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ÔÔ€+ÔÝ  ÝÒ € ÒÒ „ ÒÑ  ÑÓ` °‡XøÈ“XÓÔ€+¼ÔÑ\R AØ'\Ñ›œÞ ÞÌDONALD›€EUGENE€HARRIS,à àà à)Ìà àà àà àà àà àà à)ÌÓ#` Ü‚Xøôx‘X#Óà àPlaintiff/Appellant,à à)à àAppeal€No.Ìà àà à)à à01„A„01„9801„CV„00041Ìv.à àà à)Ìà àà à)à àDavidson€CircuitÌGLENN€S.€BUCKSPAN,€M.D.,à à)à àNo.€€95C„1489Ìindividually€andà à)ÌÙ€!ÙœßR€.0-A1-j|úF` ç `€€@ÿRß›GLENN€S.€BUCKSPAN,€M.D.,P.C.à à)Ìà àà à)Ìà àDefendant/Appellee.à à)Ìà àà à)ÌÌÌÓ  ÓCOURT€OF€APPEALS€OF€TENNESSEEÌÌÌAPPEAL€FROM€THE€CIRCUIT€COURT€FOR€DAVIDSON€COUNTYÌÌAT€NASHVILLE,€TENNESSEEÌÌÌTHE€HONORABLE€BARBARA€N.€HAYNES,€JUDGEÌÓ ` Ü‚XœÈ“X ÓÌÌÌÌÓ  ÓLARRY€D.€ASHWORTHÌ227€Second€Avenue,€NorthÌNashville,€Tennessee€€37201ÌÌPETER€D.€HEILÌP.€O.€Box€40651ÌNashville,€Tennessee€€37204€Ìà àATTORNEYS€FOR€PLAINTIFF/APPELLANTÌÌÌÌC.€J.€GIDEON,€JR.ÌJOE€W.€ELLIS,€IIÌNationsBank€Plaza,€Suite€1900Ì414€Union€StreetÌNashville,€Tennessee€€37219„1782Ìà àATTORNEYS€FOR€DEFENDANT/APPELLEEÌÌÓ  ÓÌÌÓ  ÓAFFIRMEDÌÌÌÌÓ  Óà àà àWILLIAM€B.€CAIN,€JUDGEÌÑ7€öXXdìXXdì7ÑÑ€ ÑÓÓÓ  ÓòòÔ€+°ÔOPINIONóóÌÓ  ÓÓ#` Ü` ä œÈ“X#ÓÓ€ÓÔ€+¼ÔòòI.óóà àòòFACTSóóÌÌà àThis€is€a€medical€malpractice€action€in€which€the€plaintiff€appealsÏfrom€a€directed€verdict€in€favor€of€the€defendant.ÌÌà àPlaintiff,€Donald€Gene€Harris,€is€a€professional€wrestler€andÏpresented€himself€on€January€25,€1993€to€the€defendant,€Dr.€Glenn€S.ÏBuckspan,€for€an€evaluation€of€bilateral€gynecomastia€or€breast€enlargement.€ÏAfter€discussing€various€surgical€options,€Dr.€Buckspan€referred€Plaintiff€toÏDr.€Craig€Sussman€for€endocrinology€study€and€possible€non„surgicalÏmanagement€of€Plaintiff's€enlarged€breast€condition.ÌÌà àDr.€Buckspan's€clinical€note€for€this€January€25,€1993€visit€wasÏadmitted€in€evidence€and€reveals€the€following:ÌÓÓà8 àIs€seen€in€consultation€with€bilateral€gynecomastia.€€[Mr.ÏHarris]€does€have€a€past€history€of€having€used€anabolicÏsteroids€in€the€past.€€The€left€side€is€larger€than€the€right.€ÏHe€has€a€moderate€amount€of€excess€skin.€ÌÌà8 àI€explained€to€him€in€detail€the€ramifications€of€operativeÍmanagement€in€the€form€of€suction€assisted€and€directÏexcision€through€an€inferior€periareola€incision.€€I€alsoÏdiscussed€the€fact€that€he€did€have€excess€skin€and€that€thisÏcould€be€corrected€more€completely€with€a€crescentÏshaped€excision€in€a€superior€areola€excision€but€thatÏwould€require€a€radial€incision€medially€and€laterally.€€IÏdiscussed€with€him€the€anticip[a]ted€results€and€theÏdifficulty€in€obtaining€adequate€reduction€without€excessÏconcavity€or€excess€skin€for€which€would€be€fairly€loose.€ÏI€explained€to€him€the€fact€that€we€could€do€this€in€aÏstaged€procedure€and€that€we€could€try€to€maintainÏcontour€but€it€would€be€very€likely€there€could€be€needÏfor€secondary€procedures€or€even€further€reduction€if€this€Ïwere€€unsatisfactory€€to€€him.€€€I€discussed€€with€€him€thÌà8 àepossible€[sic]€complications€of€bleeding€and€infection€andÏthe€need€for€reoperation.€€The€automobile€example€isÏcited.€€The€placement€of€the€incision€and€the€anticipatedÏhealing€process€is€described€including€the€need€to€limit€hisÏbody€activity.€€The€need€for€postoperative€compression€isÏdiscussed.€€Potential€for€hypertrophy€of€the€scars€isÏdiscussed.€€The€patient€is€referred€to€Dr.€Craig€SussmanÏfor€his€evaluation€to€see€if€there€is€any€nonsurgicalÏmanagement€that€can€be€carried€out.ÌÌÓ€ÓÌ€à àNo€such€non„surgical€treatment€was€determined€to€be€of€any€valueÏand€on€April€26,€1993,€plaintiff€returned€to€Dr.€Buckspan.€€Following€thisÏconsultation,€Dr.€Buckspan€entered€a€clinical€note€as€follows:ÌÓÓà8 àIs€seen€in€follow€up€consultation€today.€€He€has€beenÏevaluated€by€Dr.€Craig€Sussman€and€has€noÏendocrinologic€abnormalities.€€I€discussed€with€him€theÏmethods€of€reconstructing€his€gynecomastia€and€at€thisÏtime€he€elects€to€proceed€with€a€transverse€excision€andÏfree€nipple€grafting.€€He€is€aware€of€the€potential€loss€ofÏskin€as€well€as€the€nipple€areola€grafts€and€the€need€forÏpotential€reconstruction.€€I€also€discussed€and€pointed€outÏto€him€on€his€chest€the€extent€of€the€incision€and€the€factÏthat€there€could€be€widening,€hypertrophy€of€the€scars.€ÏHe€elects€to€proceed€in€the€near€future.ÌÌÓ€ÓÌà àOn€this€same€day,€April€26,€1993,€following€consultation€with€Dr.ÏBuckspan,€plaintiff€signed€what€is€designated€as€an€"operative€permit"Ïcontaining,€in€pertinent€part,€the€following:ÌÓÓà8 àPLEASE€READ€THIS€CAREFULLY€AND€FEEL€FREEÏTO€ASK€ANY€QUESTIONS€YOU€MAY€HAVE€ABOUTÏYOUR€SURGERY€OR€THIS€PERMIT.ÌÌà8 àPATIENTòò€€€€€€€€€€€€€€òòDon€Harris€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÏóóóóDATE€OF€SURGERY€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÌÌÓ,"` Ü` ä ðœÈ Ð X,Óà àÔ€+XÔ1.