ÿWPC. Õ" ?ÇiÅ~|ôÓ”#Áo¶¯7=óS"L2©€¸3cíÄìiÇ~5æ7!éLU¼‰ }0{ ¿T‡0Šæ²5ÓMDóNéÈ Ú£&ä©ð—_jg𯸢*ÕáÀÐE}÷“|!ùOªì`ÌOù"3¤ÖÕô-‰„£…hCÕÕÕSôeA1i_l ;Ès´öÖôñ@_`uÿ«•(*Pë¹pKB&qÀX’͕ޠûëØîdC’qsÓîŠ,è¢`UÍiîNi¥'%FeæÜÇÙ°Ìù)B.ÂìfNü½‡y5¢´oü‹Íva¨Ù\:†Ù1€õ‹P¯kŒ3»€M¡s´û%H hFå¥o†ßCÑpEŸå 8ÆG¾n žhÂ1q–ciŒ¦ØêZ ²ÌÝ޲T• GׄIo›!Þã«ì¨S8^Ì{ûÃ+=ûûqè™.0¿ö¯à±×‘’F|=ÏãÒ4å¼>—dqœÂË ®jDõ õ&žWŸ`a’0Þƒ>½_iÿP¢RB’²X¤B°;ñmÐ#}Þ7Œ.ÀJ<•ãÞ ^/ÆõÿÒ |KiŸY°Ã 8ûo§¡vW¥SçåÇr®­²|Ú?1Ñ^@¼:±9b %\UNb 0ˆ°U&N8N†ˆž z´Ò. . ï 0 Dï Æ3 Æù Æ¿ Æ… … NK«M^ øEÓÙÙPi ¹zÃw=4AUd mfk}}}}}}}}}}}}bèèèèèèèèèHð#É8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8&8& 0 ë)))) Bì)ì) 0¤ * D5­* D-â* 0K++ ASZ+Æ­+ 0¤s, 0D- A«[-»(@øÐ Z‹6Times New Roman Regular(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regular Ñ ° Ñ Ñ e Ñ ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt åÝ ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€The€scheduled€procedure€was€described€as€an€ð ðout„patient€procedureðð€in€plaintiffððs€complaint.(#Ã$òòÚ  Ú0Ú  ÚóóLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5 ¡Ý ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€Defense€counsel€acknowledged€that€Dr.€Hays€could€give€a€videotaped€deposition€over€the€upcoming€weekend,Ð ° Ðbut€expressed€concern€with€regard€to€whether€Dr.€Hays€would€be€in€the€proper€state€of€mind€to€offer€an€opinion€at€thisÐ tÄ Ðtime.Ð 8ˆ Ð3„\/Ï  ÉÝ ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú4Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€The€court€specifically€found€that€defendantsðð€were€entitled€to€the€following€set„offs€for€amounts€paid€onÐ ° Ðaccount€of€Mr.€Hunterððs€death:€(1)€life€insurance€proceeds€to€Sherry€Hunter€totaling€$185,000.00;€(2)€life€insuranceÐ tÄ Ðproceeds€paid€to€Benjamin€Hunter€in€the€amount€of€$185,000.00;€(3)€ð ðchildððs€social€security€benefitsðð€paid€to€BenjaminÐ 8ˆ ÐHunter€in€the€amount€of€$5,523.00,€and€Joseph€S.€Hunter€in€the€amount€of€$42,897.00;€(4)€ð ðone„time€widowððs€socialÐ üL Ðsecurity€benefitðð€paid€to€Sherry€Hunter€in€amount€totaling€$255.00;€and€(5)€social€security€benefits€payment€to€SherryÐ À ÐHunter€in€the€total€amount€of€$7,890.00.€Ô_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_ÔÔ_Ôò òó óÔ_Ô †Ý ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú5Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€Point€of€fact,€we€note€that€defendantsðð€brief€does€not€explicitly€or€solely€examine€the€issue€of€whether€the€courtÐ ° Ðerred€in€denying€defendantsðð€Motion€in€Limine€#10,€but€rather€appears€to€address€both€questions€as€part€of€a€single€issue. FÝ ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú6Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€During€a€bench€conference,€the€trial€court€appeared€to€acknowledge€that€counsel€was€required€to€identify€aÐ e Ðrelied€upon€authoritative€text,€stating:Ð )Ä ÐÌà8  àà8` Ð Ð àTHE€COURT:€You€just€canððt€say,€ð ðItððs€an€authoritative€text,€let€me€show€you€theÐ ±L # Ðtext.ðð€€As€far€as€weððre€concerned,€this€is€anesthesia€by€[Wifeððs€counsel].Ðe` x` x Ðò òÌó ó Ý ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú7Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€The€Courtððs€holding€reversed€ò òòòDavidson€Benedict€v.€Seversonóóó ó,€109€Tenn.€572,€72€S.W.€967€(Tenn.€1902),€ð ðtoÐ e Ðthe€extent€that€òòò òDavidson€Benedict€ó óóóprohibits€consideration€of€spousal€consortium€losses€when€calculating€the€pecuniaryÐ +Æ Ðvalue€of€a€deceasedððs€life€under€the€wrongful€death€statute.ðð€€òòò òIdó óóó.€at€600. pÝ ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú8Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€Although€the€court€determined€that€the€issue€of€loss€of€consortium€damages€was€properly€before€it,€the€courtÐ e Ðconcluded€that€the€retroactive€application€of€òòò òJordanó óóó€to€allow€recovery€for€loss€of€consortium€damages€would€not€increaseÐ )Ä Ðthe€plaintiffððs€damages€because€both€plaintiffs€ð ðreceived€$130,000,€the€maximum€allowable€under€the€GTLA€per€injuredÐ ïŠ Ðperson.ðð€€òòò òIdó óóó.€€(citation€omitted).€€Ð ³N Ðo=/ê:i¢×+003|x%ÿU‹ÿÀÀÀ aÝ ƒRœ¤$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ô¯½ò»»ÔÝ  ÝÔ_Ô€Plaintiff€voluntarily€dismissed€the€suit€against€Defendant€Moyers€and€summary€judgments€were€granted€toÐ ° Ðthe€remaining€Defendants,€except€Defendants,€Jay€Michael€Ura,€M.D.,€and€Nashville€Anesthesia€Services.- ù-  AdministratrixShipleyHighersWarlickarthroscopyObermeierinterscaleneRenfro$intraoperativelyMoyers CRNAv]alueLimine iesBallardMcDanielDaubertEichhorn CSXpayoutsp]ecuniarym]entalRemittiturT.C.A. TREMR Ura CmtyTuggleAllright Sysspousalt]hisEyrichexist[ingDonelsont]hereT.R.A.P. t]her]ulesT.R.C.P.f]ormalw]hetherAerosmith autoregulationDesflurane autoregulatory Evidsupport[sintracranial$vasoconstrictionischemia CVPDishman CrimBragenKorsakovMcCayHypotensionEichberg S.W.W]hereStallingsSmarr M.R.Mahla cmtunrungunringpretermitthat thatFeinbergvertebralsEnsorSaklerAssocsP.S.C.Eberhart S.CtTzimasdispositiveMcCollumHuffstutterSadler WittSeverson GTLAcase[sPridemark COASuttles W.S.˜\\IB01S01\CLERK1NASÈÈ,,,,ÈÈ0(|G2œ¤$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€½»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ô¯½ò»»Ô d(|3L$££Ý ƒ£ª!ÝÑ€.ÑÑ8€½»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV)ÿÿ!dxdx)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3L$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€½»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€½»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÔ_ÔÑ  ÑÔ€¼½»»»ÔÑ8€GIXXdì»»d8ÑÑ  Ñà@ü ü ìàÔ‡îÌ½ÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#†¼½»îîÌ#ԈРÖ& ÐÓ  ÓAugust€7,€2003€SessionÐ üL ÐÔ‡XGIX»¼½ÔÌò òÔ#†¼½»XXGI#ÔSHERRY€HUNTER,€As€Administratrix€of€the€Estate€of€LAWRENCEÐ úJ ÐHUNTER,€Deceasedòòóó€v.€JAY€MICHAEL€URA,€òòet€alóó.Ô‡XGIX»¼½Ôó óÐ  ^ ÐÌà@@½½ìàò òA€Direct€Appeal€from€the€Circuit€Court€for€Davidson€CountyÐ  ^ Ðà@@øøìàNo.€96C„3784€€€€€€The€Honorable€Marietta€M.€Shipley,€JudgeÐ ú J ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<½` AßÐ ¾  ÐÌà@@TTìàNo.€M2002„02573„COA„R3„CV€„€Filed€October€28,€2003ó óÔ#†¼½»XXGIÏ#ÔÔ‡XGIX»¼½Ôò òÐ ¹  ÐÌßA€V) °°` dE<` AßÐ ‘á  Ðó óÌÓ  ÓÔ‡XGIXXXGIÔà  àAdministratrix€of€estate€of€deceased€husband€filed€wrongful€death€action€against€defendantsÐ ŒÜ Ðanesthesiologist€and€anesthesia€services€group.€€Jury€returned€a€verdict€for€plaintiff,€findingÐ xÈ Ðdefendants€at€fault€and€awarding€damages€for€medical€and€funeral€expenses,€and€the€pecuniary€valueÐ d´ Ðof€the€life€of€the€deceased€including€loss€of€consortium€of€wife€and€children.€€Defendants€appeal,Ð P  Ðraising€several€procedural€and€evidentiary€issues€for€consideration.€€We€vacate€and€remand.Ð <Œ ÐÔ#†XGIXXXGI?#ÔÔ#†¼½»XXGI¡#ÔÔ‡XGIX»¼½ÔÌÓ3ÓÌò òTenn.€R.€App.€P.€3;€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Vacated€andÐ P ÐRemandedó óÐ ì< ÐÌòòÓ  ÓÔ#†¼½»àXGIò#ÔÔ‡XGIX.¼½ÔW.€Frank€Crawford,€P.J.,€W.S.óó,€delivered€the€opinion€of€the€court,€in€which€òòAlan€E.€Highers,Ð Ä ÐJ.óó€and€òòDavid€R.€Farmer,€J.óó,€joined.Ð ° ÐÌE.€Reynolds€Davies,€Jr.,€Ed€R.€Davies,€Nashville;€Daniel€D.€Warlick,€Nashville€„€For€Appellants,€JayÐ ˆØ ÐMichael€Ura,€M.D.€and€Nashville€Anesthesia€ServicesÐ t Ä ÐÌGary€K.€Smith,€C.€Philip€M.€Campbell,€Memphis,€For€Appellee,€Sherry€HunterÐ L"œ! ÐÓ°ÓÌò òOPINIONó óÔ#†¼½»XXGIß#ÔÔ‡XGIX»¼½ÔÐ $$t# ÐÌòòóóÔ#†¼½»XXGI #ÔÔ‡XGIX»¼½ÔÓ  Óò òÑ€OYÑÑ€ïOÑÑ8€GIXXdìXXdì8Ñó óà  àThe€deceased,€Mr.€Lawrence€Hunter€(ð ðHusbandðð),€was€admitted€to€the€Columbia€SouthernÐ ü%L!% ÐHills€Medical€Center€on€October€27,€1995,€to€undergo€an€arthroscopy€of€his€right€shoulder.׃ ×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€PriorÐ è&8"& Ðto€the€operation,€Dr.€Stephen€J.€Obermeier€(ð ðDr.€Obermeierðð)€administered€an€interscalene€nerveÐ Ô'$#' Ðblock.€€Ð À($( ÐÌà  àOn€October€17,€1996,€Plaintiff,€Sherry€Hunter,€as€Administratrix€of€the€Estate€of€LawrenceÐ ˜*è%* ÐHunter,€deceased,€filed€a€Complaint€for€wrongful€death€against€the€Defendants,€Jay€Michael€Ura€,Ð „+Ô&+ý ÐÔ_ÔM.D.€(ð ðDr.€Uraðð)Ô#†¼½»XXGIw #ÔÔ‡XGIX»¼½Ô;€Stephen€J.€Obermeier,€M.D.;€Susan€Moyers,€CRNA;€Nashville€AnesthesiaÐ ° ÐServices€(ð ðNASðð);€H.C.A.€Health€Services,€Inc.;€H.C.A.€Health€Services€of€Tennessee,€Inc.,€d/b/aÐ œì ÐColumbia€Southern€Hills€Medical€Center,€and€Columbia€Southern€Hills€Medical€Center.׃"×Ý ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×Ð ˆØ ÐÌà  àThe€Complaint€avers€that€the€operation€was€ð ðinitiated€as€an€arthroscopy€of€the€right€shoulderÐ `° Ðand€intraoperatively€converted€to€an€open€rotator€cuff€repair.ðð€€During€the€surgery,€Dr.€UraÐ L œ Ðadministered€a€general€anesthesia€to€the€patient.€€Upon€completion€of€the€operation,€the€ð ðanesthesiaÐ 8 ˆ Ðteamðð€was€unable€to€awaken€Husband.€€Continued€post„operative€efforts€to€awaken€the€patientÐ $ t Ðproved€unsuccessful€and,€on€November€1,€1995,€Husband€was€declared€brain€dead.€€At€the€time€ofÐ  ` Ðhis€death,€the€deceased€was€a€49„year„old€executive€with€Nissan€Motor€Manufacturing€Corporation,Ð ü L  ÐU.S.A.,€and€the€father€of€two€minor€sons.€€The€Complaint€alleges,€among€other€thing:Ð è 8  ÐÌà8  àà8` Ð Ð àPlaintiff€alleges€that€Plaintiffððs€decedent€suffered,€in€conjunction€withÐ À  Ðthe€operative€procedure,€a€diffuse€hypoxic€insult€to€the€brain.€€SaidÐ ¬ü  Ðloss€of€oxygen€to€the€brain€was€the€direct€and€proximate€cause€ofÐ ˜è  ÐPlaintiffððs€decedentððs€death€and€said€hypoxic€episode€was€due€to€andÐ „Ô  Ðdirectly€and€proximately€caused€by€the€negligence€of€the€Defendants,Ð pÀ ÐUra,€Obermeier,€Moyers,€CRNA,€as€well€as€other€employees€orÐ \¬ Ðagents€of€the€Defendant€Hospital€staff.ÐH˜` x` x ÐÌà8  àà8` Ð Ð àPlaintiff€alleges€that€the€Defendants,€their€agents/employees,€wereÐ  p Ðnegligent€and€that€the€professional€services€rendered€to€PlaintiffððsÐ  \ Ðdecedent€fell€below€acceptable€standards€of€professional€practiceÐ øH Ðincluding,€but€not€limited€to€the€following:Ðä4` x` x ÐÌà8  àà8` Ð Ð àa.€Failing€to€provide€appropriate€informed€consent€or€adhere€toÐ ¼  Ðconsent€given€by€the€patient€and€as€such,€the€administration€of€generalÐ ¨ø Ðanesthesia€constitutes€assault€and€battery€resulting€in€the€death€ofÐ ”ä ÐPlaintiffððs€decedent;ЀÐ` x` x ÐÌà8  àà8` Ð Ð àb.€Failing€to€properly€monitor€and/or€accommodate€proper€monitoringÐ X ¨ Ðof€Plaintiffððs€decedent€preoperatively€and€intraoperatively;ÐD!”` x` x ÐÌà8  àà8` Ð Ð àc.€Failing€to€diagnose€in€a€timely€fashion€loss€of€oxygen€to€PlaintiffððsÐ #l! Ðdecedentððs€brain€when€reasonable€care,€had€it€been€exercised,€wouldÐ $X" Ðhave€indicated€that€Plaintiff€was€suffering€from€cerebral€hypoxia;Ðô$D #` x` x ÐÌà8  àà8` Ð Ð àd.€Failing€to€take€appropriate€steps€to€prevent€cerebral€hypoxia;ÐÌ&"%` x` x Ðâ âÐ ¸'#& ÐÑOYÑâ âѰ°Ñâ âÑ  Ñà8  àà8` Ð Ð àe.€Failure€to€take€appropriate€steps€to€resolve€existing€cerebralÐ ° Ðâ âhypoxia€before€significant€and€ultimately€fatal€brain€damageÐ œì Ðoccurred;ЈØ` x` x ÐÌà8  àà8` Ð Ð àf.€Failure€to€exercise€reasonable€and€ordinary€care€under€theÐ `° Ðcircumstances;€andÐL œ` x` x ÐÌà8  àà8` Ð Ð àg.€Failure€to€follow€acceptable€standards€of€professional€practiceÐ $ t Ðunder€the€circumstances€while€providing€medical€services€toÐ  ` ÐPlaintiffððs€decedent.Ðü L ` x` x ÐÌà8  àà8` Ð Ð à******************************************************ÐÔ$ ` x` x ÐÌà8  àà8` Ð Ð àThe€negligence€of€the€Defendants,€their€agents,€servants€andÐ ¬ü  Ðemployees,€including,€but€not€limited€to€those€acts€set€forth€above,Ð ˜è  Ðwere€the€direct€and€proximate€cause€of€Plaintiffððs€decedentððs€deathÐ „Ô  Ðand€the€physical€and€mental€pain€and€suffering€sustained€byÐ pÀ ÐPlaintiffððs€decedent€prior€to€death.Ð\¬` x` x ÐÌà  àThe€Complaint€seeks€judgment€for€damages€for€(1)€the€pecuniary€value€of€the€deceasedððs€life;Ð 4„ Ð(2)€physical€and€mental€pain€and€suffering€incurred€by€the€deceased€prior€to€death;€and€(3)€ð ð[v]alueÐ  p Ðof€services€to€be€provided€by€[deceased]€to€Plaintiff€and€Plaintiffððs€minor€children.ðð€€On€theseÐ  \ Ðgrounds,€Plaintiff€prayed€for€a€judgment€against€defendants€in€the€amount€of€$15,000,000.00€ð ðplusÐ øH Ðpre„judgment€interest,€discretionary€costs€and€all€other€allowable€costs.