tegretolððs€effects.€€First,€Dr.€Brown,€a€clinical€pharmacist,Ð Í Ðstated€that,€although€he€had€no€experience€filling€prescriptions€of€Tegretol€and€had€never€personallyÐ ¶ Ðperformed€studies€on€the€drug,€he€explained€that€his€research€revealed€Tegretolððs€ability€for€inducingÐ Ÿï Ðthe€liver€to€produce€the€enzyme€responsible€for€metabolizing€oral€contraceptives.€€He€also€stated€thatÐ ˆØ Ðhe€was€familiar€with€the€oral€contraceptives€Appellant€was€prescribed€and€that,€if€such€oralÐ qÁ Ðcontraceptives€had€a€stronger€concentration€of€estrogen,€Tegretol€would€likely€have€had€no€curtailingÐ Zª Ðeffect€on€the€oral€contraceptives.€€Though€some€of€the€articles€upon€which€Brown€relies€state€thatÐ C“ ÐCarbamazepine,€another€name€for€Tegretol,€òòmayóó€decrease€the€efficacy€of€oral€contraceptives,Ð ,| Ðnumerous€other€sources€state€that€Tegretol€òòdoesóó€decrease€the€efficacy€of€oral€contraceptives.׃×Ý ƒ#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€BrownÐ e Ðtestified€that€many€of€the€articles€and€abstracts€themselves€have€been€published€and€subjected€to€peerÐ ° Ðreview.€€Brown€further€stated€that€the€interaction€between€Tegretol€and€oral€contraceptives€has€beenÐ ™é Ðwidely€known€and€generally€accepted€for€years.€€After€ruling€out€the€possibility€of€pill€failure€orÐ ‚Ò Ðgastrointestinal€problems,€which€affect€the€bodyððs€ability€to€absorb€the€oral€contraceptives€properly,Ð k» Ðand€assuming€that€Appellant€properly€took€her€medication,€Brown€concluded€that,€after€conductingÐ T¤ Ðhis€research,€the€Tegretol€prescription€compromised€the€therapeutic€effects€of€the€oralÐ =  Ðcontraceptives.Ð & v Ðà  àÌà  àFurther,€Appellant€presented€the€testimony€of€Dr.€Block,€an€OB/GYN,€in€order€to€establishÐ ø H Ðthe€element€of€causation.€€Block€explained€that€oral€contraceptives€suppress€ovulation€and€produceÐ á 1  Ða€cervix€mucus€which€is€hostile€to€sperm€penetration.€€Block€further€testified€that€oral€contraceptivesÐ Ê   Ðhave€a€failure€rate€of€less€than€one€percent€and€that€the€other€notable€causes€of€contraception€failureÐ ³  Ðare€gastrointestinal€problems,€such€as€vomiting€or€diarrhea,€and€drug€interactions.€€He€stated€that€itÐ œì  Ðwas€widely€disseminated€in€the€medical€community€that€Tegretol€reduces€the€efficacy€of€oralÐ …Õ  Ðcontraceptives.€€Block€further€stated€that,€based€on€his€own€knowledge,€any€amount€of€Tegretol,Ð n¾  Ðmore€likely€than€not,€had€an€effect€on€Appellantððs€oral€contraceptives.€€After€ruling€out€theÐ W§  Ðpossibilities€of€the€less€than€one€percent€failure€rate,€which€is€minimal,€and€gastrointestinalÐ @ Ðproblems,€of€which€there€was€no€evidence,€Block€concluded€that€the€Tegretol€prescription€was€moreÐ )y Ðlikely€than€not€the€cause€of€Appellantððs€unplanned€pregnancy.€€òòSee€Wilson€v.€CSX€Trans.,€Inc.óó,€No.Ð b ÐE2002„00291„COA„R9„CV,€2003€WL€1233536,€at€*7„8€(Tenn.€Ct.€App.€Mar.€18,€2003)€(discussingÐ ûK Ðthe€testimony€of€Dr.€Nassetta,€who€determined€the€most€likely€source€for€the€cause€of€a€brain€tumor).€Ð ä4 ÐAfter€considering€the€record€as€a€whole,€the€qualifications€of€the€expert€witnesses,€and€the€data€andÐ Í Ðresearch€upon€which€they€relied,€we€hold€that€the€trial€court€erred€when€it€decided€to€excludeÐ ¶ ÐBrownððs€and€Blockððs€testimony€relating€to€causation€on€the€grounds€that€it€would€not€substantiallyÐ Ÿï Ðassist€the€trier€of€fact€or€was€untrustworthy.Ð ˆØ Ðà  àÌà  àWe€note€that€the€trial€court€awarded€summary€judgment€to€Walgreenððs€on€the€same€basis€asÐ Zª ÐHaykal€and€Sauter:€the€fact€that€Appellant€failed€to€establish€the€element€of€causation.€€This€CourtÐ C“ Ðis€mindful€that,€once€a€duty€has€been€established,€the€scope€of€the€duty€for€a€pharmacist€is€a€questionÐ ,| Ðof€fact.€€òòDooley€v.€Everettóó,€805€S.W.2d€380,€386€(Tenn.€Ct.€App.€1990).€€Because€the€trial€courtÐ e Ðaddressed€only€the€element€of€causation€for€Haykal,€Sauter,€and€Walgreenððs,€we€are€unable€toÐ þN Ðdetermine€whether€summary€judgment€is€appropriate€on€other€grounds.€€Therefore,€we€reverse€theÐ ° Ðtrial€courtððs€grant€of€summary€judgment.Ð ™é ÐÌÓ  Óò òÌÌConclusionó óÐ ?  ÐÌÓ  Óà  àFor€the€aforementioned€reasons,€we€reverse€the€grant€of€summary€judgment€in€favor€ofÐ  b ÐAppellees€and€remand€this€case€for€further€proceedings€consistent€with€this€opinion.€€Costs€of€thisÐ û K Ðappeal€are€taxed€to€Appellees,€Dr.€Radwan€Haykal,€the€estate€of€Dr.€Robert€Sauter,€and€WalgreenÐ ä 4  ÐCo.,€for€which€execution€may€issue€if€necessary.Ð Í   Ðà  àÔ#†XÀ¯XXX"º #ÔÌÌÌòòóóÌÌÌÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð e Ðà  àà ` àà ¸ àà  àà h àà À àà  àALAN€E.€HIGHERS,€JUDGEÐ þN Ð