à8 àI€hereby€request€and€authorize€Dr.€Glenn€S.ÏBuckspan€and€his€associates€to€perform€a€surgicalÏoperation€known€as€òò€€òòBilateral€subcutaneousÏmastectomies€with€suction€assistance€and€skinÏexcision€and€free€nipple€grafting€€€€óó.ÌÌà àóó2.à8 àI€further€state€that€I€have€requested€this€surgery€forÏthe€purpose€of€improving€my€function€orÏappearance,€or€both.ÌÌà à3.à8 àThe€procedure€listed€above€has€been€explained€toÏme€by€Dr.€Buckspan€and€his€staff€and€I€completelyÏunderstand€the€nature€of€the€procedure.€€TheÏfollowing€points€have€been€particularly€stressed€toÏme:òò€€òòbleeding,€swelling,€infection,€permanent€scar,Ïchange€in€sensation,€partial€or€complete€loss€ofÏgraft€€€óó.ÌóóÌà à4.à8 àI€recognize€that€during€the€course€of€the€operation,Ïunforeseen€conditions€may€necessitate€additionalÏor€different€procedures€than€those€set€forth€above.€ÏI€therefore€further€authorize€and€request€that€Dr.ÏBuckspan,€his€associates,€or€other€physicianÏwhom€Dr.€Buckspan€may€request,€perform€suchÏprocedures€as€are,€in€Dr.€Buckspan's€professionalÏjudgement,€necessary€and€desir[e]able,€including,Ïbut€not€limited€to,€procedures€involving€pathologyÏand€radiology.€€The€authority€granted€under€thisÏparagraph€four€(4)€shall€extend€to€remedyingÏconditions€that€are€not€known€to€Dr.€Buckspan€atÏthe€time€the€operation€is€commenced.ÌÌÓ  Ó.€.€.ÌÓ  ÓÌà à6.à8 àI€am€aware€that€the€practice€of€medicine€andÏsurgery€is€not€an€exact€science,€and€that€IÏacknowledge€that€no€guarantees€have€been€made€toÏme€as€to€the€results€of€the€operation€or€procedure.ÌÌà à7.à8 àI€acknowledge€that€you€have€warned€me€that€myÏbody€or€my€skin,€or€my€physical€system€couldÏhave€a€bad€or€disagreeable€reaction€to€thisÏprocedure€or€anesthesia,€including€the€followingÏspecific€possible€reactions,€results,€or€side€effects:Ìà àà àòò€€€òòbleeding,€swelling,€infection,€unfavorable€scar€€€€€€€€óóóóÌÌà à8.à8 àI€understand€that€the€results€obtained€from€thisÏsurgery€depends€in€part€on€my€following€postÏoperative€instructions.€€I€agree€to€cooperate€withÏDr.€Buckspan€and€his€staff€in€my€follow€up€careÏuntil€I€have€been€completely€discharged.ÌÌÓ  Ó.€.€.ÌÓ  ÓÌà à10.à8 àI€have€read€this€permit€completely€and€fullyÏunderstand€it€and€I€have€had€an€opportunity€toÏhave€answered€any€questions€I€may€have€about€theÏpermit€and€my€surgery.ÌÌà àà8 àÔ€+¼ÔDO€NOT€SIGN€THIS€PERMIT€UNTILÏYOU€HAVE€READ€IT€ANDÏCOMPLETELY€UNDERSTAND€THEÏCONTENTS.ÌÌÔ€+ôÔà àPATIENT€SIGNATUREòò€€òòx€€Donald€G.€Harrisóó€óóWITNESSòò€€òòD€Adamson€€óóóó€DATEòò€òò4„26€ÌÔ€+¼ÔÌÓ€ÓÌà àóóóóSurgery€by€Dr.€Buckspan€was€scheduled€at€St.€Thomas€Hospital€inÏNashville€on€May€11,€1993.€€Prior€to€the€administration€of€anesthesia€on€thatÏdate,€plaintiff€signed€a€document€entitled€"consent€for€surgical€or€invasiveÏmedical€procedures"€providing,€in€pertinent€part,€as€follows:ÌÓÓà8 àPATIENT:òò€€€€€€€€€€€òòDonald€Harrisóó€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ÏóóDATE:òò€€€€€€€€€€òò11€May€1993€€€€€€óóóóTIME:òò€€€€€€€€€€€€€òò8:40€€€€€€€€€€ÏóóA.M.Ìà8 àÔ€+XÔóóI,òò€€€€€€€€€€€€€€€€€€€€€€€€€€òòDonald€Harris€€€€€€€€€€€€€€€€€€€€€€€€€€óóóó,€do€hereby€authorizeÏDoctoròòòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Buckspan€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ïóóóóor€one€of€his€associates€as€follows:òò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Íóóand€such€hospital€personnel€as€he€may€designate€and€authorize€toÏassist€and€to€perform€upon€me€the€following€procedure€and€such€postÏcare€and€treatment€as€may€be€required€for€my€best€care.€€òò€€€€€€€€òòBilateralÏsubcutaneous€mastectomies€with€suction€assistance€and€skin€excisionÏand€free€nipple€grafts€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óó.Ìà8 àóóThe€said€operative€procedure€(or€invasive€medical€procedure),€itsÏnature,€complications€and€risks,€and€alternatives€have€been€explainedÏto€me€by€my€attending€physician.€€My€physician€has€not€guaranteedÏany€specific€results€from€such€contemplated€procedure€or€surgery.ÌÌà8 àI€recognize€that€during€the€course€of€the€operation€(or€invasive€medicalÏprocedure)€unforeseen€conditions€may€necessitate€òòadditionalóó€orÏdifferent€procedures€than€those€set€forth€above.€€I€therefore€authorizeÏthe€above€physician,€or€persons€he€may€designate,€to€perform€suchÏprocedures€as€are,€in€his€professional€judgment,€necessary€andÏdesirable.€€This€authority€is€extended€to€remedying€conditions€that€areÏnot€known€by€my€physician€at€the€time€the€operation€(or€invasiveÏmedical€procedure)€is€commenced.