ððÐ ä4 ÐÌà  àOn€October€28,€1998,€Plaintiff€filed€a€Motion€to€Amend€Complaint€adding€a€claim€for€lossÐ ¼  Ðof€consortium€damages€and€a€claim€for€punitive€damages€in€the€amount€of€$45,000,000.00.€Ð ¨ø ÐDefendantsðð€response€to€Plaintiffððs€motion€objected€to€the€inclusion€of€a€claim€for€punitive€damagesÐ ”ä Ðbut€did€not€object€to€Plaintiffððs€loss€of€consortium€claims.€€The€trial€court€allowed€the€amendmentÐ €Ð Ðonly€as€to€the€loss€of€consortium€claims.Ð l¼ ÐÌà  àBy€Order€entered€February€27,€2001,€the€case€was€set€for€a€jury€trial€to€begin€September€10,Ð D!” Ð2001.€€On€May€2,€2001,€Plaintiff€filed€a€Motion€in€Limine€seeking€to€preclude€defendants€ð ðfromÐ 0"€  Ðoffering€expert€testimony€as€to€the€causation€or€ð ðpossibleðð€causation€of€the€injuries€or€death€ofÐ #l! ÐPlaintiffððs€decedent€from€occlusion€of€the€carotid€artery(ies)....ðð€€The€trial€court€entered€aÐ $X" ÐMemorandum€Opinion€on€July€2,€2001,€addressing€Plaintiffððs€motion€to€preclude€defense€expertÐ ô$D # Ðtestimony€regarding€the€aforementioned€ð ðcarotid€artery€occlusion€theory.ðð€€As€the€basis€for€itsÐ à%0!$ Ðopinion,€the€court€examined€the€deposition€testimony€of€defense€experts,€Dr.€Michael€Hays€(ð ðDr.Ð Ì&"% ÐHaysðð),€Dr.€John€Eichhorn€(ð ðDr.€Eichhornðð),€and€Dr.€Ballard€Wright€(ð ðDr.€Wrightðð)€with€regard€toÐ ¸'#& Ðthe€carotid€artery€occlusion€theory,€noting:€Ð ¤(ô#' ÐÌà8  àà8` Ð Ð àThe€doctors€that€have€set€forth€the€ð ðcarotid€artery€occlusion€theoryððÐ |*Ì%) Ðposit€that€three€simultaneous€events€caused€the€death€of€Mr.€Hunter.€Ð h+¸&* ÐThe€three€events€are€(1)€a€left€styloid€process€sufficiently€elongatedÐ ° Ðto€occlude€the€left€carotid€artery,€(2)€a€turning€of€Mr.€Hunterððs€headÐ œì Ðto€the€left€during€the€surgery,€and€(3)€an€interscalene€block€whichÐ ˆØ Ðcolluded€the€right€carotid€artery.ÐtÄ` x` x ÐÌò òó óà  àUpon€examination€of€the€individual€deposition€testimony€of€each€doctor,€the€court€grantedÐ L œ ÐPlaintiffððs€motion€as€to€Dr.€Hays,€finding€that€his€testimony€ð ðwhile€within€the€realm€of€scientificÐ 8 ˆ Ðpossibility,€falls€short€of€the€strictures€of€legal€probability€necessary€to€be€an€admissible€expertÐ $ t Ðopinion.ðð€€With€regard€to€defense€experts€Dr.€Eichhorn€and€Dr.€Wright,€the€court€expressed€ð ðsomeÐ  ` Ðconcern€about€the€admissibilityðð€of€the€expertsðð€testimony€based€on€their€depositions.€€However,Ð ü L  Ðrecognizing€that€the€expertsðð€testimony€was€offered€in€the€limited€and€highly€scrutinized€form€ofÐ è 8  Ðdiscovery€depositions,€the€court€decided€to€hold€a€Daubert/McDaniel€hearing€prior€to€trial€to€furtherÐ Ô$  Ðconsider€the€admissibility€of€the€expertsðð€testimony€regarding€the€carotid€artery€occlusion€theory.€Ð À  ÐÌà  àThe€trial€court€held€a€Daubert/McDaniel€hearing€on€August€30,€2001.€€Several€months€later,Ð ˜è  Ðthe€court€entered€a€Memorandum€Opinion€examining€the€question€of€ð ðwhether€Dr.€EichhornððsÐ „Ô  Ðtestimony€complies€with€the€factors€for€determining€reliability€of€scientific€evidence€in€ò òòòMcDanielÐ pÀ Ðv.€CSXóóó ó,€955€S.W.2d€257€(Tenn.€1997)[,]€as€well€as€the€legal€sufficiency€of€a€professional€opinionÐ \¬ Ðin€òòò òLindsey€v.€Miami€Development€Corp.ó óóó,€689€S.W.2d€856€(Tenn.€1985).ðð€€After€determining€thatÐ H˜ ÐDr.€Eichhorn€was€qualified€to€testify€as€an€expert,€the€court€found€that€the€expert€ð ðpassed€the€initialÐ 4„ Ðthreshold€necessitated€by€ò òòòMcDanielóóó ó,ðð€and€thereby€permitted€both€Dr.€Eichhorn€and€Dr.€Wright,Ð  p Ðprovided€Dr.€Wright€testified€ð ðin€a€similar€vein,ðð€to€testify€at€trial.Ð  \ ÐÌà  àOn€September€4,€2001,€Plaintiff€filed€a€Motion€in€Limine€seeking€to€preclude€defendantsÐ ä4 Ðfrom€ð ðintroducing€or€attempting€to€introduce€into€evidence€or€making€any€reference€in€opening€orÐ Ð  Ðclosing€arguments€to€any€collateral€source€payments€at€the€trial€of€this€case.ðð€€Plaintiff€filed€aÐ ¼  ÐMemorandum€of€Law€in€support€of€her€motion,€asserting€that€defendants€were€not€entitled€to€set„offsÐ ¨ø Ðor€credits€for€payments€made€to€Plaintiff€by€Husbandððs€employer€in€the€form€of€insurance€and€deathÐ ”ä Ðbenefits,€and€retirement€plan€payouts.€€Plaintiff€also€sought€to€exclude€introduction€of€social€securityÐ €Ð Ðbenefits,€and€investment€payouts.Ð l¼ ÐÓÓÌÓ‹6Óà  àDefendants€filed€Motion€in€Limine€#10€on€September€4,€2001,€seeking€to€exclude,€asÐ 0"€  Ðsubstantive€evidence,€any€learned€treatise€materials€ð ðthat€may€be€utilized€or€referred€to€by€plaintiffsððÐ #l! Ðexpert€witness.ðð€€On€April€8,€2002,€defendants€filed€another€Motion€in€Limine,€seeking€to€precludeÐ $X" ÐPlaintiff€from€introducing€ð ðproof€of€actual€economic€losses€relating€to€loss€of€services€and€loss€ofÐ ô$D # Ðearned€income€to€the€extent€these€losses€will€be€paid€or€have€been€paid€and€replaced€by€moniesÐ à%0!$ Ðreceived€by€Plaintiff€and€her€children€as€a€result€of€Larry€Hunterððs€death.ðð€€Alternatively,€defendantsÐ Ì&"% Ðmoved€for€a€set„off€or€credit€of€the€above„cited€amounts€against€any€judgment€rendered€in€favor€ofÐ ¸'#& ÐPlaintiff.Ð ¤(ô#' Ðâ âÐ )à$( Ðà  àDefendants€filed€Motion€in€Limine€#13€on€April€19,€2002,€renewing€their€application€for€ð ðaÐ ° Ðtotal€of€eight€(8)€peremptory€challenges€at€the€time€of€jury€selection.ðð€€Defendants€also€moved€toÐ œì Ðlimit€Plaintiff€to€four€total€peremptory€jury€challenges.Ð ˆØ Ðâ âÌà  àThe€jury€trial€began€on€April€22,€2002,€and€lasted€through€May€3,€2002.€€During€the€courseÐ `° Ðof€the€trial,€it€was€learned€that€Dr.€Hays,€defendantsðð€primary€causation€and€standard€of€care€expert,Ð L œ Ðhad€been€diagnosed€with€cancer€and€would€be€unable€to€testify€at€trial€due€to€treatment€conflicts.€Ð 8 ˆ ÐDefendants€asserted€that€it€would€be€prejudicial€to€their€case€if€Dr.€Hays€were€unable€to€testify€liveÐ $ t Ðat€trial,€and€therefore€moved€for€a€mistrial.׃×Ý ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€The€court€denied€defendantsðð€motion,€but€permitted€theÐ  ` Ðparties€to€make€arrangements€to€take€Dr.€Haysððs€videotaped€deposition€during€the€upcomingÐ ü L  Ðweekend.€€When€the€trial€convened€the€following€week,€defense€counsel€informed€the€court€that€itÐ è 8  Ðdid€not€take€the€videotaped€deposition€as€planned€because€of€concerns€regarding€Dr.€Haysððs€health.€Ð Ô$  ÐDefendants€thereby€renewed€their€motion€for€mistrial€to€no€avail.Ð À  Ðà8  àà8` Ð Ð àÐ ` x` x Ðà  àAt€the€close€of€trial,€the€jury€rendered€a€verdict€for€Plaintiff€against€Dr.€Ura€and€NAS,Ð ˜è  Ðawarding€Plaintiff€damages€in€the€amount€of€$43,950.00€for€medical€expenses,€$11,360.64€in€funeralÐ „Ô  Ðexpenses,€and€$5,800,000.00€for€the€ð ð[p]ecuniary€value€of€life€of€Larry€Hunter€including€loss€ofÐ pÀ Ðconsortium€of€wife€and€children.ðð€€The€jury€refused€to€award€Plaintiff€damages€for€the€ð ð[m]entalÐ \¬ Ðsuffering€of€Larry€Hunter€from€time€of€injury€until€time€of€death.ðð€€On€May€17,€2002,€the€trial€courtÐ H˜ Ðentered€judgment€on€the€jury€verdict€in€the€total€amount€of€$5,855,310.64.Ð 4„ ÐÓÓÌÓCÓà  àPlaintiff€filed€a€Motion€for€Prejudgment€Interest€on€June€17,€2002.€€This€same€day,Ð øH ÐDefendants€filed€ð ðDefendantsðð€Motion€to€Set€Aside€Judgment€And€To€Have€A€Judgment€EnteredÐ ä4 ÐIn€Accordance€With€the€Motion€for€Directed€Verdict,ðð€ð ðDefendantsðð€Motion€for€New€Trial,ðð€Ð Ð  Ðð ðDefendantsðð€Motion€for€Remittitur,ðð€and€ð ðDefendantsðð€Motion€to€Alter€or€Amend€the€Judgment.ðð€Ð ¼  Ðò òó óÓÓÌÓEÓà  àOn€October€7,€2002,€the€court€entered€an€Order€on€the€post„trial€motions€submitted€by€theÐ €Ð Ðrespective€parties.€€The€court€supported€the€juryððs€verdict€finding€defendants€ð ðat€fault,ðð€and€enteredÐ l¼ Ðthe€following€rulings€as€to€the€partiesðð€post„trial€motions:Ð X ¨ ÐÌà8  àà8` Ð Ð àà ¸ àIt€is€therefore,€ORDERED€as€follows:Ð0"€ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à1.€Defendantsðð€motion€to€set€aside€the€judgment€and€to€haveÐ $X" Ðjudgment€entered€in€accordance€with€the€motion€for€directed€verdictÐ ô$D # Ðis€denied.Ðà%0!$` x` x ÐÐ Ì&"% Ðà8  àà8` Ð Ð àà ¸ à2.€Defendantsðð€motion€for€new€trial€based€upon€theÐ ° Ðassignments€of€error€in€Section€II,€A„P,€and€R„S€of€the€motion,€isÐ œì Ðdenied.ЈØ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à3.€The€court€agrees€with€the€juryððs€verdict€relating€to€theÐ `° Ðdetermination€of€Defendantsðð€fault€and€the€juryððs€award€of€$2.8Ð L œ Ðmillion€dollars€for€the€present„day„value€of€the€lost€earning€capacityÐ 8 ˆ Ðof€the€decedent.€€The€court€disagrees€with€the€juryððs€award€of€anÐ $ t Ðadditional€$3.0€million€dollars€for€loss€of€consortium€damages,€andÐ  ` Ðdisagrees€with€the€juryððs€award€of€$5.8€million€dollars€for€theÐ ü L  Ðpecuniary€value€of€the€life€of€the€decedent.Ðè 8 ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à4.€Defendantsðð€motion€for€remittitur€is€granted.€€The€courtÐ À  Ðsuggests€a€remittitur€in€the€amount€of€$1.5€million€dollars€of€theÐ ¬ü  Ðjudgment€entered€on€May€17,€2002.Иè ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à5.€Plaintiff€must€file€a€notice€with€the€Circuit€Court€ClerkÐ pÀ Ðaccepting€the€suggested€remittitur,€accepting€the€suggested€remittiturÐ \¬ Ðunder€protest,€or€rejecting€the€suggested€remittitur€within€òò15óó€daysÐ H˜ Ðfrom€the€entry€of€this€order.€€If€Plaintiff€fails€to€file€such€notice,€or€ifÐ 4„ ÐPlaintiff€rejects€the€suggested€remittitur,€Defendantsðð€motion€for€newÐ  p Ðtrial€is€granted.Ð \` x` x ÐÌà8  àà8` Ð Ð àà ¸ à6.€Defendantsðð€motion€to€alter€or€amend€the€judgment€isÐ ä4 Ðdenied.ÐÐ ` x` x ÐÌà8  àà8` Ð Ð à******************************************************Шø` x` x ÐÌà8  àà8` Ð Ð àà ¸ à8.€Plaintiffððs€motion€for€an€award€of€pre„judgment€interest€isÐ €Ð Ðdenied.Ðl¼` x` x ÐÌÓÓThe€court€further€awarded€defendants€a€set„off€against€the€judgment€entered€in€this€case€in€the€totalÐ D!” Ðamount€of€$426,565.00€to€account€for€collateral€source€payments€received€by€Plaintiff.׃×Ý ƒ #ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€Plaintiff€wasÐ #l! Ðawarded€$35,468.59€in€discretionary€costs.€€Taking€into€account€the€set„offs,€the€courtððs€discretionaryÐ ô$D # Ðcost€award,€and€the€suggested€remittitur,€the€court€calculated€a€total€modified€judgment€in€favor€ofÐ ° ÐPlaintiff€in€the€amount€of€$3,964,214.23.Ð ˆØ ÐÓ–PÓà  àOn€October€16,€2002,€Plaintiff€filed€a€Notice€of€Acceptance€of€Remittitur€Under€Protest.€€OnÐ `° ÐJanuary€10,€2003,€this€Court€filed€an€Order€directing€plaintiff€to€obtain€a€final€judgment€from€the€trialÐ L œ Ðcourt,€as€the€trial€court€had€ð ðnot€yet€entered€an€order€reducing€the€amount€of€the€judgmentðð€inÐ 8 ˆ Ðaccordance€with€its€suggestion€of€remittitur.€€On€January€28,€2003,€the€trial€court€filed€an€OrderÐ $ t Ðstating€in€pertinent€part:Ð  ` ÐÌà8  àà8` Ð Ð àà ¸ àThe€court€hereby€reduces€the€May€17,€2002€judgment€toÐ è 8  Ðreflect€the€accepted€remittitur€(under€protest)€and€other€reductions,€allÐ Ô$  Ðas€more€fully€described€in€the€order€of€October€7,€2002€the€contentsÐ À  Ðof€which€are€hereby€incorporated€by€reference.Ьü ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àAs€stated€in€the€order€of€October€7,€2002,€the€amount€of€theÐ „Ô  Ðremitted€final€judgment€in€this€case€is€$3,928,745.64,€plusÐ pÀ Ðdiscretionary€costs€in€the€amount€of€$35,468.59,€for€which€executionÐ \¬ Ðmay€issue€if€necessary.ÐH˜` x` x ÐÌò òó óà  àDefendants€appeal,€presenting€the€following€issues€for€review,€as€stated€in€their€brief:Ð  p ÐÌà8  àà8` Ð Ð à1.€Whether€the€trial€court€erroneously€awarded€Plaintiff€Sherry€HunterÐ øH Ðeight€peremptory€challenges€contrary€to€T.C.A.€ðð€22„3„105€whichÐ ä4 Ðallows€only€four€peremptory€challenges€per€party.ÐÐ ` x` x ÐÌà8  àà8` Ð Ð à2.€Whether€the€trial€court€erred€in€denying€Defendantsðð€pre„trialÐ ¨ø Ðmotion€in€limine€#10€relating€to€the€exclusion€of€learned€treatiseÐ ”ä Ðmaterials€resulting€in€the€improper€admission€and€use€of€hearsayÐ €Ð Ðtreatises€and€other€ð ðmedical€literatureðð€by€Plaintiff€throughout€theÐ l¼ Ðtrial.ÐX ¨` x` x ÐÌà8  àà8` Ð Ð à3.€Whether€the€trial€court€erred€in€determining€that€Plaintiffððs€out„of„Ð 0"€  Ðstate€expert€witness€on€anesthesiology€and€causation€issues,€Dr.Ð #l! ÐWilliam€O.€Witt,€was€competent€to€testify€under€T.C.A.€ðð€29„26„115,Ð $X" Ðand€whether€it€erred€by€allowing€Dr.€Witt€to€testify€as€an€expert€atÐ ô$D # Ðtrial€over€Defendantsðð€objections€to€his€qualifications€based€upon€theÐ à%0!$ Ðlocality€rule.ÐÌ&"%` x` x Ðò òó óÌà8  àà8` Ð Ð à4.€Whether€the€court€erred€in€allowing€Dr.€Witt€to€introduce€theÐ ¤(ô#' Ðsubstance€of€unidentified€ð ðmedical€literatureðð€and/or€treatise€materialsÐ )à$( Ðinto€evidence€in€violation€of€the€rule€excluding€hearsay.Ð|*Ì%)` x` x ÐÐ h+¸&* Ðà8  àà8` Ð Ð à5.€Whether€the€court€erred€by€allowing€Plaintiffððs€counsel€to€conductÐ ° Ða€cross„examination€of€Defendantsðð€expert€witness,€John€Eichhorn,Ð œì ÐM.D.,€with€statements€contained€in€published€treatises€or€periodicalsÐ ˆØ Ðwhich€were€never€identified€or€established€as€reliable€authority€by€anyÐ tÄ Ðwitness€contrary€to€TRE€618.Ð`°` x` x ÐÌà8  àà8` Ð Ð à6.€Whether€the€court€erred€by€permitting€Plaintiffððs€counsel€toÐ 8 ˆ Ðconduct€a€cross„examination€of€Dr.€Eichhorn€by€challenging€theÐ $ t Ðwitness€on€various€occasions€to€ð ðcite€me€to€one€piece€of€medicalÐ  ` Ðliteratureðð€supporting€his€testimony€contrary€to€the€provisions€of€TREÐ ü L  Ð618€and€705.Ðè 8 ` x` x ÐÌà8  àà8` Ð Ð à7.€Whether€the€trial€court€abused€its€discretion€in€denyingÐ À  ÐDefendantsðð€motion€for€mistrial€after€Plaintiffððs€counsel€conducted€anÐ ¬ü  Ðimproper€cross„examination€of€Dr.€Eichhorn€concerning€a€specificÐ ˜è  Ðinstance€of€prior€conduct;€namely,€a€statement€allegedly€attributed€toÐ „Ô  Ðthe€witness€that€he€compared€his€role€as€a€defense€expert€to€that€of€aÐ pÀ Ðð ðprostitute,ðð€when€there€was€no€reasonable€factual€basis€for€suchÐ \¬ Ðquestioning€and€where€Plaintiff€failed€to€request€a€jury„out€hearingÐ H˜ Ðbefore€questioning€the€witness€as€required€by€TRE€608(b)(1).Ð4„` x` x ÐÌà8  àà8` Ð Ð à8.€Whether€the€trial€court€abused€its€discretion€in€denyingÐ  \ ÐDefendantsðð€motions€for€mistrials€or€to€continue€the€trial€afterÐ øH ÐDefendants€were€notified€at€the€end€of€the€first€week€of€trial€that€aÐ ä4 Ðplanned€expert€witness,€Dr.€Michael€Hays,€a€local€anesthesiologist€inÐ Ð  Ðprivate€practice€in€Nashville,€was€unavailable€to€testify€due€to€the€factÐ ¼  Ðthat€he€had€been€diagnosed€with€malignant€lymphoma€during€the€trialÐ ¨ø Ðand€planned€to€undergo€immediate€diagnostic€tests€and€chemotherapyÐ ”ä Ðtreatment.ЀÐ` x` x ÐÌà8  àà8` Ð Ð à9.€Whether€the€trial€court€erred€in€granting€Plaintiffððs€pre„trial€motionÐ X ¨ Ðin€limine€relating€to€Dr.€Haysðð€anticipated€expert€testimony€aboutÐ D!” Ðcausation€of€injury€and€the€carotid€artery€occlusion€theory.Ð0"€ ` x` x ÐÌà8  àà8` Ð Ð à10.€Whether€the€trial€court€erred€in€denying€Defendantsðð€motion€forÐ $X" Ðdirected€verdict€at€the€close€of€all€the€evidence€based€uponÐ ô$D # ÐDefendantsðð€objections€to€Dr.€Wittððs€competence€to€testify€as€anÐ à%0!$ Ðexpert€witness€under€the€locality€rule,€T.C.A.€ðð€29„26„115.ÐÌ&"%` x` x ÐÌà8  àà8` Ð Ð à11.€Whether€the€trial€court€erred€in€allowing€Plaintiffððs€counsel€toÐ ¤(ô#' Ðargue€to€the€jury€that€everything€the€Plaintiff€claims€in€this€case€isÐ )à$( Ðsupported€by€the€ð ðmedical€literature;ðð€i.e.,€the€ð ðvast€body€ofÐ |*Ì%) Ðinformation€that€is€shared€among€medical€professionalsðð€when,€inÐ h+¸&* Ðfact,€no€supporting€treatises,€periodicals,€or€literature€had€beenÐ ° Ðidentified€or€established€as€reliable€authority€by€any€witness.Мì` x` x ÐÌà8  àà8` Ð Ð à12.€€Whether€the€trial€court€erred€in€allowing€Plaintiffððs€counsel€toÐ tÄ Ðargue€to€the€jury€that€Defendants€had€failed€to€produce€ð ðany€medicalÐ `° Ðliterature€to€support€their€version€ð!ð€their€defense€of€the€case,ðð€whenÐ L œ ÐPlaintiff€even€acknowledged€and€the€court€had€ruled€during€the€pre„Ð 8 ˆ Ðtrial€hearing€on€motions€inòòò ò€limineó óóó€that€introduction€of€medicalÐ $ t Ðliterature€into€the€evidence€would€not€be€permitted.Ð `` x` x ÐÌà8  àà8` Ð Ð à13.€€Whether€the€trial€court€erred€in€allowing€Plaintiffððs€counsel€toÐ è 8  Ðargue€to€the€jury€that€testimony€given€by€Plaintiffððs€expert€witness€hasÐ Ô$  Ðbeen€ð ðin€textbooks€longer€than€weððve€been€alive,ðð€ð ðthat€it€has€been€inÐ À  Ðevery€book€written€on€this€subject€during€our€lifetime,ðð€and€that€ð ðnotÐ ¬ü  Ðonce€in€the€history€of€medicineðð€had€this€testimony€been€challenged.Иè ` x` x ÐÌà8  àà8` Ð Ð à14.€Whether€the€trial€court€erred€in€allowing€Plaintiffððs€counsel€toÐ pÀ Ðargue€to€the€jury€that€in€establishing€the€standard€of€care€in€thisÐ \¬ Ðcommunity,€is€it€okay€to€ignore€ð ðyears€and€years€and€years€ofÐ H˜ Ðcollective€knowledge€ð!ð€brilliant€doctors€who€have€practiced€who€haveÐ 4„ Ðnever€had€their€opinions€disputedðð€or€ð ðto€ignore€all€medicalÐ  p Ðknowledge€that€has€never€been€drawn€into€question.ððÐ \` x` x ÐÌà8  àà8` Ð Ð à15.€Whether€the€courtððs€retrospective€application€of€the€òòJordanóóÐ ä4 Ðdecision€allowing€the€jury€to€award€loss€of€consortium€damages€inÐ Ð  Ðthis€case€is€unconstitutional€as€it€violates€Defendantsðð€rights€underÐ ¼  ÐArt.€I,€ðð€20€of€the€Tennessee€Constitution,€and€vested€rights€protectedÐ ¨ø Ðby€the€Due€Process€and€Equal€Protection€Clauses€of€the€14thÐ ”ä ÐAmendment€to€the€Constitution€of€the€United€States.ЀÐ` x` x ÐÌà8  àà8` Ð Ð à16.€Whether€the€court€violated€Defendantsðð€guaranty€to€trial€by€juryÐ X ¨ Ðunder€the€Tennessee€Constitution€by€commenting€upon€the€evidenceÐ D!” Ðduring€the€jury€charge€that€this€case€was€ð ða€very€interesting€andÐ 0"€  Ðdifficult€case,ðð€and€that€the€jury€would€find€Question€#1€on€theÐ #l! Ðverdict€form€(were€the€Defendants€at€fault?)€to€be€a€ð ðdeceptivelyÐ $X" Ðsimple€questionðð€and€one€to€which€there€was€ð ðobviously€not€a€simpleÐ ô$D # Ðanswer.ððÐà%0!$` x` x ÐÌà8  àà8` Ð Ð à17.€Whether€the€trial€court€erred€by€allowing€Plaintiff€to€recover€theÐ ¸'#& Ðtotal€amount€awarded€by€the€jury€for€the€pecuniary€value€of€the€life€ofÐ ¤(ô#' Ðthe€deceased€where€such€value€included€economic€damages€whichÐ )à$( Ðâ âwere€ð ðreplacedðð€(within€the€meaning€of€T.C.A.€ðð€29„26„119)€by€aÐ |*Ì%) Ð$1M+€death€benefit€paid€to€Plaintiff€Sherry€Hunter€in€1996€by€NissanÐ ° ÐMotor€Manufacturing€Corporation€(Mr.€Hunterððs€employer).Мì` x` x Ðâ âÌà8  àà8` Ð Ð à18.€Whether€the€cumulative€effect€of€all€the€errors€complained€of€inÐ tÄ Ðthis€appeal€denied€Defendants€a€fair€trial€by€a€fair€and€impartial€jury.Ð`°` x` x ÐÌPlaintiff€raises€the€following€additional€issues,€as€stated€in€her€brief:Ð 8 ˆ ÐÌà8  àà8` Ð Ð à1.€Whether€the€trial€court€erred€in€remitting€by€1.5€million€dollars€theÐ  ` Ðjuryððs€award€for€loss€of€consortium€as€a€component€of€the€pecuniaryÐ ü L  Ðvalue€of€the€life€of€Plaintiffððs€decedent€Larry€Hunter.Ðè 8 ` x` x ÐÌà8  àà8` Ð Ð à2.€Whether€the€trial€court€erred€in€denying€Plaintiffððs€Motion€forÐ À  ÐAward€of€Prejudgment€Interest.Ьü ` x` x ÐÌò òó óà  àThe€first€issue€for€review€is€whether€the€trial€court€erred€in€allowing€Plaintiff€eightÐ „Ô  Ðperemptory€jury€challenges.€€To€provide€a€brief€procedural€background€for€this€issue,€we€note€thatÐ pÀ Ðthe€trial€court€first€considered€the€question€of€the€number€of€allowable€peremptory€challenges€perÐ \¬ Ðside€at€a€pre„trial€hearing€on€April€18,€2002.€€At€this€hearing,€the€court€made€no€final€ruling€as€to€theÐ H˜ Ðnumber€of€peremptory€challenges€to€be€granted,€instead€remarking:Ð 4„ ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Now,€we€could€look€at€this€in€a€nonlegal€wayÐ  \ Ðand€just€say,€ð ðEither€we€all€get€four,€or€well€all€get€eight.ðð€€We€couldÐ øH Ðdo€it€that€way.Ðä4` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€SMITH€[PLAINTIFF€COUNSEL]:€I€donððt€care€which€itÐ ¼  Ðis.Шø` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€WARLICK€[DEFENDANTSðð€COUNSEL]:€TheÐ €Ð Ðwrongful€death€is€a€statutory€cause€of€action,€and€it€ð!ð€there€ð!ð€Iððve€triedÐ l¼ Ðthis€recently.€€Itððs€a€titular€plaintiff.€€The€ð!ð€derivation€of€the€ð!ðÐX ¨` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€There€is€no€derivative€claim€here.Ð0"€ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€WARLICK:€Damages€come€out€of€the€statute.Ð$X"` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Well,€I€thought€we€could€start€with€somethingÐ à%0!$ Ðeasy,€but€I€donððt€know€where€to€put€it€on€the€list.€€Okay.€€Well,Ð Ì&"% Ðwhether€we€have€4€or€8,€weððll€have€at€least€12.и'#&` x` x ÐÌò òó óThe€following€day,€defendants€filed€Motion€in€Limine€#13,€renewing€their€application€for€a€total€ofÐ )à$( Ðeight€peremptory€challenges,€and€seeking€to€limit€Plaintiff€to€four€peremptory€challenges.€€Ð |*Ì%) ÐÐ h+¸&* Ðà  àAs€stated,€a€jury€trial€began€on€April€22,€2002.€€The€court€opened€the€proceedings€by€firstÐ ° Ðaddressing€the€issue€of€peremptory€challenges:Ð œì ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Okay.€€I€guess€the€first€issue€is€the€number€ofÐ tÄ Ðchallenges.€€Iððve€decided€that€thereððs€no€perfect€answer€to€thisÐ `° Ðquestion.€€Iððm€still€not€clear€that€the€practice€of€ð!ð€that€Dr.€Ura€is€a€partÐ L œ Ðof€ð!ð€Ð8 ˆ` x` x ÐÌà8  àà8` Ð Ð à******************************************************Ð `` x` x ÐÌà8  àà8` Ð Ð àà ¸ àIððm€still€not€clear€as€to€whether€there€could€be€a€judgmentÐ è 8  Ðagainst€Dr.€Uraððs€practice.€€By€the€same€token,€Iððm€not€exactly€clearÐ Ô$  Ðas€to€whether€the€son€could€have€a€different€loss€of€consortium€in€theÐ À  Ðestate.€€So€Iððm€sure€weððll€get€to€those€questions€later€at€trial.Ьü ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBut€Iððm€going€to€give€everybody€eight,€and€thatððs€what€weððllÐ „Ô  Ðdo€on€the€challenges.€€Okay?€€I€donððt€think€there€is€a€ð!ð€ÐpÀ` x` x ÐÌò òó óDefendants€entered€no€oral€objection€to€the€courtððs€ruling.€€It€is€further€undisputed€that€PlaintiffððsÐ H˜ Ðcounsel€exercised€eight€peremptory€challenges€during€the€course€of€jury€selection.Ð 4„ ÐÌà  àT.C.A.€ðð€22„3„105€(1994)€establishes€the€number€of€peremptory€challenges€allowed€per€partyÐ  \ Ðin€a€civil€trial.€€The€statute€provides,€in€pertinent€part:Ð øH ÐÌà8  àà8` Ð Ð àò ò22„3„105.€€Peremptory€challenges€ð!ð€Effect€of€consolidation€ofÐ Ð  Ðcases.€ð!ð€ó ó(a)€Either€party€to€a€civil€action€may€challenge€four€(4)€jurorsÐ ¼  Ðwithout€assigning€any€cause.Ьü` x` x ÐÌà8  àà8` Ð Ð à(b)€In€the€event€there€is€more€than€one€(1)€party€plaintiff€or€more€thanÐ „Ô Ðone€(1)€party€defendant€in€a€civil€action,€four€(4)€additional€challengesÐ pÀ Ðshall€be€allowed€to€such€side€or€sides€of€the€case;€and€the€trial€courtÐ \ ¬ Ðshall€in€its€discretion€divide€the€aggregate€number€of€challengesÐ H!˜ Ðbetween€the€parties€on€the€same€side€which€shall€not€exceed€eight€(8)Ð 4"„  Ðchallenges€to€the€side,€regardless€of€the€number€of€parties.€€EvenÐ  #p! Ðwhen€two€(2)€or€more€cases€are€consolidated€for€trial€purposes,€theÐ  $\" Ðtotal€challenges€shall€be€eight€(8),€as€herein€provided.Ðø$H #` x` x ÐÌDefendants€contend€that€the€trial€court€erred€in€allowing€plaintiff€eight€peremptory€challenges,€asÐ Ð& "% ÐT.C.A.€ðð€22„3„105€limits€a€single€plaintiff€party€in€a€civil€action€to€four€peremptory€challenges.€Ð ¼' #& ÐAccording€to€defendants,€Husbandððs€estate€is€the€sole€plaintiff€in€this€matter,€and€is€therefore€onlyÐ ¨(ø#' Ðentitled€to€four€challenges€pursuant€to€the€statute.€€Moreover,€defendants€maintain€that€the€trialÐ ”)ä$( Ðcourtððs€decision€to€allow€Plaintiff€to€exercise€five€challenges€resulted€in€prejudice€to€the€judicialÐ €*Ð%) Ðprocess,€and€thereby€constitutes€reversible€error.Ð l+¼&* Їà  àWhen€interpreting€a€statute,€the€role€of€the€Court€is€to€ð ðascertain€and€give€effect€to€theÐ ° Ðlegislative€intent.ðð€€ò òòòSharp€v.€Richardsonóóó ó,€937€S.W.2d€846,€850€(Tenn.€1996).€€In€the€absence€ofÐ œì Ðambiguity,€legislative€intent€is€derived€from€the€face€of€a€statute,€and€the€Court€may€not€depart€fromÐ ˆØ Ðthe€ð ðnatural€and€ordinaryðð€meaning€of€the€statuteððs€language.€€ò òòòDavis€v.€Reaganóóó ó,€951€S.W.2d€766,€768Ð tÄ Ð(Tenn.€1997);€ò òòòWestland€West€Cmty.€Assoc.€v.€Knox€Countyóóó ó,€948€S.W.2d€281,€283€(Tenn.€1997).Ð `° ÐÌà  àApplying€the€above„cited€principles€of€statutory€construction,€we€find€that€T.C.A.€ðð€22„3„Ð 8 ˆ Ð105(a)€plainly€limits€a€single€party€plaintiff€or€defendant€in€a€civil€action€to€four€peremptoryÐ $ t Ðchallenges.€€The€statute€is€free€of€ambiguity,€and€we€are€thus€unwilling€to€depart€from€the€ð ðnaturalÐ  ` Ðand€ordinaryðð€meaning€of€the€statuteððs€language.€€ò òòòCf.€Tuggle€v.€Allright€Parking€Sys.,€Inc.óóó ó,€922Ð ü L  ÐS.W.2d€105,€107€(Tenn.€1996)€(Holding€of€Court€that€plain€language€of€T.C.A.