ÌÌÓ€ÓÌÔ€+¼ÔòòII.óóà àòòMedical€BatteryóóÌÌà àThis€case€was€argued€before€this€court€on€July€6,€1998,€one€weekÏbefore€the€Supreme€Court€released€its€opinion€in€ò òòòBlanchard€v.€Kellumó óóó,ÏNo.€02„S„01„9709„CV„00083€(Tenn.€1998).€€In€ò òòòBlanchard,ó óóó€the€SupremeÏCourt€recognized€a€distinction€between€an€unauthorized€procedure€and€aÏprocedure€authorized€on€less€than€adequate€information€to€the€patient.ÌÌà àSaid€the€Supreme€Court:ÌÓÓà8 àà àWe€believe€that€there€is€a€distinction€between€:€Ï(1)€cases€in€which€a€doctor€performs€an€unauthorizedÏprocedure;€and€(2)€cases€in€which€the€procedure€isÏauthorized€but€the€patient€claims€that€the€doctor€failed€toÏinform€the€patient€of€any€or€all€the€risks€inherent€in€theÏprocedure.€€Performance€of€an€unauthorized€procedureÏconstitutes€a€medical€battery.€€A€simple€inquiry€can€beÏused€to€determine€whether€a€case€constitutes€a€medicalÏbattery:€€(1)€was€the€patient€aware€that€the€doctor€wasÏgoing€to€perform€the€procedure€(i.e.,€did€the€patient€knowÏthat€the€dentist€was€going€to€perform€a€root€canal€on€aÍspecified€tooth€or€that€the€doctor€was€going€to€performÏsurgery€on€the€specified€knee?);€and,€if€so€(2)€did€theÏpatient€authorize€performance€of€the€procedure?€€AÏplaintiff's€cause€of€action€may€be€classified€as€a€medicalÏbattery€only€when€answers€to€either€of€the€above€questionsÏare€in€the€negative.€€If,€however,€answers€to€the€aboveÏquestions€are€affirmative€and€if€the€plaintiff€is€allegingÏthat€the€doctor€failed€to€inform€of€any€or€all€risks€orÏaspects€associated€with€a€procedure,€the€patient's€cause€ofÏaction€rests€on€an€informed€consent€theory.ÌÌà8 àà àInformed€consent€cases€require,€by€statute,€expertÏevidence€to€establish€whether€the€information€provided€toÏthe€patient€deviated€from€the€usual€and€customaryÏinformation€given€to€patients€to€procure€consent€in€similarÏsituations.€€ò òòòSee€generally€German€v.€Nichopoulosóóó ó,Ï577€S.W.2d€197€(Tenn.€Ct.€App.€1978)€(holding€expertÏevidence€required€to€establish€informed€consent€whenÏpatient€knew€of€procedure€to€be€performed€but€allegedÏthat€no€risks€associated€with€procedure€were€disclosed);Ïòòseeóó€òòalsoóó€Tenn.€Code€Ann.€ðð€29„26„115,€„118.€€The€inquiryÏfocuses€on€whether€the€doctor€provided€òòanyóó€or€òòadequateóóÏinformation€to€allow€a€patient€to€formulate€an€intelligentÏand€informed€decision€when€authorizing€or€consenting€toÏa€procedure.€€ò òòòShadrick€v.€Coker,€M.D.óóó ó,€963€S.W.2dÏ726€(Tenn.€1998).€€To€determine€the€adequacy€ofÏinformation€provided€in€an€informed€consent€case,€a€courtÏmust€consider€the€nature€of€the€medical€treatment,€extentÏof€the€risks€involved€and€the€applicable€standard€of€care.€ÏòòIdóó.;€Tenn.€Code€Ann.€ðð€29„26„118.€€These€determinationsÏrequire€expert€testimony€and€are€outside€the€commonÏknowledge€of€a€lay€witness.ÌÌò òòòBlanchard€v.€Kellumó óóó,€No.€02„S„01„9709„CV„00083,€slip€op.€at€4„5€(Tenn.ÏJuly€13,€1998).€€Footnotes€omitted.ÌÌÓ€ÓÌà àWhile€the€plaintiff€at€bar€argues€that€the€procedure€by€Dr.ÏBuckspan€was€unauthorized,€such€argument€does€not€withstand€the€"simpleÍinquiry"€of€ò òòòBlanchardó óóó.€€Plaintiff€understood€that€Dr.€Buckspan€was€goingÏto€operate€on€his€chest€in€treatment€of€bilateral€gynecomastia€and€HarrisÏauthorized€the€performance€of€the€procedure.€€Thus,€we€are€not€dealing€withÏ"medical€battery"€under€ò òòòBlanchardó óóó,€but€with€alleged€lack€of€informedÏconsent€under€Tennessee€Code€Annotated€section€29„16„118.ÌÌà àPlaintiff€admits€that€he€knowingly€executed€both€the€"operativeÏpermit"€dated€April€26,€1993€and€the€"consent€for€surgical€or€invasiveÏmedical€procedures"€of€May€11,€1993.€€He€insists,€however,€that€in€hisÏvarious€consultations€with€Dr.€Buckspan€he€was€told€that€surgery€could€beÏperformed€that€would€reduce€the€size€of€his€breasts€and€that€such€surgeryÏwould€consist€of€two€small€incisions,€one€in€the€area€of€each€breast€and€thatÏtissue€would€be€removed€through€these€incisions.€€He€claims€he€was€furtherÏtold€that€only€a€small€hairline€scar€would€remain;€he€was€neither€informedÏthat€an€incision€would€be€made€across€the€entire€breadth€of€his€chest,€nor€toldÏthat€he€would€undergo€a€"mastectomy"€and€"free€nipple€graft"€where€hisÏnipples€would€be€surgically€removed€and€then€reimplanted.€€He€further€saysÏhe€was€never€advised€that€the€surgery€would€result€in€raised,€red,€rope„likeÏhypertrophic€scars€or€mispositioned€and€malformed€nipples.ÌÌà àPlaintiff€was€not€satisfied€with€the€results€of€the€procedureÏperformed€by€Dr.€Buckspan€and€sued€alleging€lack€of€informed€consent€andÏprofessional€negligence.ÌÌòòIII.à àInformed€ConsentóóÌÌà àThe€Supreme€Court€of€Tennessee€has€held:ÌÓ,"` Ü` ä ÄœÈ Ð X,ÓÓÓà8 àà8 à"the€plaintiff€shall€prove€by€evidence€asÏrequired€by€ðð€29„26„115(b)€that€the€defendantÏdid€not€supply€appropriate€information€to€theÏpatient€in€obtaining€his€informed€consent€(to€theÏprocedure€out€of€which€plaintiffs€claimÏallegedly€arose)€in€accordance€with€theÏrecognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€in€the€specialty,€ifÏany,€that€the€defendant€practices€in€theÏcommunity€in€which€he€practices€and€in€similarÏcommunities."ÌÌà8 àIncorporating€the€common€law€controlling€theÏeffectiveness€of€consent,€the€statute€explicitly€requires€asÏpart€of€the€plaintiff's€burden€of€proof€that€the€standard€ofÏcare€for€obtaining€informed€consent€must€be€shown€byÏexpert€evidence€in€the€same€manner€as€provided€in€T.C.A.Ïðð€29„26„115(b).€€As€stated€in€òòò òBaldwin€v.€Knightó óóó,€569ÏS.W.2d€450,€453€(Tenn.€1978),€T.C.A.€ðð€29„26„115(b)Ï"adds€.€.€.€to€the€present€case€law€requirements€relating€toÏexpert€testimony,€(1)€the€necessity€that€a€medical€expertÏbe€licensed€in€this€state€or€a€contiguous€bordering€state;Ï(2)€the€relevant€specialty€requirement;€and€(3)€judicialÏdiscretion€to€waive€those€requirements€upon€a€showing€ofÏthe€unavailability€of€such€witnesses."€€Where€a€person€hasÏthe€capacity€to€consent,€consent€may€not€be€effectiveÏbecause€the€person€was€not€sufficiently€aware€of€the€extentÏof€the€risks€or€the€nature€of€the€treatment€involved.ÌÌà àà8 à€€"Counsel€insists€that€simply€because€plaintiffÏtestified€that€no€one€told€her€of€any€possibleÏrisks€prior€to€receiving€the€injection,€a€òòprimaÏfacie€óócase€based€on€lack€of€informed€consentÏwas€made€out.€.€.€.€€[I]n€matters€of€informedÏconsent€the€plaintiff€has€the€burden€of€provingÏby€expert€medical€evidence,€(a)€what€aÏreasonable€medical€practitioner€of€the€same€orÏsimilar€communities€under€the€same€or€similarÏcircumstances€would€have€disclosed€to€theÏpatient€about€attendant€risks€incident€to€aÏproposed€diagnosis€or€treatment€and€(b)€that€theÍdefendant€departed€from€the€norm."ÌÌòòà8 àGerman€v.€Nichopoulosóó,€577€S.W.2d€197,€204€(Tenn.ÏApp.€1978),€òòcert.€deniedóó€(Tenn.€1979).€òòÌÌò òCardwell€v.€Bechtoló óóó,€724€S.W.2d€739,€750€(Tenn.€1987).ÌÌÓ€ÓÌà àPlaintiff€insists€that€he€is€entitled€to€rely€on€oral€assurancesÏallegedly€given€him€by€Dr.€Buckspan€and€that€such€right€of€reliance€is€notÏsubsumed€into€the€consent€forms€that€he€admittedly€signed.€€This€assertion€isÏnot€disputed€by€the€defendant€but€there€is€no€expert€testimony€in€the€recordÏestablishing€that€breach€of€such€alleged€oral€representations€violated€theÏapplicable€standard€of€care.€€Plaintiff's€expert€witness,€Dr.€Joseph€Bussey,Ïtestified€that€the€standard€of€care€for€informed€consent€"€requires€that€theÏpatient€fully€understand€the€procedure€that's€recommended€and€the€variousÏprocedures€that€could€satisfy€the€needs€of€that€patient€and€the€risks€andÏcomplications€related€to€those€procedures€and€that€the€patient€is€accepting€ofÏthose€conditions€before€he€would€agree€to€have€the€procedure€performed."ÌÌà àThe€expert€testimony€offered€does€not€establish€"(a)€what€aÏreasonable€medical€practitioner€of€the€same€or€similar€communities€underÏthe€same€or€similar€circumstances€would€have€disclosed€to€the€patient€aboutÏattendant€risks€incident€to€a€diagnosis€or€treatment€and€(b)€that€the€defendantÏdeparted€from€the€norm."€€ò òòòGerman€v.€Nichopoulosó óóó,€577€S.W.2d€197,€204Ï(Tenn.€App.€1978).ÌÌà àThe€lay€assertions€of€Plaintiff€as€to€oral€representations€andÏassurances€made€to€him€by€Dr.€Buckspan€taken€as€being€true€can€not€make€aÏjury€question€without€the€expert€testimony€required€by€Tennessee€CodeÍAnnotated€section€29„26„118.ÌÌà àThe€trial€court€correctly€directed€a€verdict€for€the€defendant€onÏinformed€consent.ÌÌòòIV.à àProfessional€NegligenceóóÌÌà àJust€as€Tennessee€Code€Annotated€section€29„26„118€mandatesÏexpert€testimony€to€establish€the€recognized€standard€of€acceptableÏprofessional€practice€and€the€breach€of€such€standard€by€the€physician€inÏorder€to€make€a€òòprima€facieóó€case€of€inadequacy€of€consent,€so€section€29„26„115€requires€such€expert€testimony€in€a€malpractice€action.€ÌÌà àThis€statute€requires:ÌÓÓà8 àà à(a)€In€a€malpractice€action,€the€claimant€shall€haveÏthe€burden€of€proving€by€evidence€as€provided€byÏsubsection€(b):Ìà8 àà à(1)€The€recognized€standard€of€acceptableÏprofessional€practice€in€the€profession€and€the€specialtyÏthereof,€if€any,€that€the€defendant€practices€in€theÏcommunity€in€which€he€practices€or€in€a€similarÏcommunity€at€the€time€the€alleged€injury€or€wrongfulÏaction€occurred;Ìà8 àà à(2)€That€the€defendant€acted€with€less€than€or€failedÏto€act€with€ordinary€and€reasonable€care€in€accordanceÏwith€such€standard;€andÌà8 àà à(3)€As€a€proximate€result€of€the€defendant's€negligentÏact€or€omission,€the€plaintiff€suffered€injuries€whichÏwould€not€otherwise€have€occurred.