€ðð€22„3„105(b)€allowsÐ è 8  Ðfor€four€additional€peremptory€challenges€where€there€is€more€than€one€party€plaintiff€or€partyÐ Ô$  Ðdefendant).€€Ð À  ÐÌà  àPlaintiffððs€contends€that€this€action€involves€three€separate€consortium€claimants:€Plaintiff,Ð ˜è  Ðand€her€two€sons,€both€minors€at€the€time€of€their€fatherððs€death.€€Based€on€this€assertion,€PlaintiffÐ „Ô  Ðargues€that€they€[she€and€her€two€sons]€were€entitled€to€use€eight€peremptory€challenges€pursuantÐ pÀ Ðto€T.C.A.€ðð€22„3„105(b).€€Ð \¬ ÐÓÓÌÓšÓà  àIn€òòò òJordan€v.€Three€Rivers€Hosp.ó óóó,€984€S.W.2d€593€(Tenn.€1999),€our€Supreme€Court€heldÐ  p Ðthat€a€court€may€consider€spousal€and€parental€consortium€damages€in€wrongful€death€actions€ð ðwhenÐ  \ Ðcalculating€the€pecuniary€value€of€a€deceasedððs€life,ðð€but€òòò òó óóóstressed€that€ð ð[t]his€holding€does€not€createÐ øH Ða€new€cause€of€action€but€merely€refines€the€term€ð ðpecuniary€value.ðððð€òòò òIdó óóó.€at€601.€€Three€years€later,Ð ä4 Ðin€òòò òKline€v.€Eyrichó óóó,€69€S.W.3d€197€(Tenn.€2002),€the€Court€again€explained€the€status€of€a€wrongfulÐ Ð  Ðdeath€action:Ð ¼  ÐÌà8  àà8` Ð Ð àà ¸ àThe€parties€do€not€dispute€that€the€statutes€permitting€anÐ ”ä Ðaction€for€the€wrongful€death€of€another€create€ð ðno€right€of€actionÐ €Ð Ðexist[ing]€independently€of€that€which€the€deceased€would€have€had,Ð l¼ Ðhad€[he€or€she]€survived.ðð€€ò òòòSee€Rogers€v.€Donelson„HermitageÐ X ¨ ÐChamber€of€Commerceóóó ó,€807€S.W.2d€242,€245€(Tenn.€Ct.€App.Ð D!” Ð1990);€ò òòòMemphis€St.€Ry.€Co.€v.€Cooperóóó ó,€203€Tenn.€425,€431;€313Ð 0"€  ÐS.W.2d€444,€447€(1958).€€Although€the€living€beneficiaries€of€theÐ #l! Ðaction€may€seek€a€limited€recovery€for€their€own€losses€in€addition€toÐ $X" Ðthose€of€the€decedent,€ò òòòsee€Hill€v.€City€of€Germantownóóó ó,€31€S.W.3dÐ ô$D # Ð234,€239€(Tenn.€2000);€ò òòòJordan€v.€Baptist€Three€Rivers€Hosp.óóó ó,€984Ð à%0!$ ÐS.W.2d€593,€598€(Tenn.€1999),€the€right€of€action€itself€remains€oneÐ Ì&"% Ðthat€is€ð ðsingle,€entire[,]€and€indivisible.ðð€€ò òòòSee€Wheeler€v.€Burleyóóó ó,€No.Ð ¸'#& Ð01A01„9701„CV„00006,€1997€WL€528801€(Tenn.€Ct.€App.€filed€atÐ ¤(ô#' ÐNashville,€Aug.€27,€1997),€òòò òperm.€to€appeal€deniedó óóó,€Apr.€13,€1998.€Ð )à$( Ðâ âIn€point€of€fact,€therefore,€ð ð[t]here€can€be€but€one€cause€of€action€forÐ |*Ì%) Ðthe€wrongful€death€of€another.ðð€€ò òòòMatthews€v.€Mitchellóóó ó,€705€S.W.2dÐ ° Ð657,€660€(Tenn.€Ct.€App.€1985).Мì` x` x Ðâ âÌò òòòIdóóó ó.€at€206„07.€€Accordingly,€ò òòòóóó ówe€find€that€the€sonsðð€loss€of€consortium€claims€do€not€constitute€newÐ tÄ Ðand€separate€causes€of€action.€€Plaintiff,€as€Administratrix,€is€the€sole€party€plaintiff€and,€as€such,€isÐ `° Ðentitled€to€only€four€peremptory€challenges.€Ð L œ ÐÌà  àHaving€determined€that€the€trial€court€erred€in€granting€Plaintiff€eight€peremptory€challenges,Ð $ t Ðand€thereafter€permitting€Plaintiff€to€exercise€five€such€challenges,€we€must€now€examine€whetherÐ  ` Ðthe€trial€courtððs€ruling€constitutes€reversible€error€requiring€remand€for€a€new€trial.€€T.R.A.P.€36(b)Ð ü L  Ðprovides:Ð è 8  Ðà8  àà8` Ð Ð àò ò(b)€Effect€of€Error.€ó ó€A€final€judgment€from€which€relief€is€availableÐ Ô$  Ðand€otherwise€appropriate€shall€not€be€set€aside€unless,€consideringÐ Ä  Ðthe€whole€record,€error€involving€a€substantial€right€more€probablyÐ °  Ðthan€not€affected€the€judgment€or€òòò òwould€result€in€prejudice€to€theÐ œì  Ðjudicial€process.€ó óóó[emphasis€supplied].òòò òÐˆØ ` x` x ÐÌó óóóIn€ò òòòTuggle€v.€Allright€Parking€Sys.,€Inc.óóó ó,€922€S.W.2d€105€(Tenn.€1996),€our€Supreme€Court,€facedÐ \¬ Ðwith€noncompliance€with€T.C.A.€ðð€22„3„105,€said:Ð H˜ ÐÌà8  àà8` Ð Ð àHaving€determined€that€the€trial€court€erred,€we€must€next€considerÐ  p Ðwhether€the€error€requires€remand€for€a€new€trial.€€We€haveÐ  \ Ðpreviously€stated,€in€the€criminal€context,€that€ð ð[t]he€Legislature,€inÐ øH Ðits€wisdom,€certainly€has€the€right€and€power€to€direct€the€judicialÐ ä4 Ðprocess.ðð€€ò òòòState€v.€Cookóóó ó,€816€S.W.2d€322,€327€(Tenn.€1991).€€WeÐ Ð  Ðalso€have€emphasized€that,€ð ð[r]ules€prescribing€jury€selectionÐ ¼  Ðprocedures€are€intended€to€protect€the€integrity€of€the€jury€system€byÐ ¨ø Ðproviding€a€uniform€and€ordered€method€that€ensures€the€accused€aÐ ”ä Ðfair€and€impartial€jury€chosen€from€a€fair€cross„section€of€theÐ €Ð Ðcommunity.ðð€€ò òòòState€v.€Colemanóóó ó,€865€S.W.2d€455,€458€(Tenn.€1993).€Ð l¼ ÐAlthough€the€stakes€are€different€in€civil€cases,€the€power€of€theÐ X ¨ ÐLegislature€to€direct€the€judicial€process€is€unchanged,€and€theÐ D!” Ðpurpose€of€the€procedural€rules€is€the€same€ð!ð€to€insure€uniformity,Ð 0"€  Ðimpartiality,€and€fairness€in€jury€selection.€€While€it€is€difficult€for€anÐ #l! Ðindividual€litigant€to€prove€that€a€deviation€from€such€proceduralÐ $X" Ðrules€ð ðmore€probably€than€notðð€affects€the€judgment€in€a€particularÐ ô$D # Ðcase,€òòò òit€is€clear€that€compliance€with€such€rules€protect€the€integrityÐ à%0!$ Ðof€the€jury€system€and€safeguard€the€administration€of€justiceó óóó.€€òòò òIdó óóó.€Ð Ì&"% ÐTherefore,€such€deviations€from€prescribed€procedural€rules€haveÐ ¸'#& Ðbeen€held€to€constitute€prejudice€to€the€judicial€process€under€Tenn.Ð ¤(ô#' ÐR.€App.€P.€€36(b).€Ð)à$(` x` x Ðâ âÐ |*Ì%) Ðà8  àà8` Ð Ð àà ¸ àIn€this€case,€[plaintiff]€was€denied€the€use€of€his€statutorilyÐ ° Ðâ âmandated€number€of€peremptory€challenges.€€In€our€view,€denial€ofÐ œì Ðthat€right,€which€was€designed€to€safeguard€the€administration€ofÐ ˆØ Ðjustice,€constitutes€prejudice€to€the€judicial€process€and€requires€aÐ tÄ Ðreversal€in€this€case€under€Tenn.€R.€App.€P.€36(b).€€As€a€result,€weÐ `° Ðaffirm€the€Court€of€Appealsðð€decision€that€a€new€trial€must€beÐ L œ Ðgranted.Ð8 ˆ` x` x ÐÌò òòòIdóóó ó.€at€108€(citations€omitted)€(emphasis€added).Ð  ` ÐÌà  àWhile€we€recognize€that€Plaintiffððs€issue€on€appeal€in€òòò òTuggle€ó óóówas€premised€upon€the€trialÐ è 8  Ðcourtððs€denial€of€entitlement€to€statutorily€mandated€peremptory€challenges,€we€find€the€SupremeÐ Ô$  ÐCourtððs€ruling€no€less€persuasive€or€applicable€in€the€instant€case.€€In€òòò òTuggleó óóó,€the€court€interpretedÐ À  Ðthe€plain€and€mandatory€language€set€forth€in€T.C.A.€ðð€22„3„105(b)€to€require€a€grant€of€fourÐ ¬ü  Ðadditional€challenges€in€circumstances€involving€more€than€one€party€plaintiff€or€defendant.€€òòò òIdó óóó.€atÐ ˜è  Ð107.€€Although€subsection€(a)€of€this€statute€does€not€utilize€the€same€mandatory€language€(ð ðshallÐ „Ô  Ðbe€allowedðð)€as€(b),€we€reiterate€that€the€plain€language€of€subsection€(a)€limits€the€number€ofÐ pÀ Ðpermissible€peremptory€challenges€for€a€single€party€plaintiff€or€defendant€to€four.€€The€trial€courtððsÐ \¬ Ðfailure€to€comply€with€the€procedural€guidelines€set€forth€in€subsection€(a),€when€applying€theÐ H˜ Ðreasoning€utilized€by€the€Court€in€ò òòòTuggleóóó ó,€ð ðconstitutes€prejudice€to€the€judicial€processðð€andÐ 4„ Ðtherefore€requires€a€reversal€in€this€case€under€T.R.A.P.€36(b).Ð  p ÐÌà  àWe€briefly€address€Plaintiffððs€final€assertion€that€defendants€waived€this€allegation€of€errorÐ øH Ðin€failing€to€enter€an€oral€or€written€objection€to€the€courtððs€ruling€at€trial.€€Defendants€contend€thatÐ ä4 Ðtheir€filing€of€Motion€in€Limine€#13€on€April€19,€2002,€prior€to€commencement€of€trial,€sufficientlyÐ Ð  Ðapprised€the€court€of€defendants€objection€to€allowing€plaintiff€more€than€four€peremptoryÐ ¼  Ðchallenges.€€Defendants€aver€that€ð ð[t]here€was€no€need€for€the€Defendants€to€take€exception€to€theÐ ¨ø Ðruling€of€the€trial€court,ðð€nor€was€action€further€required€to€ð ðpreserve€this€issue€on€appeal.ððÐ ”ä ÐÌà  àT.R.C.P.€46€states€that€ð ð[f]ormal€exceptions€to€rulings€or€orders€of€the€court€are€unnecessary.ðð€Ð l¼ ÐThis€Court€applied€Rule€46€in€the€case€of€€òòò òSmith€v.€Williamsó óóó,€575€S.W.2d€503€(Tenn.€Ct.€App.Ð X ¨ Ð1978).€€In€ò òòòWilliamsóóó ó,€the€parties€entered€an€agreed€order€waiving€a€jury€trial€and€agreeing€that€theÐ D!” Ðlawsuit€would€be€tried€before€the€trial€court€without€a€jury.€€ò òòòIdóóó ó.€at€504.€€The€trial€judge€refused€to€signÐ 0"€  Ðthe€order€and€instead€impaneled€a€jury€to€hear€the€issues.€€ò òòòIdóóó ó.€€On€appeal,€defendant€raised€as€one€ofÐ #l! Ðhis€issues€and€assignments€of€error€the€correctness€of€the€trial€courtððs€decision€to€impanel€a€jury.€€InÐ $X" Ðexamining€the€issue,€this€Court€noted:Ð ô$D # ÐÌà8  àà8` Ð Ð àà ¸ àThe€record€does€not€reveal€an€objection€or€exception€by€theÐ Ì&"% Ðdefendants€to€the€ruling€of€the€trial€judge€that€the€issues€would€beÐ ¸'#& Ðsubmitted€to€a€jury.€€We€hold,€however,€that€under€Rule€46,Ð ¤(ô#' ÐTennessee€Rules€of€Civil€Procedure,€an€objection€at€that€point€wasÐ )à$( Ðnot€necessary.€€At€the€time€the€motion€was€tendered€and€the€action€ofÐ |*Ì%) Ðthe€trial€judge€was€sought,€both€parties€made€known€to€the€judge€theÐ h+¸&* Ðaction€desired€on€the€motion,€namely,€to€waive€the€jury.€€TheÐ ° Ðdefendants€made€this€ruling€by€the€trial€judge€the€basis€of€GroundÐ œì ÐVIII€of€their€Motion€for€New€Trial€and€Assignment€of€Error€No.€1Ð ˆØ Ðbefore€this€Court.€€We,€therefore,€hold€that€the€claimed€error€isÐ tÄ Ðproperly€before€this€Court€for€review.Ð`°` x` x ÐÌò òòòIdóóó ó.€at€504.Ð 8 ˆ ÐÌòòò òó óóóWe€find€Plaintiffððs€assertion€without€merit.€€The€judgment€of€the€trial€court€is€reversed€and€the€caseÐ  ` Ðis€remanded€for€a€new€trial.Ð ü L  ÐÌà  àSince€this€case€will€be€remanded€for€trial,€we€will€discuss€the€pertinent€remaining€issues.Ð Ô$  Ðò òó óÓÓÌÓ<ÄÓà  àUpon€our€review€of€the€issues€and€relevant€case€law€in€this€matter,€we€find€that€defendantsððÐ ˜è  Ðsecond€and€fourth€issues€can€be€considered€simultaneously.׃×Ý ƒ #ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€€Defendantsðð€second€issue€raises€theÐ „Ô  Ðquestion€of€whether€the€ð ðtrial€court€erred€in€denying€Defendantsðð€pre„trial€motion€in€limine€#10Ð pÀ Ðrelating€to€the€exclusion€of€learned€treatise€materials€resulting€in€the€improper€admission€and€use€ofÐ \¬ Ðhearsay€treatises€and€other€ð ðmedical€literatureðð€by€Plaintiff€throughout€the€trial.ðð€€Defendantsðð€fourthÐ H˜ Ðissue€asks€this€Court€to€review€ð ð[w]hether€the€court€erred€in€allowing€Dr.€Witt€to€introduce€theÐ 4„ Ðsubstance€of€unidentified€ð ðmedical€literatureðð€and/or€treatise€materials€into€evidence€in€violation€ofÐ  p Ðthe€rule€excluding€hearsay.ððÐ  \ ÐÌà  àDefendantsðð€Motion€in€Limine€#10€sought€to€exclude€the€introduction€of€learned€treatiseÐ ä4 Ðmaterials€as€substantive€evidence,€stating€specifically:Ð Ð  ÐÌà8  àà8` Ð Ð àà ¸ àProperly€authenticated€reliable€authority€may€be€used€toÐ ¨ø Ðòòimpeachóó€an€expertððs€credibility.€€It€may€not€be€admitted€as€substantiveÐ ”ä Ðevidence.€€Tennessee€Rule€of€Evidence€618.€€An€expert€may€not,Ð €Ð Ðhowever,€read€from€the€medical€literature€to€establish€as€substantiveÐ l¼ Ðevidence€the€matters€contained€in€the€literature,€nor€may€the€expertÐ X ¨ Ðread€the€literature,€and€then€testify€to€what€the€literature€states.€€òòCaryÐ D!” Ðv.€Aerosmithóó,€777€S.W.2d€8,€818€(Tenn.€Ct.€App.€1989).Ð0"€ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àThe€defendant€hereby€moves€this€Honorable€Court€in€limineÐ $X" Ðto€prevent€improper€use€of€medical€literature€beyond€òòimpeachment€óóofÐ ô$D # Ða€witnessðð€credibility.Ðà%0!$` x` x ÐÌò òó óThe€parties€have€not€pointed€out,€nor€has€the€Court€found€in€the€record,€an€order€of€the€court€rulingÐ ¸'#& Ðon€this€motion.€€Therefore,€the€issue€pertaining€to€this€motion€òòin€limineóó€will€not€be€considered.Ð ¤(ô#' Їà  àDuring€the€course€of€trial,€Plaintiffððs€expert,€Dr.€Witt,€was€recalled€to€rebut€the€testimony€ofÐ ° Ðdefendantððs€expert,€Dr.€Eichhorn,€with€regard€to€testimony€offered€by€defendantsðð€expert€on€theÐ œì Ðcarotid€artery€occlusion€theory.€€Defendants€specifically€charge€as€error€the€trial€courtððs€decision€toÐ ˆØ Ðallow€Dr.€Witt€to€state€that€several€of€his€opinions€were€ð ðsupported€in€the€medical€literature.ðð€€WeÐ tÄ Ðquote€at€length€from€Dr.€Wittððs€testimony.ò òó óÐ `° ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Were€any€of€the€anesthetic€medications€administered€toÐ 8 ˆ ÐLarry€Hunter€detrimental€to€autoregulation?Ð$ t` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àA.€€Well,€certainly€the€Desflurane€modifies€autoregulation,Ð ü L  Ðmostly€at€the€upper€levels,€as€I€mentioned.