ÌÌTenn.€Code€Ann.€ðð€29„26„115(a)(1980).ÌÌÓ€ÓÌà àPlaintiff€recognized€this€statutory€requirement€inasmuch€as€heÏprocured€the€testimony€of€Dr.€Joseph€Bussey.€€However,€while€Dr.€BusseyÏopines€that€Dr.€Buckspan€violated€the€applicable€standard€of€care€in€theÏperformance€of€the€procedure€he€used€in€surgically€treating€Plaintiff'sÏgynecomastia,€it€is€clear€when€considering€Dr.€Bussey's€testimony€as€a€wholeÏthat€this€opinion€is€insufficient€to€establish€a€òòprima€facieóó€case€for€submissionÏto€the€jury.€€Dr.€Bussey€testifies€as€follows:ÌÓ2(` Ü` ä IJœÈ ‚°Ø'X2ÓÓÓà8 àà àQ.à àDoctor,€are€you€familiar€in€this€case€with€theÏtype€of€procedure€that€was€performed€on€Donald€Harris?€ÏAre€you€familiar€with€the€recognized€standard€ofÏacceptable€professional€practice€in€plastic€andÏreconstructive€surgery€as€it€applies€to€the€treatment€ofÏgynecomastia?Ìà8 àà àA.à àYes,€sir.Ìà8 àà àQ.à àDoctor,€have€you€formed€an€opinion€as€toÏwhether€the€defendant€complied€with€the€recognizedÏstandard€of€acceptable€professional€practice€in€the€field€ofÏplastic€and€reconstructive€surgery€in€his€treatment€of€DonÏHarris€for€gynecomastia?Ìà8 àà àA.à àYes,€I€have.Ìà8 àà àQ.à àWhat€is€that€opinion?Ìà8 àà àA.à àThat€it€was€not€complied€with.€€The€standardÏof€care€wasn't€met,€because€there€are€so€many€proceduresÏthat€could€be€used€that€would€be€less€disfiguring€than€theÏone€actually€recommended€and€performed€on€Mr.€Harris.Ìà8 àà àà àà àQ.à àDoctor,€if€you€would,€explain€to€the€juryÏwhat€the€standard€of€care€„„€you've€heard€that€term.€ÏExplain€to€the€jury€what€standard€of€care€means€as€appliesÏin€this€case€to€plastic€and€reconstructive€surgeries.Ìà8 àà àA.à àStandard€of€care€applies€to€the€standard€thatÏreasonable€physicians€under€like€and€similarÏcircumstances€would€apply€when€selecting€a€procedureÏthat€they€knew€technically€how€to€perform€and€thatÏapplied€to€the€particular€situation€at€hand€and€beingÏcertain€the€patient€understood€that€procedure€as€well€asÏthe€alternative€procedures€and€then€perform€theÏprocedure€again€within€the€standard€of€care,€meaning€inÍthe€fashion€similarly€trained€and€experienced€physiciansÏwould€take€care€of€their€patient.ÌÓ  Ó.€.€.ÌÓ  Óà8 àà àQ.à àNow,€tell€me€a€little€bit€about€your€opinion€inÏthis€case.€€You€mentioned€that€you€thought€the€standard€ofÏcare€„„€you€told€us€what€you€thought€the€standard€of€careÏwas€in€this€case.€€Tell€us€in€specifics€how€the€defendantÏfell€below€the€recognized€standard€of€care€in€his€treatmentÏof€Mr.€Harris.Ìà8 àà àA.à àIt's€my€opinion€that€the€deficiency€in€meetingÏthe€standard€of€care€in€this€case€were€primarily€related€toÏthe€type€of€procedure€that€was€selected€for€treatment,€andÏthat's€based€on€looking€at€the€pictures€pre€and€post„op€andÏhaving€the€opportunity€to€examine€the€patient€and€his€twinÏbrother€and€the€pathology€report,€which€clearly€indicatesÏthat€almost€all€of€the€tissue€that€was€removed€was€fattyÏtissue,€as€opposed€to€glandular€tissue,€and€the€fact€thatÏthere€are€and€were€in€1993€procedures€available,€whichÏwould€be€equally€easy€to€perform,€perhaps€a€lot€easier€toÏperform,€and€would€not€be€so€disfiguring€for€Mr.€Harris.Ìà8 àà àà àSpecifically€that€would€be€either€liposuctionÏalone€or€liposuction€with,€if€necessary,€the€type€of€nippleÏincision€that€I€was€diagramming€œ[sic]€and›€the€surgicalÏremoval€of€the€glandular€tissue€beneath€the€nipple€areolarÏcomplex,€as€opposed€to€what,€at€least€in€my€opinion,€wasÏessentially€a€cancer€operation,€where€you€remove€theÏentire€breast€and€have€to€remove€the€excess€skin€andÏcreate€flaps€and€do€the€free€nipple€transfer€grafting.Ìà8 àà àQ.à àDoctor,€let€me€ask€you€again€within€aÏreasonable€degree€of€medical€certainty,€as€a€result€of€theÏtreatment€that€Don€Harris€received€at€the€hands€of€Dr.ÏBuckspan,€did€he€suffer€damages€and€injuries€that€heÏwould€not€have€otherwise€suffered€but€for€Dr.€Buckspan'sÏactions?Ìà8 àà àA.à àHe€certainly€suffered€some€very€extensiveÏscarring€and€some€appearance€that€the€nipple€areolarÏcomplex€differs€in€size€and€location€from€where€it€wasÏoriginally.€€Essentially€that's€the€damages€to€himÏpersonally€that€instead€of€improving€his€appearance€it€isÏmuch€worse€than€it€was€before€he€had€the€surgery.ÌÌÓ€ÓÌà àThus,€it€appears€from€the€testimony€of€Dr.€Bussey€that€it€is€Dr.ÏBuckspan's€choice€of€procedure€in€preference€to€other€available€proceduresÏthat€apparently€violated€the€applicable€standard€of€care.ÌÌà àOn€cross€examination,€however,€Dr.€Bussey€testifies:ÌÓÓà8 àà àQ.à àUsing€as€what€you€define€as€the€standard€ofÏacceptable€professional€practice€in€this€community,€didÏDr.€Buckspan's€decision€to€send€this€man€to€see€Dr.€CraigÏSussman€comply€with€the€standard€of€care?Ìà8 àà àA.à àYes,€he€referred€him€for€endocrinologicalÏevaluation€for€possible€medical€treatment.Ìà8 àà àQ.à àWasn't€that€a€good€thing€to€do€that€compliedÏwith€the€standards€of€care?Ìà àà àA.à àYes.Ìà8 àà àQ.à àIsn't€it€also€your€testimony€„„€perhaps€theÏjury€should€know€you€gave€the€deposition€in€this€case,€youÏwill€recall,€on€August€13th,€1996€at€your€office€in€Austell,Ïdidn't€you?Ìà àà àA.à àYes,€I€did.Ìà8 àà àQ.à àIsn't€it€also€your€testimony€in€your€opinionÏthat€assuming€the€patient€listened€you€have€no€criticismsÏof€the€operative€consent€form€at€all,€isn't€that€right?Ìà8 àà àA.à àI€don't€remember€the€exact€phrase€I€used,€butÏI€don't€see€how€listen€comports€with€the€written€consentÏform.Ìà8 àà àQ.à àIt's€your€use€of€the€language.€€I€can€ask€it€thisÏway€and€we€can€refer€back€to€the€deposition€if€we€want€to.€ÏIsn't€it€true,€Doctor,€that€this€consent€form€itself€is€theÏkind€of€consent€form€that€passes€without€criticism€amongÏsurgeons€complying€with€accepted€standards€ofÏprofessional€practice?Ìà8 àà àA.à àThe€written€consent€form€is€indeed€that.Ìà8 àà àQ.à àDid€you€look€at€the€written€consent€form€toÏsee€what€kind€of€information€was€disclosed€on€the€formÏitself?Ìà àà àA.à àYes.Ìà8 àà àQ.à àSo€if€the€patient€looked€at€the€consent€form,Íhe€would€know€that€the€surgery€he€was€going€to€have€„„Ïcarried€with€it€the€risk€of€bleeding,€correct?Ìà àà àA.à àYes.Ìà àà àQ.à àSwelling?Ìà àà àA.à àYes.Ìà àà àQ.à àInfection?Ìà8 àà àA.à àI€am€assuming€those€are€correct.€€It's€been€aÏwhile€since€I€read€the€document.€€I€have€no€reason€toÏdispute€that.Ìà àà àQ.à àUnfavorable€scar?Ìà àà àA.à àI€am€assuming€that's€correct.Ìà àà àQ.à àIsn't€that€on€there?Ìà àà àA.à àI€think€it€is.Ìà8 àà àQ.à àDoesn't€this€gentleman€have€an€unfavorableÏscar?Ìà àà àA.à àYes.Ìà àà àQ.à àA€permanent€scar?Ìà8 àà àA.à àIn€my€opinion€they€are€more€than€likelyÏpermanent.Ìà àà àQ.à àChange€in€sensation?Ìà àà àA.à àYes.Ìà àà àQ.à àPartial€or€complete€loss€of€grafts?Ìà àà àA.à àYes.Ìà8 àà àQ.à àAll€of€those€potential€risks€and€complicationsÏwere€listed€on€the€consent€form€signed€by€Mr.€Harris€twoÏto€three€weeks€before€surgery,€correct?Ìà àà àA.à àYes.Ìà8 àà àQ.à àIn€addition,€the€same€consent€form€describesÏa€procedure€as€a€bilateral€subcutaneous€mastectomy€withÏsuction€assistance,€skin€excision€and€free€nipple€graft.€ÏThat€describes€the€procedure€he€underwent€on€May€11th,Ï1993,€doesn't€it?Ìà àà àA.à àYes.Ìà8 àà àQ.à àIsn't€it€true,€Dr.€Bussey,€that€in€terms€ofÏlooking€at€the€operative€note,€the€procedure€that€Dr.ÏBuckspan€performed€was€an€acceptable€procedure€for€aÏcorrection€of€this€patient's€problem?Ìà8 àà àA.à àIn€looking€at€the€operative€note,€it's€aÏprocedure€that€has€been€accepted€as€something€that'sÏreasonable€for€correction€of€gynecomastia€depending€onÏthe€volume€and€degree€of€tosis€and€the€appropriateÍunderstanding€of€other€procedures€that€could€beÏperformed€with€less€disfigurement.Ìà8 àà àQ.à àDo€you€have€to€today€qualify€your€answerÏjust€as€you€did,€or€can€you€answer€it€yes€or€no?Ìà8 àà àA.à àI€don't€have€to€qualify€it.€€It€has€beenÏaccepted€as€a€procedure€that€is€appropriate€for€thisÏdiagnosis.ÌÌÓ€ÓÌà àIn€summary€on€cross€examination€Dr.€Bussey€further€testified:ÌÓÓà8 àà àQ.à àIsn't€it€true€that€the€surgical€procedure€itselfÏas€described,€the€technical€aspect€of€the€surgicalÏprocedure,€was€properly€carried€out€in€accordance€withÏaccepted€standards€of€care?Ìà8 àà àA.à àThe€surgical€procedure€itself€it€appearedÏfrom€the€operative€record€was€carried€out€within€theÏacceptable€standards€of€care.€€That's€correct.Ìà8 àà àQ.à àLet's€see€if€we€can€recap€then.€€We've€got€aÏsurgeon,€a€plastic€surgeon,€who€is€board€certified€whoseÏhad€enough€experience€in€this€community€to€know€theÏstandard€of€care,€correct?Ìà àà àA.à àYes.Ìà8 àà àQ.à àWho€complies€with€the€standard€of€care€inÏsending€the€patient€on€to€see€an€endocrinologist,€right?Ìà àà àA.à àThat's€correct.Ìà8 àà àQ.à àWho€performs€a€procedure€that€is€one€of€theÏaccepted€methods€of€addressing€gynecomastia€but€not€theÏone€you€would€choose,€right?Ìà àà àA.à àNot€for€this€patient.€€That's€correct.€€Ìà8 àà àQ.à àAnd€technically€performs€the€procedure€in€aÏfashion€that€complies€with€accepted€standards€of€care,Ïcorrect?