€€But€the€significance€of€itÐ è 8  Ðis€that€it€really€takes€the€issue€of€autoregulation€to€a€point€where€itððsÐ Ô$  Ðreally€not€a€very€significant€issue€in€this€ð!ð€in€this€case.ÐÀ ` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àQ.€Why?Иè ` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àA.€€Because€at€the€concentrations€used,€Desflurane€eliminatesÐ pÀ Ðvirtually€all€of€the€autoregulatory€response.Ð\¬` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àQ.€€And€is€that€opinion€supported€in€the€medical€literature?Ð4„` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àA.€€Yes.Ð \` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àQ.€€Do€you€have€literature€to€support€that€here€with€you€today?Ðä4` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àA.€€Yes.м ` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àQ.€€And,€in€substance,€what€does€it€say?Дä` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àMR.€WARLICK:€Objection,€Your€Honor.€€Weððre€back€to€RuleÐ l¼ Ð618€and€heððs€not€even€crossing€the€witness.ÐX ¨` x` x ÐÌò òó óà  àThe€court€instructed€the€lawyers€to€approach€and€a€bench€conference€ensued.€€DefenseÐ 0"€  Ðcounsel€objected€to€Dr.€Witt€testifying€about€or€directly€stating€the€substance€of€the€medical€literatureÐ #l! Ðrelied€upon€for€his€opinion.€€Plaintiffððs€counsel€asserted€that€he€was€relying€upon€Tenn.€R.€Evid.€703Ð $X" Ðfor€admission€of€the€expertððs€opinion€and€statements.€€The€court€concluded€that€it€would€allowÐ ô$D # ÐPlaintiffððs€counsel€to€complete€direct€examination€and€would€permit€the€witness€to€ð ðstate€how€[theÐ à%0!$ Ðliterature]€support[s]€his€theory.ðð€€When€questioning€resumed,€counsel€inquired:Ð Ì&"% ÐÌà8  àà8` Ð Ð àà ¸ àQ.€(By€Mr.€Smith)€Dr.€Witt,€is€the€literature€that€youÐ ¤(ô#' Ðreferenced€on€this€issue,€that€you€have€here€today,€consistent€with€theÐ )à$( Ðtestimony€youððve€given€on€this€issue?Ð|*Ì%)` x` x Ðà8  àà8` Ð Ð àÐh+¸&*` x` x ÐÑïOÑâ âÑe°Ñâ âÑ  Ñà8  àà8` Ð Ð àà ¸ àA.€€Yes.Ðe` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Now,€I€want€to€ask€you€about€something€else€that€Dr.€UraÐ =Ø Ðtestified€about,€and€that€was€that€hyperventilation€and€some€of€theseÐ )Ä Ðanesthetic€medications€that€he€gave,€will€lower€the€intracranialÐ ° Ðpressure.€€I€want€you€to€assume€that€he€testified€to€that.€Ð œ` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àDo€you€agree€or€disagree€with€that?ÐÙ t` x` x Ðà8  àÐ Ð Ð  Ðà8  àà8` Ð Ð àà ¸ àA.€€Disagree€with€that.б L ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Why?Љ$ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Hyperventilation€will€lower€intracranial€pressure€that€isÐ aü  Ðalready€pathologically€elevated.€€It€will€not€lower€a€baselineÐ Mè  Ðintracranial€pressure,€except€insofar€as€it€produces€vasoconstrictionÐ 9Ô  Ðof€the€blood€vessels€in€the€brain.€€And€itððs€possible€to€actuallyÐ %À Ðproduce€ischemia€in€the€brain€ð!ð€inadequate€blood€flow€to€the€brain€ð!ðÐ ¬ Ðby€hyperventilation€alone,€as€well€as€several€other€deleterious€effects.Ðý˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Do€you€have€literature€here€with€you€today€that€supportsÐ Õp Ðthat€opinion?ÐÁ\` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Yes.Й4` x` x ÐÌà8  àà8` Ð Ð à******************************************************Ðq ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€I€want€you€to€assume€that€Dr.€Eichhorn€characterized€yourÐ Iä Ðtestimony€on€the€range€of€the€central€venous€pressure€of€between€10Ð 5Ð Ðand€18€as€ridiculous.Ð!¼` x` x ÐÌà8  àà8` Ð Ð àà ¸ àDo€you€agree€or€disagree€with€that€comment?Ðù ”` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€I€disagree.ÐÑ"l!` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Why?Щ$D #` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€There€is€abundant€evidence€that€positive€pressureÐ &"% Ðventilation€impedes€return€of€venous€blood€to€the€chest.€€That€is,€theÐ m'#& Ðmajor€impact€of€positive€pressure€ventilation€is€to€increase€centralÐ Y(ô#' Ðvenous€pressure.ÐE)à$(` x` x ÐÌà8  àà8` Ð Ð àà ¸ àNow,€whether€ð!ð€I€didnððt€hear€his€testimony.€€Where€there€mayÐ +¸&* Ðhave€been€a€misunderstanding€is€that€what€I€said€ð!ð€and€I€think€I€wasÐ  ,¤'+ Ðclear€ð!ð€is€that€the€CVP€will€not€affect€intracranial€pressure€unless€orÐ e Ðuntil€it€goes€above€the€level€of€intracranial€pressure.ÐQì` x` x ÐÌà8  àà8` Ð Ð àà ¸ àSo,€in€other€words,€on€a€ventilator,€I€calculated€that€the€CVPÐ )Ä Ðwas€probably€somewhere€between€10€and€18.€€And€I€believe€IÐ ° Ðtestified€to€that€earlier.€€I€have€no€way€of€knowing€what€it€was,Ð  œ Ðbecause€it€wasnððt€measured.Ðí ˆ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBut€what€my€point€was,€that€the€intracranial€pressure€could€beÐ Å ` Ðincreased€by€placing€this€patient€on€a€ventilator,€it€would€not€beÐ ± L  Ðdecreased,€and€in€no€case,€would€it€be€less€than€10.€€I€chose€to€use€theÐ  8  Ðmore€conservative€number€of€10€in€my€calculations€of€cerebralÐ ‰$  Ðperfusion€pressure.Ðu ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€And€is€the€statement€that€you€just€made€supported€in€theÐ Mè  Ðliterature?Ð9Ô ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Yes.Ь` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Do€you€have€that€literature€with€you€here€today?Ðé„` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Yes.ÐÁ\` x` x ÐÌà8  àà8` Ð Ð à******************************************************Й4` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€At€what€level€of€administration€of€Desflurane€doesÐ q  Ðautoregulation€get€perked?Ð]ø` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€You€start€seeing€an€impact€ð!ð€at€least€supported€in€theÐ 5Ð Ðliterature,€itððs€probably€a€continuum€ð!ð€but€at€least€supported€in€theÐ !¼ Ðliterature,€somewhere€around€3€percent,€and€by€the€time€you€get€up€toÐ  ¨ Ð9€percent,€itððs€completely€eliminated.Ðù ”` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€And€how€much€was€administered€for€most€of€this€case?ÐÑ"l!` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€The€range€was€from€3€to€8.Щ$D #` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€And€is€that€statement€that€you€just€made€supported€in€theÐ &"% Ðliterature€that€you€have€here€with€you€today?Ðm'#&` x` x Ðà8  àà8` Ð Ð àÐ ` x` x Ðà8  àà8` Ð Ð àà ¸ àA.€€Yes.ÐE)à$(` x` x ÐÌò òó óDefendants€did€not€enter€an€oral€objection€to€Dr.€Wittððs€above„cited€testimony€during€the€course€ofÐ +¸&* Ðdirect€examination;€however,€at€the€conclusion€of€the€proof€in€this€trial,€defense€counsel€made€aÐ  ,¤'+ Ðmotion€to€strike€ð ðany€testimony€that€[Dr.€Witt]€says€was€supported€by€the€literature.ðð€€Said€motionÐ e Ðwas€denied€by€the€court.Ð Qì ÐÌà  àThe€trial€court€is€afforded€wide€discretion€in€the€admission€or€rejection€of€evidence,€and€theÐ )Ä Ðtrial€courtððs€action€will€be€reversed€on€appeal€only€when€there€is€a€showing€of€an€abuse€of€discretion.€Ð ° Ðò òòòSee€Otis€v.€Cambridge€Mut.€Fire€Ins.€Co.óóó ó,€850€S.W.2d€439€(Tenn.€1992);€ò òòòDavis€v.€Hallóóó ó,€920€S.W.2dÐ  œ Ð213,€217€(Tenn.€Ct.€App.€1995).Ð í ˆ ÐÌà  àTenn.€R.€Evid.€618€states:Ð Å ` ÐÌà8  àà8` Ð Ð àò òRULE€618.€€IMPEACHMENT€OF€EXPERT€BY€LEARNEDÐ  8  ÐTREATISESó óЉ$ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTo€the€extent€called€to€the€attention€of€an€expert€witness€uponÐ aü  Ðcross„examination€or€relied€upon€by€the€witness€in€directÐ Mè  Ðexamination,€statements€contained€in€published€treatises,€periodicals,Ð 9Ô  Ðor€pamphlets€on€a€subject€of€history,€medicine,€or€other€science€or€art,Ð %À Ðestablished€as€a€reliable€authority€by€the€testimony€or€admission€ofÐ ¬ Ðthe€witness,€by€other€expert€testimony€or€by€judicial€notice,€may€beÐ ý˜ Ðused€to€impeach€the€expert€witnessððs€credibility€but€may€not€beÐ é„ Ðreceived€as€substantive€evidence.ÐÕp` x` x ÐÌà  àIt€appears€to€the€Court€that€the€questions€and€answers€complained€about€are€somewhatÐ ­H Ðanalogous€to€Dr.€Witt€testifying€that€as€a€basis€for€his€opinion€he€relied,€among€other€things,€onÐ ™4 Ðmedical€literature,€such€as€published€articles€and€treatises.€€However,€as€noted€above,€no€objectionÐ …  Ðwas€made€to€the€questions€propounded€to€Dr.€Witt€and€it€was€only€after€renewing€motions€forÐ q  Ðdirected€verdict€in€the€case€that€defendant€moved€to€strike€this€part€of€Dr.€Wittððs€testimony.€€Tenn.Ð ]ø ÐR.€Evid.€103€states€in€pertinent€part:Ð Iä ÐÌà8  àà8` Ð Ð à(a)€Effect€of€Erroneous€Ruling.€„€Error€may€not€be€predicated€upon€aÐ !¼ Ðruling€which€admits€or€excludes€evidence€unless€a€substantial€right€ofÐ  ¨ Ðthe€party€is€affected,€and€Ðù ”` x` x Ðà8  àà8` Ð Ð à(1)€òòò òObjectionó óóó.€„€In€case€the€ruling€is€one€admitting€evidence,€a€timelyÐ å!€  Ðobjection€or€motion€to€strike€appears€of€record,€stating€the€specificÐ Ñ"l! Ðground€of€objection€if€the€specific€ground€was€not€apparent€from€theÐ ½#X" Ðcontext;€.€.€.Щ$D #` x` x ÐÌà  àWe€do€not€believe€that€making€a€motion,€after€renewing€motions€for€directed€verdict,€is€aÐ &"% Ðtimely€motion€to€strike€the€alleged€erroneous€evidence.Ð m'#& Ðò òó óÓ  ÓÌà  àDefendantsðð€issues€three€and€ten€deal€with€the€qualifications€of€plaintiffððs€witness,€Dr.Ð E)à$( ÐWilliam€O.€Witt,€as€an€expert€witness.€€Because€this€question€will€necessarily€be€determined€inÐ 1*Ì%) Ðthe€trial€on€remand,€we€pretermit€defendantsðð€issues€three€and€ten.Ð +¸&* Ðò òó óÐ  ,¤'+ Ðà  àDefendantsðð€next€three€issues€stem€from€plaintiff„counselððs€cross„examination€of€defenseÐ e Ðexpert€Dr.€Eichhorn.€€Ð Qì Ðò òó óÌà  àDefendantsðð€first€related€issue€asks€this€Court€to€consider€whether€the€trial€court€erred€inÐ )Ä Ðpermitting€Plaintiffððs€counsel€ð ðto€conduct€a€cross„examination€of€[Dr.€Eichhorn]€with€statementsÐ ° Ðcontained€in€published€treatises€or€periodicals€which€were€never€identified€or€established€asÐ  œ Ðreliable€authority€by€any€witness€contrary€to€[Tenn.€R.€Evid.€618].ððÐ í ˆ ÐÌà  àð ðThe€propriety,€scope,€manner€and€control€of€the€cross-examination€of€witnessesðð€restsÐ Å ` Ðwithin€the€discretion€of€the€trial€court.€ò òòòState€v.€Dishmanóóó ó,€915€S.W.2d€458,€463€(Tenn.€Crim.Ð ± L  ÐApp.€1995)€(citing€ò òòòCoffee€v.€Stateóóó ó,€188€Tenn.€1,€4,€216€S.W.2d€702,€703€(1948);€òòò òDavis€v.€Stateó óóó,Ð  8  Ð186€Tenn.€545,€212€S.W.2d€374,€375€(1948)).€€Exercise€of€this€discretion€will€generally€not€beÐ ‰$  Ðdisturbed€absent€a€finding€of€abuse.€€ò òòòState€v.€Bragenóóó ó,€920€S.W.2d€227,€244€(Tenn.€Crim.€App.Ð u  Ð1995)€(citing€€ò òòòStateóóó ó€ò òòòv.€Lewisóóó ó,€803€S.W.2d€260,€262€(Tenn.€Crim.€App.€1990)).Ð aü  ÐÌà  àTenn.€R.€Evid.€618€indicates€that€a€published€treatise€or€medical€journal/periodical€mustÐ 9Ô  Ðbe€ð ðestablished€as€a€reliable€authority€by€the€testimony€or€admission€of€the€witness,€by€otherÐ %À Ðexpert€testimony,€or€by€judicial€notice,ðð€where€said€treatise€or€journal/periodical€is€relied€upon€toÐ ¬ Ðimpeach€an€expert€witnessððs€credibility€during€cross€examination.€€Stated€more€completely:€Ð ý˜ ÐÌà8  àà8` Ð Ð àð ð[T]he€propriety,€scope,€manner€and€control€of€theÐ Õp Ðcross-examination€of€witnesses€...€rests€within€the€sound€discretionÐ Á\ Ðof€the€trial€court.ðð€€ò òòòState€v.€Korsakovóóó ó,€34€S.W.3d€534,€545€(Tenn.Ð ­H ÐCrim.€App.€2000);€ò òòòsee€also€State€v.€Barnardóóó ó,€899€S.W.2d€617,€624Ð ™4 Ð(Tenn.€Crim.€App.€1994).€€Once€again,€however,€the€trial€courtððsÐ …  Ðexercise€of€discretion€is€circumscribed€by€the€Tennessee€Rules€ofÐ q  ÐEvidence.€€€As€relevant€to€the€current€discussion,€Tenn.€R.€Evid.Ð ]ø Ð618€permits€the€use€of€ð ðlearned€treatises,ðð€i.e.,€ð ðstatementsÐ Iä Ðcontained€in€published€treatises,€periodicals,€or€pamphlets€on€aÐ 5Ð Ðsubject€of€history,€medicine,€or€other€science€or€art,ðð€to€impeach€anÐ !¼ Ðexpert€witnessðð€credibility€provided€the€following€prerequisites€areÐ  ¨ Ðsatisfied:€€(1)€The€treatise€was€called€to€the€attention€of€the€expertÐ ù ” Ðwitness€upon€cross-examination€or€relied€upon€by€the€witness€inÐ å!€  Ðdirect€examination;€€and€(2)€The€treatise€has€been€established€as€aÐ Ñ"l! Ðreliable€authority€by€the€testimony€or€admission€of€the€witness,€byÐ ½#X" Ðother€expert€testimony,€or€by€judicial€notice.€€We€note€that€theÐ ©$D # Ðadoption€of€this€rule€in€1990€was€merely€a€restatement€of€currentÐ •%0!