Ìà àà àA.à àYes.ÌÌÓ€ÓÌà àIt€is€not€a€departure€from€the€applicable€standard€of€care€for€aÏphysician€to€use€a€procedure€that€is€but€one€of€several€procedures€recognizedÏin€the€profession€as€adequate€in€the€treatment€of€the€plaintiff's€condition.€€InÍò òòòBlankenship€v.€Baptist€Memorial€Hospitaló óóó,€this€court€observed:ÌÓÓà8 àà àIn€òòò òSnyder€v.€St.€Louis€Southwestern€R.€Coó óóó.,Ï228€Mo.€App.€626,€72€S.W.2d€504,€512,€the€court€said€onÏthis€question:Ìà8 àà à"We€have€found€no€better€statement€of€the€rule€ofÏcare€required€of€a€physician€than€in€the€case€of€ò òòòBailey€v.Ï[St.€Louis„San€Francisco]€R.€Co.,€ó óóóMo.€App.,€296ÏS.W.€477,€cited€by€plaintiff,€where€this€court,€speakingÏthrough€Judge€Cox,€said:Ìà8 àà à"€'Physicians€and€surgeons€must€be€allowed€a€wideÏrange€in€the€exercise€of€their€judgment€and€discretion.€ÏThe€science€of€medicine€is€not€an€exact€science.€€In€manyÏinstances€there€can€be€no€fixed€rule€by€which€to€determineÏduty€of€a€physician,€but€he€must€often€use€his€own€bestÏjudgment€and€act€accordingly.€€By€reason€of€that€fact€theÏlaw€will€not€hold€a€physician€guilty€of€negligence€*€*€*,Ïeven€though€his€judgment€may€prove€erroneous€in€a€givenÏcase,€unless€it€be€shown€that€the€course€pursued€wasÏclearly€against€the€course€recognized€as€correct€by€theÏprofession€generally.€€As€long€as€there€is€room€for€anÏhonest€difference€of€opinion€among€competent€physicians,Ïa€physician€who€uses€his€own€best€judgment€cannot€beÏconvicted€of€negligence,€even€though€it€may€afterwardÏdevelop€that€he€was€mistaken.€[Citing€cases].'"Ìà8 àà à[6]€And€where€there€is€a€difference€of€opinion€amongÏphysicians€or€surgeons€with€reference€to€the€treatment€toÏbe€given€in€a€particular€case,€a€physician€will€€not€be€heldÏliable€for€malpractice€if€he€follows€the€course€ofÏtreatment€advocated€by€a€considerable€number€ofÏphysicians€of€good€standing€in€his€community.€€It€wouldÏnot€be€competent€for€a€court€or€jury€in€such€a€case€to€sayÏthat€a€physician€who€followed€either€of€said€differentÏmethods€of€treatment€was€negligent.ÌÌò òòòBlankenship€v.€Baptist€Mem'l€Hosp.ó óóó,€26€Tenn.€App.€131,€143„44,€168ÏS.W.2d€491,€496€(1942);€ò òòòsee€also€McPeak€v.€Vanderbilt€Univ.€Hosp.ó óóó,Ï33€Tenn.€App.€76,€229€S.W.2d€150€(1950).òòò ò€óóó óÌÌÌÓ€Óà àThis€rule€is€reiterated€in€Tennessee€Pattern€Instructions€(civil)€3rdÍat€section€6.14.€€(The€pattern€jury€instruction€presupposes€a€dispute€in€expertÏwitness€testimony€which€does€not€exist€in€this€case.)ÌÌà àDr.€Buckspan,€along€with€his€two€experts,€Doctors€DeLozier€andÏBarton,€testified€that€the€procedure€used€by€Dr.€Buckspan€complied€with€theÏapplicable€standard€of€care€and€that€neither€in€choosing€the€particularÏprocedure,€nor€in€the€execution€of€the€same,€did€the€conduct€of€Dr.€BuckspanÏfall€below€the€standard€of€care.€ÌÌà àTaking€the€testimony€of€Dr.€Bussey€as€a€whole,€he€simply€disagreesÏwith€the€procedure€used€by€Dr.€Buckspan,€while€at€the€same€timeÏacknowledging€that€such€procedure€is€a€recognized€method€of€treatingÏgynecomastia€and€that€the€procedure€was€performed€in€a€professionallyÏacceptable€manner.€€Thus€it€is€that€no€expert€testimony€in€the€recordÏestablishes€a€òòprima€facieóó€case€that€Dr.€Buckspan€deviated€from€the€applicableÏstandard€of€care€in€his€treatment€of€Plaintiff.€€The€trial€court€correctlyÏdirected€a€verdict€in€favor€of€the€defendant€on€the€medical€malpractice€issue.ÌÌòòV.à àRes€ipsa€LoquituróóÌÌà àPlaintiff€relying€on€ò òòòUnderwood€v.€H.€C.€A.€Health€Servs.€ofÏTennesseeó óóó,€892€S.W.2d€423€(Tenn.€Ct.€App.€1994),€asserts€the€applicationÏof€res€ipsa€loquitur.ÌÌà àTennessee€Code€Annotated€section€29„26„115(c)€provides:ÌÓÓà8 àIn€a€malpractice€action€as€described€in€subsection€(a)€ofÏthis€section€there€shall€be€no€presumption€of€negligence€onÏthe€part€of€the€defendant.€€Provided,€however,€there€shallÍbe€a€rebuttable€presumption€that€the€defendant€wasÏnegligent€where€it€is€shown€by€the€proof€that€theÏinstrumentality€causing€injury€was€in€the€defendant's€(orÏdefendants')€exclusive€control€and€that€the€accident€orÏinjury€was€one€which€ordinarily€doesn't€occur€in€theÏabsence€of€negligence.ÌÌTenn.€Code€Ann.€ðð€29„16„115(c)(1980).ÌÌÓ€ÓÌà àò òòòUnderwood€ó óóóinvolved€an€action€by€a€hospital€visitor€for€injuriesÏsustained€when€the€cover€of€a€self„service€ice€dispenser€in€the€hospitalÏcafeteria€fell€on€her.€€The€trial€court€directed€a€verdict€for€the€defendantÏwhich€was€affirmed€by€the€court€of€appeals.€€The€case€had€nothing€to€do€withÏres€ipsa€loquitur€in€the€context€of€a€medical€malpractice€claim.