$ ÐTennessee€law,€which€provided:Ð&"%` x` x ÐÌà8  àà8` Ð Ð àà8¸ ` x` xàð ðAn€expert€witness€may€be€cross-examined€by€theÐ Y(ô#' Ðuse€of€standard€authorities€on€the€subject....€ð ðWhenÐ E)à$( Ða€witness€is€testifying€as€an€expert,€it€is€competentÐ 1*Ì%) Ðto€test€his€knowledge€and€accuracy€uponÐ +¸&* Ðcross-examination€by€reading€to€him,€or€having€himÐ  ,¤'+ Ðread,€extracts€from€standard€authorities€upon€theÐ e Ðsubject-matter€involved,€and€then€asking€himÐ Qì Ðwhether€he€agreed€or€disagreed€with€the€authorities,Ð =Ø Ðand€comparing€his€opinion€with€those€of€theÐ )Ä Ðwriter.ðððð€Ð°¸ ¸  ÐÌòòò òState€v.€Coulteró óóó,€67€S.W.3d€3,€64€(Tenn.€Crim.€App.€2001)€(citing€ò òòòNix€v.€Stateóóó ó,€530€S.W.2d€524,Ð í ˆ Ð531€(Tenn.€Crim.€App.€1975)€(quoting€ò òòòMcCay€v.€Mitchellóóó ó,€62€Tenn.€App.€424,€463€S.W.2d€710,Ð Ù t Ð720€(1970)))€(citations€omitted).Ð Å ` ÐÌà  àDefendants€take€issue€with€several€questions€asked€by€Plaintiffððs€counsel€of€Dr.€EichhornÐ  8  Ðon€cross„examination,€contending€that€these€questions€were€based€upon€or€taken€directly€fromÐ ‰$  Ðð ðpublished€treatises€or€periodicals€which€were€never€identified€or€established€as€reliable€authorityÐ u  Ðby€any€witness€contrary€to€[Tenn.€R.€Evid.€618].ðð€€We€quote€from€the€trial€transcripts€the€specificÐ aü  Ðquestions€challenged,€and€briefly€reference€the€pertinent€procedural€facts:Ð Mè  ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Let€me€see€if€you€agree€with€this€concept:€HypotensionÐ %À Ðfrom€any€cause€may€produce€cerebral€or€spinal€cord€ischemia.€Ð ¬ ÐHypotension€may€be€associated€with€positioning€and€is€usuallyÐ ý˜ Ðcaused€by€venous€pooling;€that€is,€the€sitting€position,€or€decreasedÐ é„ Ðvenous€return,€as€in€a€prone€position€with€increased€intra„Ð Õp Ðabdominal€pressure.ÐÁ\` x` x ÐÌà8  àà8` Ð Ð àà ¸ àAnd€that€second€part€we€did€not€have€in€that€case,€did€we?Й4` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Correct.Ðq ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€When€the€head€and€spinal€cord€are€elevated€above€theÐ Iä Ðlevel€of€the€heart€ð!ð€Ð5Ð` x` x ÐÌò òó óà  àDefense€counsel€interjected€and€requested€that€counsel€be€permitted€to€approach€theÐ  ¨ Ðbench.€€During€the€ensuing€bench€conference,€defense€counsel€remarked€that€Plaintiffððs€counselððsÐ ù ” Ðquestioning€ð ðsounds€like€cross„examination€from€a€reliable€authority€that€has€not€been€identifiedÐ å!€  Ðyet.ðð€€Defendantsðð€co„counsel€further€stated€that€Plaintiffððs€counsel€was€reading€as€if€from€aÐ Ñ"l! Ðbook,€therefore€requiring€counsel€to€identify€the€quoted€or€referenced€authority.€€We€note€thatÐ ½#X" Ðdefense€counsel€did€not€explicitly€state€an€objection€to€counselððs€question.€€With€the€courtððsÐ ©$D # Ðpermission,€Plaintiffððs€counsel€proceeded€with€the€following€line€of€questioning:Ð •%0!$ ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€(By€Mr.€Smith)€Let€me€start€over,€Dr.€Eichhorn.Ðm'#&` x` x ÐÌà8  àà8` Ð Ð àà ¸ àHypotension€from€any€cause€may€produce€cerebral€or€spinalÐ E)à$( Ðcord€ischemia....Ð1*Ì%)` x` x ÐÌà8  àà8` Ð Ð à******************************************************Ð ,¤'+` x` x Їà8  àà8` Ð Ð àà ¸ àQ.€€Hypotension€may€be€associated€with€positioning€and€isÐ e Ðusually€caused€by€venous€pooling,€e.g.,€in€the€sitting€position.ÐQì` x` x ÐÌà8  àà8` Ð Ð àà ¸ àWhen€the€head€and€spinal€cord€are€elevated€above€the€levelÐ )Ä Ðof€the€heart,€blood€pressure€should€be€referenced€to€head€level€toÐ ° Ðensure€that€monitored€pressure€reflects€perfusion€pressure.Ð œ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àDo€you€agree€or€disagree€with€that?ÐÙ t` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************б L ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Are€you€familiar€with€the€ò òòòManual€of€Complications€inÐ ‰$  ÐAnesthesiaóóó ó?Ðu ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€There€are€two€or€three€of€them,€which€one?ÐMè ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€How€about€Michael€Mahla?Ð%À` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Say€that€again.Ðý˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Mahla.€€M„A„H„L„A?ÐÕp` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€I€donððt€believe€I€have€that€book.ЭH` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Youððve€got€those€in€your€library,€donððt€you?Ð… ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€Itððs€possible,€I€donððt€know.Ð]ø` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Do€you€consider€those€to€be€reliable€texts,Ð 5Ð ÐòòComplications€in€Anesthesiaóó?Ð!¼` x` x ÐÌà8  àà8` Ð Ð àà ¸ àA.€€I€understand€the€nature€of€your€question.€€I€donððt€chooseÐ ù ” Ðto€characterize€any€textbook€or€publication€as€authoritative€orÐ å!€  Ðreliable,€because,€frankly,€theyððre€just€words.ÐÑ"l!` x` x ÐÌà8  àà8` Ð Ð à******************************************************Щ$D #` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Fair€enough.€€Let€me€see€if€you€would€agree€or€disagreeÐ &"% Ðwith€this.Ðm'#&` x` x ÐÌò òó óà  àDefense€counsel€asked€for€a€bench€conference€and€ð ðrenewedðð€his€previous€objection€toÐ E)à$( Ðthe€questions€as€based€upon€a€learned€treatise€that€had€not€been€established€as€a€reliable€authority.€Ð 1*Ì%) ÐThe€trial€court€permitted€Plaintiffððs€counsel€to€proceed€despite€defendantsðð€objection,€and€counselÐ +¸&* Ðresumed€questioning:Ð  ,¤'+ Їà8  àà8` Ð Ð àà ¸ àQ.€€(By€Mr.€Smith)€Let€me€see€if€you€agree€with€this.Ðe` x` x ÐÌà8  àà8` Ð Ð àà ¸ àFor€patients€in€a€head„elevated€position,€the€appropriateÐ =Ø Ðzero€reference€for€blood€pressure€is€the€brain€at€the€externalÐ )Ä Ðauditory€meatus,€not€the€heart.€€Failure€to€use€the€brain€as€the€zeroÐ ° Ðreference,€after€sitting€a€patient€up,€will€lead€to€an€overestimationÐ  œ Ðof€cerebral€perfusion€pressure.Ðí ˆ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àDo€you€agree€or€disagree€with€that?ÐÅ `` x` x ÐÌà8  àà8` Ð Ð à******************************************************Ð 8 ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Well,€Iððm€going€to€stick€right€now€with€the€wordÐ u  Ðð ðinadvertent,ðð€but€I€certainly€have€no€problem€with€you€usingÐ aü  Ðð ðaccidental.ðð€€In€fact,€Iððll€use€it,€okay?ÐMè ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àAccidental€hypotension€is€quite€probably€the€most€frequentÐ %À Ðcomplication€of€the€sitting€position.€€Its€presence€requires€rapidÐ ¬ Ðdetection€and€prompt€treatment€if€significant€cerebral€hypoxia€is€toÐ ý˜ Ðbe€avoided.€€Agree€or€disagree?Ðé„` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************ÐÁ\` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€And€you€would€agree€with€me€that€you€have€read€in€theÐ ™4 Ðliterature€many,€many€times€that€the€warnings€are€out€there€that,Ð …  Ðindeed,€would€say,€just€because€you€get€below€the€level€ofÐ q  Ðautoregulation€doesnððt€mean€that€youððre€going€to€lose€blood€flow€toÐ ]ø Ðthe€brain€and€have€hypoxia,€because€some€people€will€be€able€toÐ Iä Ðtolerate€it,€but€others€wonððt,€and€you€need€to€get€the€pressure€backÐ 5Ð Ðup.€€€Ð!¼` x` x ÐÌà8  àà8` Ð Ð àà ¸ àThatððs€just€all€over€the€medical€literature,€isnððt€it,€Doctor?Ðù ”` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************ÐÑ"l!` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€Let[ððs]€see€if€you€agree€with€this€statement.Щ$D #` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€Your€Honor,€I€renew€myÐ &"% Ðobjection.Ðm'#&` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Okay.ÐE)à$(` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€SMITH:€May€I€proceed,€Your€Honor?Ð+¸&*` x` x ÐÐ  ,¤'+ Ðà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Yes.Ðe` x` x ÐÌà8  àà8` Ð Ð àà ¸ àQ.€€(By€Mr.€Smith)€Although€difficult€to€determineÐ =Ø Ðprecisely,€it€has€previously€been€estimated€that€at€least€2,000Ð )Ä Ðpreventable€instances€of€anesthesia„related€death€or€permanentÐ ° Ðbrain€damage€occur€in€the€United€States€each€year.€€Agree€orÐ  œ Ðdisagree?Ðí ˆ` x` x ÐÌò òó óà  àOther€than€the€two€objections€cited,€no€additional€objections€were€entered€by€defenseÐ Å ` Ðcounsel€into€the€record.€€However,€we€note€that€where€counsel€interposes€timely€objections€to€aÐ ± L  Ðline€of€testimony,€counsel€is€not€required€to€repeat€his€objection€in€every€instance€where€suchÐ  8  Ðtestimony€was€elicited€from€the€witness.€€òòò òGulf€Refining€Co.€v.€Frazieróóó ó,€19€Tenn.€App.€76,€83Ð ‰$  ÐS.W.2d€285,€299€(Tenn.€Ct.€App.€1934).€€ð ðOne€ruling€on€one€question€is€enough,€and€a€repetitionÐ u  Ðof€similar€exceptions€is€not€to€be€required,€if,€indeed,€to€be€tolerated.ððò òòò€Idóóó ó.€(quoting€€òòò òLouisville€&Ð aü  ÐN.€Railroad€Co.€v.€Goweró óóó,€85€Tenn.€465,€471,€3€S.€W.€824,€826;€òòò òMcCormick€v.€Stateó óóó,€135€Tenn.Ð Mè  Ð218,€230,€186€S.€W.€95,€L.€R.€A.€1916F,€382).ò òó óÐ 9Ô  ÐÌà  àFrom€our€reading€of€the€trial€transcripts,€it€is€apparent€that€counselððs€cross„examinationÐ ¬ Ðwas€framed€by€medical€literature;€literature€that€counsel€failed€to€identify€or€establish€as€reliableÐ ý˜ Ðauthority.€€In€ò òòòMcCay€v.€Mitchellóóó ó,€463€S.W.2d€710€(Tenn.€Ct.€App.€1970),€this€Court€stated:Ð é„ ÐÌà8  àà8` Ð Ð àà ¸ àIt€is€established€in€Tennessee€[that]€an€expert€witness€mayÐ Á\ Ðbe€cross„examined€by€the€use€of€standard€authorities€on€the€subject.€Ð ­H ÐThe€òòò òCourt€in€Sale€v.€Eichberg€ó óóó(1900)€105€Tenn.€333,€59Ð ™4 ÐS.W.1020,€cited€ò òòòByers€v.€Nashville,€C.€&€St.€L.€Railroad€Co.óóó ó,€94Ð …  ÐTenn.€345,€29€S.W.€128,€which€states:€ð ðWhen€a€witness€isÐ q  Ðtestifying€as€an€expert,€it€is€competent€to€test€his€knowledge€andÐ ]ø Ðaccuracy€upon€cross„examination€by€reading€to€him,€or€having€himÐ Iä Ðread,€extracts€from€standard€authorities€upon€the€subject„matterÐ 5Ð Ðinvolved,€and€then€asking€him€whether€he€agreed€or€disagreed€withÐ !¼ Ðthe€authorities,€and€comparing€his€opinion€with€those€of€theÐ  ¨ Ðwriter.ððÐù ”` x` x ÐÌò òòòIdóóó ó.€at€720.Ð Ñ"l! ÐÌà  àIn€this€case,€it€appears€as€though€Plaintiffððs€counsel€was€permitted€to€circumvent€theÐ ©$D # Ðrequirement€of€establishing€and€identifying€the€literary€authority€upon€which€he€was€relying€toÐ •%0!$ Ðframe€his€cross„examination€questions׃×Ý ƒ #ÃÝòòÚ  Ú6Ú  ÚóóÝ  Ý×  ×€by€simply€presenting€his€inquiries€as€general€questionsÐ &"% Ðseeking€agreement€or€disagreement€with€a€noted€theory€or€statement€of€facts.€€The€format€utilizedÐ e Ðby€counsel€in€questioning€Dr.€Eichhorn€closely€mirrors€the€generally€accepted€method€of€firstÐ Qì Ðreading€excerpts€from€a€standard€authority€to€the€expert,€and€then€asking€whether€he€agrees€orÐ =Ø Ðdisagrees€with€the€stated€authority.€€ò òòòSeeóóó ó€òòò òidó óóó.€€However,€in€questioning€an€expert€witness€withÐ )Ä Ðregard€to€statements€or€excerpts€from€a€standard€authority,€counsel€must€first€establish€theÐ ° Ðauthoritative€character€of€the€book€or€treatise€offered€for€the€purpose€of€cross„examination.€€ò òòòSeeóóó óÐ  œ Ðò òòòidóóó ó.€€In€the€instant€case,€counsel€failed€to€identify€the€authority€or€authorities€upon€which€he€wasÐ í ˆ Ðbasing€his€questions,€and€therefore€failed€to€establish€the€authoritative€nature€of€these€texts.€€AsÐ Ù t Ðsuch,€the€trial€court€erred€in€permitting€counsel€to€question€Dr.€Eichhorn€with€regard€to€theoriesÐ Å ` Ðor€statements€plucked€from€or€based€upon€unidentified€treatises€or€books.Ð ± L  ÐÌà  àMoreover,€from€our€review€of€the€record€and€trial€transcripts€in€this€case,€we€find€noÐ ‰$  Ðevidence€to€indicate€that€Michael€Mahlaððs€òòò òManual€of€Complications€in€Anesthesiaóóó ó€was€everÐ u  Ðestablished€as€a€reliable€authority.€€We€note€that€Dr.€Eichhorn€refused€to€acknowledge€this€text€asÐ aü  Ðstandard€authority,€and€therefore€the€burden€was€on€Plaintiff€to€introduce€proof€of€theÐ Mè  Ðauthoritative€nature€of€the€text€by€independent€evidence:Ð 9Ô  ÐÌà8  àà8` Ð Ð à[W]here€the€expert€being€cross„examined€does€not€or€will€notÐ ¬ Ðacknowledge€the€medical€authority€presented,€the€authoritativeÐ ý˜ Ðcharacter€of€the€book€or€treatise€offered€for€the€purpose€of€cross„Ð é„ Ðexamination€must€be€proven€by€independent€evidence.€€òòò òStallings€v.Ð Õp ÐState€ó óóó(1953)€232€Ind.€646,€114€N.E.2d€771;€òòò òSmarr€v.€State€ó óóó(1953)Ð Á\ Ð260€Ala.€30,€68€So.2d€6.€€Demanding€proof€as€to€the€authoritativeÐ ­H Ðnature€of€the€medical€work€offered€has€the€wholesome€effect€of€notÐ ™4 Ðpermitting€this€issue€to€be€determined€by€mere€statement€ofÐ …  Ðcounsel.€€òòò òLaird€v.€Boston€&€M.R.€Co.€ó óóó(1922)€80€N.H.€377,€117€A.Ð q  Ð591.Ð]ø` x` x ÐÌò òòòMcCayóóó ó,€62€Tenn.€App.€424,€463€S.W.2d€at€720.Ð 5Ð ÐÌà  àWhile€counsel€did€not€explicitly€ask€the€witness€to€agree€or€disagree€with€a€statementÐ  ¨ Ðfrom€this€particular€treatise,€it€is€evident€that€the€questions€immediately€following€counselððsÐ ù ” Ðinquiry€into€the€expertððs€familiarity€with€this€text€were€premised€upon€Mr.€Mahlaððs€work.€€UnderÐ å!€  Ðthe€circumstances€of€this€particular€case,€we€find€no€reason€for€counsel€to€question€Dr.€EichhornÐ Ñ"l! Ðas€to€his€familiarity€with€this€text€other€than€to€determine€whether€the€expert€agreed€or€disagreedÐ ½#X" Ðwith€specific€statements€or€excerpts€from€the€text.€€Therefore,€any€question€premised€upon€Mr.Ð ©$D # ÐMahlaððs€òòò òManual€of€Complications€in€Anesthesiaó óóó€was€improper,€where€said€treatise€or€text€wasÐ •%0!$ Ðnot€established€as€reliable€authority.Ð &"% ÐÐ m'#& Ðà  àIn€conclusion,€we€find€that€the€trial€court€erred€in€permitting€Plaintiffððs€counsel€to€ask€Dr.Ð e ÐEichhorn€to€agree€or€disagree€with€statements€or€excerpts€from€unidentified€authorities.€€Further,Ð Qì Ðwe€find€that€the€trial€court€erred€in€permitting€counsel€to€ask€questions€premised€upon€Mr.Ð =Ø ÐMahlaððs€ò òòòManual€of€Complications€in€Anesthesiaóóó ó,€where€plaintiff€failed€to€establish€this€text€asÐ )Ä Ðreliable€authority.Ð ° ÐÌà  àDefendants€next€present€for€review€the€issue€of€whether€the€trial€court€erred€in€allowingÐ í ˆ ÐPlaintiffððs€counsel€ð ðto€conduct€a€cross„examination€of€Dr.€Eichhorn€by€challenging€the€witnessÐ Ù t Ðon€various€occasions€to€ð ðcite€me€to€one€piece€of€medical€literatureðð€supporting€his€testimonyÐ Å ` Ðcontrary€to€the€provisions€of€[Tenn.€R.€Evid.€618€and€Tenn.€R.€Evid.€705.]ððÐ ± L  ÐÌà  àIn€their€brief€to€this€Court,€defendants€identify€three€specific€instances€in€which€PlaintiffððsÐ ‰$  Ðcounsel€asked€Dr.€Eichhorn€to€ð ðcite€me€to€one€piece€of€medical€literatureðð€supporting€the€expertððsÐ u  Ðtestimony.€€Counsel€is€entitled€to€cross€examine€to€determine€the€basis€of€an€expertððs€opinion.€Ð aü  ÐAlthough€the€questions€as€posed€take€an€adversarial€attitude,€as€cross€examination€generally€does,Ð Mè  Ðcounselððs€questions€were€seeking€to€elicit€a€basis€for€the€opinion.€€Nevertheless,€from€our€readingÐ 9Ô  Ðof€the€trial€transcript,€we€find€that€defense€counsel€did€not€enter€a€timely€objection€after€any€ofÐ %À Ðthe€allegedly€improper€questions.€€A€party€who€invites€or€waives€error,€or€who€fails€to€takeÐ ¬ Ðreasonable€steps€to€cure€an€error,€is€not€entitled€to€relief€on€appeal.€€òòò òSeeó óóó€Tenn.€R.€App.€P.€36(a),Ð ý˜ Ðcmt.€a.€€Ð é„ ÐÌà  àThe€final€issue€related€to€Plaintiffððs€counselððs€cross„examination€of€Dr.€Eichhorn€asks€thisÐ Á\ ÐCourt€to€consider€the€following€question,€as€stated€in€defendantsðð€brief:Ð ­H ÐÌà8  àà8` Ð Ð àWhether€the€trial€court€abused€its€discretion€in€denyingÐ …  ÐDefendantsðð€motion€for€mistrial€after€Plaintiffððs€counsel€conductedÐ q  Ðan€improper€cross„examination€of€Dr.€Eichhorn€concerning€aÐ ]ø Ðspecific€instance€of€prior€conduct;€namely,€a€statement€allegedlyÐ Iä Ðattributed€to€the€witness€that€he€compared€his€role€as€a€defenseÐ 5Ð Ðexpert€to€that€of€a€ð ðprostitute,ðð€when€there€was€no€reasonableÐ !¼ Ðfactual€basis€for€such€questioning€and€where€Plaintiff€failed€toÐ  ¨ Ðrequest€a€jury„out€hearing€before€questioning€the€witness€asÐ ù ” Ðrequired€by€[Tenn.€R.€Evid.]€608(b)(1).ððÐå!€ ` x` x ÐÌDuring€his€cross„examination€of€Dr.€Eichhorn,€Plaintiffððs€counsel€questioned€the€witnessÐ ½#X" Ðregarding€his€role€as€an€expert€testifying€for€the€defense€in€a€medical€malpractice€action.€€WeÐ ©$D # Ðquote€at€length€from€the€trial€transcript:€€Ð •%0!$ ÐÌà8  àà8` Ð Ð àQ.€€Well,€weððre€going€to€ð!ð€as€I€said,€weððre€going€to€discuss€that€aÐ m'#& Ðlittle€bit€more€later.ÐY(ô#'` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBut€I€want€to€talk,€for€a€moment,€about€your€roles€ð!ð€whatÐ 1*Ì%) Ðâ âyou€perceived€your€role€to€be€in€a€case€like€this€where€youððreÐ +¸&* Ðcoming€into€a€court€to€offer€expert€opinions.€€First€question€aboutÐ e Ðthat.ÐQì` x` x Ðâ âÌà8  àà8` Ð Ð àà ¸ àDo€you€perceive€it€as€your€role€in€participating€in€a€case€forÐ )Ä Ðthe€defense,€with€issues€like€this,€that€it€is€incumbent€upon€you€toÐ ° Ðcreate€a€theory€of€defense?Ð œ` x` x ÐÌà8  àà8` Ð Ð àA.€€No.ÐÙ t` x` x ÐÌà8  àà8` Ð Ð àQ.€€That€would€be€inappropriate,€wouldnððt€it?б L ` x` x ÐÌà8  àà8` Ð Ð àA.€€And€potentially€not€possible.Љ$ ` x` x ÐÌà8  àà8` Ð Ð àQ.€€Do€you€consider€it€your€role€to€be€an€advocate€for€the€party€forÐ aü  Ðwhom€youððre€testifying?ÐMè ` x` x ÐÌà8  àà8` Ð Ð àA.€€No.Ð%À` x` x ÐÌà8  àà8` Ð Ð àQ.€€That€would€be€inappropriate,€wouldnððt€it?Ðý˜` x` x ÐÌà8  àà8` Ð Ð àA.€€Correct.ÐÕp` x` x ÐÌà8  àà8` Ð Ð à******************************************************ЭH` x` x ÐÌà8  àà8` Ð Ð àQ.€€Now,€let€me€take€it€like€this,€and€make€it€a€little€bit€moreÐ …  Ðspecific.€€Youððve€testified€in€a€case€before€where€you€were€theÐ q  Ðexpert€witness€for€an€anesthesiologist€in€a€case€where€the€bloodÐ ]ø Ðpressure€got€too€low€and€the€patientððs€brain€died,€havenððt€you?ÐIä` x` x ÐÌà8  àà8` Ð Ð àA.€€I€donððt€recall€specifically,€but€itððs€certainly€possible.Ð!¼` x` x ÐÌà8  àà8` Ð Ð àQ.€€Well,€weððre€going€to€ð!ð€let€me€see€if€I€can€help€you.Ðù ”` x` x ÐÌà8  àà8` Ð Ð àà ¸ àHave€you€ever€before,€Dr.€Eichhorn,€in€serving€in€this€typeÐ Ñ"l! Ðof€role,€when€serving€as€an€expert€witness€for€an€anesthesiologist,Ð ½#X" Ðsued€because€a€patient€came€out€of€a€surgery€procedure€brain€dead,Ð ©$D # Ðbecause€of€low€blood€pressure,€said€to€the€defense€lawyer€whoÐ •%0!$ Ðhired€you,€ð ðThere€are€big€problems€with€what€your€anesthesiologistÐ &"% Ðdid,€but€I€will€help€you€create€a€theory€to€defend€this€case,€andÐ m'#& Ðshort€of€hiring€an€outright€prostitute,€Iððm€the€best€youððre€going€toÐ Y(ô#' Ðfind?ðð€€Have€you€ever€said€that?ÐE)à$(` x` x ÐÌà8  àà8` Ð Ð àMR.€REYNOLDS€DAVIES:€Your€Honor,€may€we€approach€theÐ +¸&* Ðbench.Ð ,¤'+` x` x Їò òó óà  àBefore€the€court€had€an€opportunity€to€grant€defense€counselððs€request,€Dr.€EichhornÐ e Ðdenied€that€he€had€ever€made€this€statement.€€During€the€ensuing€bench€conference,€defenseÐ Qì Ðcounsel€objected€to€the€alleged€statement€as€hearsay€within€hearsay.€€The€trial€court€ordered€theÐ =Ø Ðjury€out,€and€asked€counsel€to€provide€a€background€for€the€alleged€statement.€€After€PlaintiffððsÐ )Ä Ðcounsel€provided€the€necessary€background,€defense€counsel€restated€his€objection:Ð ° ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€What€we€have€is€a€letter€thatÐ í ˆ Ðwas€written€by€this€lawyer€who€was€indicted€where€ð!ð€wherein€heÐ Ù t Ðquotes€a€quotation€thatððs€attributable€to€Dr.€Eichhorn,€which€Dr.Ð Å ` ÐEichhorn€just€denies.б L ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Okay.€€Take€me€through€this€again.€€BecauseÐ ‰$  ÐI€asked€him€if€whatever€Dr.€Eichhorn€said€was€in€a€piece€of€paper.Ðu ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€No.€€Dr.€Eichhorn€never€saidÐ Mè  Ðanything€in€a€piece€of€paper.€€The€lawyer€ð!ð€a€lawyer€ð!ð€saidÐ 9Ô  Ðsomething€in€a€letter€to€his€insurance€carrier€ð!ð€Ð%À` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€I€see.Ðý˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€ð!ð€attributing€a€quote€to€Dr.Ð Õp ÐEichhorn€that€Dr.€Eichhorn€denies€he€ever€made.ÐÁ\` x` x ÐÌò òó óà  àIn€response€to€defendantsðð€objection,€Plaintiffððs€counsel€explained€that€the€intendedÐ ™4 Ðpurpose€of€the€question€was€to€ð ðimpeach€this€witness€on€his€biasðð€through€use€of€a€priorÐ …  Ðinconsistent€statement€pursuant€to€Tenn.€R.€Evid.€613.€€Defense€counsel€thereafter€raisedÐ q  Ðadditional€objections€under€Tenn.€R.€Evid.€403€and€Tenn.€R.€Evid.€609.€€Defense€counselÐ ]ø Ðadditionally€asked€that€a€curative€instruction€be€given€to€the€jury€or,€if€no€such€instruction€was€toÐ Iä Ðbe€given,€moved€for€a€mistrial.Ð 5Ð ÐÌà  àAfter€consideration€of€the€partiesðð€arguments€on€this€issue,€the€trial€court€determined€thatÐ  ¨ ÐTenn.€R.€Evid.€616€was€not€applicable,€and€further€concluded€that€the€alleged€statement€was€not€aÐ ù ” Ðprior€inconsistent€statement€of€the€witness,€but€rather€a€ð ðlawyerððs€characterization€of€what€Dr.Ð å!€  ÐEichhorn€said.ðð€€The€court€reasoned€that€the€letter€provided€a€reasonable€factual€basis€forÐ Ñ"l! Ðcounselððs€inquiry,€but€determined€that€the€prejudice€of€allowing€counsel€to€question€Dr.€EichhornÐ ½#X" Ðas€to€this€statement€substantially€outweighed€its€probative€value.€€On€this€basis,€the€court€decidedÐ ©$D # Ðto€ð ðleave€outðð€the€statement.€€Defense€counsel€elected€to€forego€a€curative€jury€instruction.€€TheÐ •%0!$ Ðcourt€did€not€rule€on€defendantsðð€motion€for€mistrial.Ð &"% ÐÌà  àA€hearing€on€the€partiesðð€post„trial€motions€was€held€on€August€13,€2002.€€During€thisÐ Y(ô#' Ðhearing,€defendants€addressed€the€prejudicial€effect€of€counselððs€cross„examination€question€asÐ E)à$( Ðgrounds€for€their€motion€for€mistrial.€€We€quote€at€length€the€discourse€between€defense€counselÐ 1*Ì%) Ðand€the€court€on€this€issue:Ð +¸&* ÐÐ  ,¤'+ Ðà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€I€think,€since€that€was€ourÐ e Ðonly€expert€witness,€coupled€with€the€fact€that€Dr.€Hays€could€notÐ Qì Ðbe€available,€at€no€fault€of€the€defendants,€to€ask€Dr.€Eichhorn€thatÐ =Ø Ðquestion,€knowing€that€there€was€no€way€to€prove€it€or€nothing€toÐ )Ä Ðback€it€up,€without€asking€for€a€jury„out€hearing,€was€wrong.а` x` x ÐÌà8  àà8` Ð Ð àà ¸ àYou€did€suggest€that€you€would€give€the€jury€an€instructionÐ í ˆ Ðto€ignore€it.€€However,€you€didnððt€exactly€ð!ð€you€stated€you€didnððtÐ Ù t Ðexactly€know€what€you€were€going€to€say.ÐÅ `` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBecause€it€happened€before€lunch€and€we€took€a€long€lunchÐ  8  Ðbreak.€€We€moved€for€a€curative€instruction,€or€in€the€alternativeÐ ‰$  Ðfor€a€mistrial.€€We€felt€like€the€curative€instruction€really€couldnððtÐ u  Ðcure€that€error,€and€that€we€accepted€ð!ð€we€went€on€with€the€trialÐ aü  Ðwithout€getting€the€instruction.ÐMè ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBut€we€did€move€for€a€mistrial.Ð%À` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Uh„huh.€€You€certainly€did.Ðý˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€And€I€donððt€think€we€wereÐ Õp Ðrequired€to€take€a€curative€instruction,€because€I€think€under€thoseÐ Á\ Ðcircumstances,€asking€a€doctor€if€heððs€ever€said€that,€ð ðShort€of€anÐ ­H Ðoutright€prostitute,€Iððm€the€best€youððre€ever€going€to€get,ðð€I€donððtÐ ™4 Ðknow€how€you€could€have€unrung€that€bell.€€So€ð!ð€Ð… ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€Well,€it€ð!ð€I€think€you€were€right.€€I€probablyÐ ]ø Ðencouraged€you€not€to€have€a€curative€instruction,€because€it€was€ð!ðÐ Iä Ðit€was€so€out€of€the€line€of€questioning€that€ð!ð€and€we€took€a€lunchÐ 5Ð Ðbreak€after€that,€that€itððs€often€been€my€theory€about€notÐ !¼ Ðemphasizing,€it€doesnððt€bring€it€back€to€the€juryððs€mind€about,Ð  ¨ Ðð ðWhat€in€the€world€is€that€about,ðð€okay?€€Because€the€subjectÐ ù ” Ðmatter€of€that€letter€would€have€been€much€ð!ð€would€have€beenÐ å!€  Ðpotentially€much€more€familiar€to€us€in€the€legal€world€than€itÐ Ñ"l! Ðwould€have€been€to€the€jurors.н#X"` x` x ÐÌà8  àà8` Ð Ð àà ¸ àBut€you€canððt€ð!ð€you€couldnððt€really€unring€the€bell,€thatððsÐ •%0!$ Ðtrue.€€But€we€did€not€ð!ð€and€we€did€not€look€at€any€specific€wording,Ð &"% Ðbecause€I€usually€leave€that€up€to€the€folks,€if,€you€know,Ð m'#& Ðsomebody€talks€about€insurance,€if,€you€know,€they€just€wanted€theÐ Y(ô#' Ðcurative€instruction€from€the€jury€instructions,€or€if€they€wantÐ E)à$( Ðsomething€else,€or€if€they€want€nothing.Ð1*Ì%)` x` x ÐÌà8  àà8` Ð Ð àà ¸ àI€donððt€think€that€dilutes€your€motion€for€a€mistrial.Ð ,¤'+` x` x Їà8  àà8` Ð Ð àà ¸ àOkay.€€Letððs€go€to€the€next€issue.Ðe` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€Did€ð!ð€have€you€ð!