ÌÌà àIn€this€case€there€is€no€medical€expert€testimony€establishing€theÏnegligence€of€Dr.€Buckspan€and€no€evidence€of€accident€or€injury€caused€byÏan€instrumentality€under€the€exclusive€control€of€the€defendant.€€This€actionÏis€not€one€where€a€jury€based€upon€their€own€common€knowledge€andÏobservation€can€infer€negligence.ÌÌà à"Since€there€are€only€some€instances€where€a€pleading€of€res€ipsaÏloquitur€is€applicable€in€medical€malpractice€cases,€the€doctrine€is€notÏapplicable€and€recovery€cannot€be€had€without€medical€proof€that€theÏnegligence€actually€occurred;€.€.€.€"€€61€Am.Jur.€2d€òòPhysicians,€Surgeons,Ïetc.óó,€ðð€338,€(1981).€€As€observed€by€the€Court€of€Civil€Appeals€of€Texas:ÌÓÓà8 àà àThere€are€only€very,€very€few€instances€where€aÏpleading€of€res€ipsa€loquitur€is€applicable€in€medicalÏmalpractice€cases.€€Where€negligence€is€alleged€against€aÏdoctor,€it€must€be€proved€by€expert€medical€testimonyÏbefore€the€case€can€be€developed.€€The€doctrine€of€res€ipsaÍloquitur€is€not€applicable€and€recovery€cannot€be€hadÏwithout€medical€proof€that€the€negligence€actuallyÏoccurred."€€ò òòòÌÌGoodnight€v.€Phillipsó óóó,€418€S.W.2d€862,€868€(Tex.€Civ.€App.€1967).ÌÌÓ€ÓÌà àThe€trial€court€correctly€directed€a€verdict€on€res€ipsa€loquitur.ÌÌòòVI.à àOther€IssuesóóÌÌà àThe€remaining€issues€asserted€by€Plaintiff€relate€to€damages€and€toÏthe€admissibility€of€certain€evidence.€€Having€determined€that€the€trial€courtÏwas€correct€in€directing€a€verdict€for€Defendant€on€allòòò ò€óóó óliability€issues,€it€isÏnot€necessary€to€discuss€damage€issues€although€it€might€be€well€to€point€outÏthat€evidence€offered€by€Defendant€of€prior€use€by€Plaintiff€of€anabolicÏsteroids€was€irrelevant€to€any€issue€before€the€court.€€It€may€have€been€aÏcause€for€the€development€of€the€condition€for€which€Plaintiff€soughtÏmedical€assistance€in€the€first€place.€€It€is€neither€cause€in€fact€or€proximateÏcause€of€any€injury€or€loss€suffered€by€Plaintiff.€€ò òòòSee€McClenahan€v.ÏCooleyó óóó,€806€S.W.2d€767,€774€(Tenn.€1991).ÌÌà àFinally,€Plaintiff€claims€that€his€constitutional€right€to€a€trial€byÏjury€was€violated€when€the€trial€court€acting€under€Rule€50.02€of€theÏTennessee€Rules€€of€Civil€Procedure€directed€a€verdict€for€the€defendantÏafter€declaring€a€mistrial€because€the€jury€was€unable€to€agree.€€PlaintiffÏrelies€primarily€on€a€statement€by€the€court€of€appeals€from€ò òòòKeith€v.ÏNorrisó óóó,€57€Tenn.€App.€423,€419€S.W.2d€189€(1967),€which€has€not€beenÏcited€in€any€reported€decision€in€the€ensuing€thirty„one€years.€€Said€theÍò òòòKeithó óóó€court:ÌÓÓà8 àà à[2]€€We€take€up€next,€on€its€merits,€the€question€ofÏwhether€the€trial€judge€ruled€correctly,€when€onÏdefendant's€motion€for€a€new€trial,€he€undertook€toÏcorrect€what€he€concluded€had€been€an€error,€and€grantedÏdefendant's€motion€for€a€directed€verdict.€€The€fact€thatÏthe€trial€judge€was€enough€doubtful€about€the€matter€toÏoverrule€the€motion€for€directed€verdict€indicates€to€someÏextent,€at€least,€that€reasonable€minds€might€differ€as€toÏwhether€or€not€such€motion€should€be€granted,€and€theÏsubsequent€fact€that€the€jury€to€whom€the€case€wasÏsubmitted€did€in€fact€disagree,€clearly€indicates€thatÏreasonable€minds€did€disagree.ÌÌò òòòId.ó óóó€at€429,€192.ÌÌÌÓ€Óà àTo€attribute€to€this€ill„advised€statement€from€ò òòòKeithó óóó€the€meaningÏasserted€by€the€Plaintiff€would€effectively€destroy€Rule€50.02€in€any€caseÏwhere€a€jury€was€unable€to€agree€and€a€mis„trial€thus€made€necessary.€€TheÏpertinent€portion€of€Rule€50.02€provides:€€"Whenever€a€motion€for€aÏdirected€verdict€made€at€the€close€of€all€the€evidence€is€denied€or€for€anyÏreason€is€not€granted,€the€court€is€deemed€to€have€submitted€the€action€to€theÏjury€subject€to€a€later€determination€of€the€legal€questions€raised€by€theÏmotion."ÌÌà àSuch€is€precisely€what€happened€at€bar€when€the€trial€judgeÏreserved€action€on€the€motions€for€a€directed€verdict€filed€by€the€defendantÏand€submitted€the€case€to€the€jury.€€At€a€separate€hearing€held€after€the€mis„trial€was€declared€the€trial€judge€determined€that€the€motion€for€a€directedÏverdict€was€sound€in€law€and€granted€same.€€This€action€was€in€conformityÏwith€correct€procedure.€€ò òòòHolmes€v.€Wilsonó óóó,€551€S.W.2d€682,€685€(Tenn.Ï1977).ÌÌà àThe€judgment€of€the€trial€court€is€in€all€respects€affirmed€with€costsÏassessed€against€appellant.€€€ÌÌÓÓà àÌà àà àà àà à________________________________Ìà àà àà àà àÔ€+XÔWILLIAM€B.€CAIN,€JUDGEÌÌÌÌCONCUR:ÌÌÌÌ_______________________________________ÌHENRY€F.€TODD,€PRESIDING€JUDGE,€M.S.ÌÌÌ_______________________________________ÌBEN€H.€CANTRELL,€JUDGEÌà8 àà à