ð€have€youÐ =Ø Ðoverruled€that€ground,€Your€Honor?€€Iððm€a€little€confused€as€to€theÐ )Ä Ðruling.€€The€ruling€about€the€ð!ð€I€understand€about€Dr.€ð!ð€Ð°` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€I€donððt€believe€that€there€ð!ð€Iððm€not€evenÐ í ˆ Ðruling€on€whether€the€question€should€have€been€asked.€€I€neverÐ Ù t Ðhad€to€make€a€ruling€on€that.€€I€went€right€to€the€hearing€part.€€AndÐ Å ` Ðitððs€not€clear€in€the€rule€whether€the€hearing€has€to€be€done.€Ð ± L  ÐObviously,€I€was€very€ð!ð€I€was€not€happy€about€the€question.€€I€thinkÐ  8  ÐI€made€that€very€clear€to€the€plaintiffs.Љ$ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àMR.€REYNOLDS€DAVIES:€Well,€I€just€ð!ð€I€mean,€just€forÐ aü  Ðthe€purposes€of€the€record€ð!ð€ÐMè ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTHE€COURT:€I€still€say€that€no€mistrial€should€be€granted.€Ð %À ÐSo,€yes,€I€overrule€it.Ь` x` x ÐÌò òó óà  àPlaintiff€contends€that€counselððs€question€was€proper€pursuant€to€Tenn.€R.€Evid.€613€forÐ é„ Ðthe€purpose€of€impeaching€Dr.€Eichhorn€with€a€prior€inconsistent€statement€that€demonstratedÐ Õp Ðbias€on€behalf€of€the€witness.€€We€find€Plaintiffððs€assertion€without€merit,€and€note€that€there€isÐ Á\ Ðno€evidence€to€indicate€that€Dr.€Eichhorn€ever€made€the€statement€attributed€to€him.€€The€expertÐ ­H Ðdenied€making€the€statement,€and€Plaintiffððs€only€basis€for€asking€the€question€is€a€letter,€enteredÐ ™4 Ðas€an€exhibit€at€trialò òó ó,€written€by€an€individual€unavailable€for€cross„examination,€alleging€that€Dr.Ð …  ÐEichhorn€made€such€a€statement.€€For€these€reasons,€we€find€that€there€was€no€reasonable€factualÐ q  Ðbasis€for€counsel€to€pursue€this€line€of€inquiry.€€At€the€very€least,€it€appears€that€the€prejudicialÐ ]ø Ðeffect€of€the€question,€when€asked€of€Defendantsðð€sole€expert€witness€in€the€presence€of€the€jury,Ð Iä Ðfar€outweighs€its€probative€value.€€In€view€of€Dr.€Eichhornððs€importance€to€Defendantsðð€case,€theÐ 5Ð Ðerror€more€probably€than€not€affected€the€juryððs€decision€and€is€ground€for€reversal.Ð !¼ Ðò òó óÌà  àDefendantsðð€next€issue,€as€quoted€from€their€brief,€states:Ð ù ” ÐÌà8  àà8` Ð Ð àWhether€the€trial€court€abused€its€discretion€in€denyingÐ Ñ"l! ÐDefendantsðð€motions€for€mistrial€or€to€continue€the€trial€afterÐ ½#X" ÐDefendants€were€notified€at€the€end€of€the€first€week€of€trial€that€aÐ ©$D # Ðplanned€expert€witness,€Dr.€Michael€Hays,€a€local€anesthesiologistÐ •%0!$ Ðin€private€practice€in€Nashville,€was€unavailable€to€testify€due€toÐ &"% Ðthe€fact€that€he€had€been€diagnosed€with€malignant€lymphomaÐ m'#& Ðduring€the€trial€and€planned€to€undergo€immediate€diagnostic€testsÐ Y(ô#' Ðand€chemotherapy€treatment.ÐE)à$(` x` x ÐÌà  àWe€pretermit€defendantsðð€issue€on€the€basis€of€our€decision€to€remand€this€matter€for€aÐ +¸&* Ðnew€trial.€€Ð  ,¤'+ Ðò òó óÌà  àDefendantsðð€next€issue€asks€this€Court€to€consider€the€following:Ð Qì ÐÌà8  àà8` Ð Ð àWhether€the€trial€court€erred€in€granting€Plaintiffððs€pre„trial€motionÐ )Ä Ðin€limine€relating€to€Dr.€Haysðð€anticipated€expert€testimony€aboutÐ ° Ðcausation€of€injury€and€the€carotid€artery€occlusion€theory?Ð œ` x` x ÐÌà  àThe€trial€court€is€afforded€discretion€to€determine€the€ð ðadmissibility,€qualifications,Ð Ù t Ðrelevancy€and€competency€of€expert€testimony.ðð€€ò òòòMcDaniel€v.€CSX€Transp.,€Inc.óóó ó,€955€S.W.2dÐ Å ` Ð257,€263€(Tenn.€1997).€€The€trial€courtððs€rulings€in€this€regard€will€be€upheld€except€upon€aÐ ± L  Ðshowing€of€an€abuse€of€this€discretion.€€ò òòòSeeóóó ó€ò òòòidóóó ó.€at€263„64.Ð  8  ÐÌà  àTo€reiterate,€Plaintiff€filed€a€pre„trial€motion€in€limine€seeking€to€preclude€defendantsÐ u  Ðð ðfrom€offering€expert€testimony€as€to€the€causation€or€ð ðpossibleðð€causation€of€the€injuries€orÐ aü  Ðdeath€of€Plaintiffððs€decedent€from€occlusion€of€the€carotid€artery(ies)....ðð€€In€ruling€uponÐ Mè  ÐPlaintiffððs€motion,€the€court€considered€the€deposition€testimony€of€Dr.€Hays,€Dr.€Eichhorn,€andÐ 9Ô  ÐDr.€Wright.€€With€regard€to€Dr.€Haysððs€carotid€artery€occlusion€theory€testimony,€the€courtÐ %À Ðdetermined€that€the€ð ðoverwhelming€weight€of€his€testimony€indicates€that€he€believes€this€theoryÐ ¬ Ðis€only€a€possibility.€€This€is€not€sufficient€for€an€admissible€expert€opinion.ðð€€The€court€therebyÐ ý˜ Ðgranted€Plaintiffððs€motion€with€respect€to€Dr.€Haysððs€carotid€artery€occlusion€theory€testimony.Ð é„ ÐÓÓÌÓx™Óà  àThroughout€the€course€of€his€deposition€testimony,€Dr.€Hays€was€questioned€extensivelyÐ ­H Ðwith€regard€to€the€issue€of€causation,€and€specifically€the€aforementioned€carotid€artery€occlusionÐ ™4 Ðtheory.€€The€carotid€artery€theory€testified€to€by€Dr.€Hays€is€a€theory€of€causation€as€an€alternativeÐ …  Ðtheory€of€causation€than€that€presented€by€Plaintiff.€€In€presenting€this€causation€theory,€Dr.€HaysÐ q  Ðtestifies€in€terms€of€possibilities€and€assumptions,€and€at€one€point€stated€that€that€he€did€notÐ ]ø Ðthink€ð ðanybody€is€going€to€be€able€to€know€exactly€what€happened€to€Mr.€Hunter.ðð€€Dr.€HaysÐ Iä Ðstated€that€the€impeding€of€the€left€and/or€right€carotid€arteries,€and/or€the€impeding€of€theÐ 5Ð Ðvertebrals€were€possible€explanations€for€the€complications€experienced€and€concluded€that€aÐ !¼ Ðcombination€of€all€of€these€factors€provides€a€possible€explanation€for€Mr.€Hunterððs€death.€€Dr.Ð  ¨ ÐHays€was€testifying€with€regard€to€possible€alternative€causes€and€did€not€attempt€to€make€aÐ ù ” Ðdefinitive€determination€to€express€an€opinion€as€to€the€cause€of€Mr.€Hunterððs€death.€€In€ò òòòMitchellÐ å!€  Ðv.€Ensoró óóó,€No.€W2001„01„683„COA„R3„CV,€2002€WL€31730908€(Tenn.€Ct.€App.€November€18,Ð Ñ"l! Ð2002),€a€medical€malpractice€action€filed€by€a€female€plaintiff€alleging€drastic€physical€changesÐ ½#X" Ðcaused€by€an€injection€of€a€male€hormone€drug,€this€Court€was€faced€with€a€similar€issue€as€theÐ ©$D # Ðcase€at€bar.€€This€Court€determined€that€the€trial€court€did€not€abuse€its€discretion€in€permitting€aÐ •%0!$ Ðdefendantððs€expert€to€testify€as€to€alternate€causes€of€the€plaintiffsððs€medical€condition.€€PlaintiffsÐ &"% Ðhad€objected€to€the€expertððs€testimony€as€speculative,€noting€that€he€admitted€that€he€ð ðdid€notÐ m'#& Ðhave€an€opinion€as€to€the€actual€cause€of€the€[patientððs]€condition.ðð€€ò òòòIdó óóó.€at€*13.€€This€Court€agreedÐ Y(ô#' Ðwith€the€trial€courtððs€decision€that€the€expertððs€testimony€was€ð ðrendered€for€the€sake€of€bringingÐ E)à$( Ðlight€to€other€potential€explanations€for€[the€patientððs]€condition,€but€not€to€prove€ultimateÐ 1*Ì%) Ðcausation.ðð€€ò òòòId.ó óóó€at€*14.€€We€noted€that€the€expert€did€not€express€an€opinion€concerning€causationÐ +¸&* Ðof€the€plaintiffððs€condition€but€merely€addressed€possible€alternate€causes€for€the€condition.€€InÐ  ,¤'+ Ðsupport€of€our€conclusion,€we€relied€upon€ò òòòSakler€v.€Anesthesiology€Assocs.,€P.S.C.óóó ó,€50€S.W.3dÐ e Ð210€(Ky.€Ct.€App.€2001)€where€the€Court€said:€€Ð Qì ÐÌà8  àà8` Ð Ð àà ¸ àWe€conclude€that€defendants€in€medical€malpractice€actionsÐ )Ä Ðmay€introduce€expert€witness€testimony€to€rebut€a€plaintiffððs€expertÐ ° Ðwitness€testimony€couched€in€terms€of€ð ðreasonable€medicalÐ  œ Ðprobability,ðð€even€though€the€defendantððs€expert€witnessððsÐ í ˆ Ðtestimony€is€couched€only€in€terms€of€ð ðpossibility.ðð€€In€so€deciding,Ð Ù t Ðwe€are€persuaded€by€the€reasoning€of€the€United€States€Court€ofÐ Å ` ÐAppeals€for€the€First€Circuit€in€the€case€of€òòò òWilder€v.€Eberhartó óóó,€977Ð ± L  ÐF.2d€673€(1st€Cir.€1992)€cert.€denied€508€U.S.€930„113€S.Ct.€2396,Ð  8  Ð124€L.€Ed.€2d€297€(1993).Љ$ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àIn€òòò òWilderó óóó,€a€plaintiff€patient€filed€suit€against€her€defendantÐ aü  Ðdoctor€and€clinic€for€medical€malpractice,€alleging€the€doctorððsÐ Mè  Ðsurgical€procedure€caused€her€to€suffer€an€esophageal€injury.€€AtÐ 9Ô  Ðtrial,€the€plaintiffððs€expert€witness€testified€that€her€injury€wasÐ %À Ðcaused€by€the€defendantsðð€medical€negligence.€€Expert€medicalÐ ¬ Ðtestimony€on€behalf€of€the€defendants,€however,€was€ruledÐ ý˜ Ðinadmissible€by€the€trial€court€because€it€could€not€be€expressed€inÐ é„ Ðterms€of€ð ðprobabilityðð€as€distinguished€from€ð ðmedical€possibility.ðð€Ð Õp ÐIn€holding€the€trial€court€erred€in€excluding€this€testimony,€the€FirstÐ Á\ ÐCircuit€reasoned€as€follows:ЭH` x` x ÐÌà8  àà8` Ð Ð àà8¸ ` x` xàProximate€causation€between€negligence€and€theÐ …  Ðinjury€complained€of€in€a€medical€malpractice€caseÐ q  Ðmust€be€established€by€expert€testimony.€€(CitationÐ ]ø Ðomitted).€€On€the€other€hand,€the€defendant€need€notÐ Iä Ðdisprove€causation.€€Rather,€he€must€produceÐ 5Ð Ðcredible€evidence€which€tends€to€discredit€or€rebutÐ !¼ Ðthe€plaintiffððs€evidence.€€(Citation€omitted).€€As€theÐ  ¨ ÐNew€Hampshire€Supreme€Court€recently€stated€inÐ ù ” Ðò òòòTzimasóóó ó€[òòò òv.€Coiffures€by€Michaeló óóó,€135€N.H.€498,Ð å!€  Ð606€A.2d€1082,€1084€(N.H.€1992)],€the€plaintiff€in€aÐ Ñ"l! Ðnegligence€action€bears€the€burden€of€producingÐ ½#X" Ðevidence€ð ðto€prove€that€it€is€more€likely€than€notÐ ©$D # Ðthat€[plaintiffððs]€injury€was€ð ðcaused€by€theÐ •%0!$ Ðdefendantððs€negligence.ðð€€(Citation€omitted).€Ð &"% ÐDefendant€need€not€prove€another€cause,€he€onlyÐ m'#& Ðhas€to€convince€the€trier€of€fact€that€the€allegedÐ Y(ô#' Ðnegligence€was€not€the€legal€cause€of€injury.€Ð E)à$( Ð(Citation€omitted).€€In€proving€such€a€case,€aÐ 1*Ì%) Ðdefendant€may€produce€other€ð ðpossibleðð€causes€ofÐ +¸&* Ðthe€plaintiffððs€injury.€€These€other€possible€causesÐ  ,¤'+ Ðneed€not€be€proved€with€certainty€or€more€probablyÐ e Ðthan€not.€€To€fashion€such€a€rule€would€unduly€tie€aÐ Qì Ðdefendantððs€hands€in€rebutting€a€plaintiffððs€case,Ð =Ø Ðwhere€as€here,€plaintiffððs€expert€testifies€that€noÐ )Ä Ðother€cause€could€have€caused€plaintiffððs€injury.€Ð ° ÐThe€burden€would€then€shift€and€defendant€wouldÐ  œ Ðthen€bear€the€burden€of€positively€proving€thatÐ í ˆ Ðanother€specific€cause,€not€the€negligenceÐ Ù t Ðestablished€by€plaintiffððs€expert,€caused€the€injury.€Ð Å ` ÐCertainly,€this€is€much€more€than€what€should€beÐ ± L  Ðrequired€of€a€defendant€in€rebutting€a€plaintiffððsÐ  8  Ðevidence.Љ$ ¸ ¸  ÐÌà8  àà8` Ð Ð àà8¸ ` x` xàà  àWere€we€to€accept€plaintiffððs€argument€thatÐ aü  Ðonce€a€plaintiff€puts€on€a€prima€facie€case,€aÐ Mè  Ðdefendant€cannot€rebut€it€without€proving€anotherÐ 9Ô  Ðcause,€the€resulting€inequities€would€abound.€€ForÐ %À Ðexample€if€ninety„nine€out€of€one€hundred€medicalÐ ¬ Ðexperts€agreed€that€there€were€four€equally€possibleÐ ý˜ Ðcauses€of€a€certain€injury,€A,€B,€C€and€D,€andÐ é„ Ðplaintiff€produces€the€one€expert€who€conclusivelyÐ Õp Ðstates€that€A€was€the€certain€cause€of€injury,Ð Á\ Ðdefendant€would€be€precluded€from€presenting€theÐ ­H Ðtestimony€of€any€of€the€other€ninety„nine€experts,Ð ™4 Ðunless€they€would€testify€that€B,€C,€or€D€was€theÐ …  Ðcause€of€the€injury.€€Even€if€all€of€defendantððsÐ q  Ðexperts€were€prepared€to€testify€that€any€of€theÐ ]ø Ðpossible€causes€A,€B,€C€or€D,€could€have€equallyÐ Iä Ðcaused€plaintiffððs€injury,€so€long€as€none€would€beÐ 5Ð Ðprepared€to€state€that€one€particular€cause,€otherÐ !¼ Ðthan€that€professed€by€plaintiff€more€probably€thanÐ  ¨ Ðnot€caused€plaintiffððs€injury,€then€defendantððsÐ ù ” Ðexperts€would€not€be€able€to€testify€at€all€as€toÐ å!€  Ðcausation.ÐÑ"l!¸ ¸  ÐÌà8  àà8` Ð Ð àòòò òWilderó óóó,€977€F.2d€at€676„677€n.5.€€We€agree€with€the€First€CircuitÐ ©$D # Ðthat€expert€testimony€of€this€nature€is€admissible€on€behalf€ofÐ •%0!$ Ðdefendants€in€medical€malpractice€cases€in€order€to€rebut€theÐ &"% Ðtestimony€of€plaintiffs€upon€whom€the€burden€of€proof€rests.Ðm'#&` x` x ÐÌòòò òMitchelló óóó,€2002€WL€31730908€at€*16„17€(quoting€ò òòòSakleróóó ó,€50€S.W.3d€at€213„14).Ð E)à$( ÐÌFinding€the€opinion€in€òòò òWilder€ó óóówell€reasoned,€this€Court€adopted€the€holding€expressed€in€ò òòòWilderÐ +¸&* Ðóóó óand€ò òòòSakler€óóó óas€dispositive€of€the€issue€presented.€€ò òòòIdóóó ó.€at€*17.Ð  ,¤'+ Їà  àAfter€examining€Dr.€Haysððs€deposition€testimony,€and€in€light€of€our€decision€in€ò òòòMitchellóóó ó,Ð e Ðwe€find€that€the€trial€court€erred€in€granting€Plaintiffððs€pre„trial€motion€in€limine€precluding€Dr.Ð Qì ÐHays€from€testifying€about€possible€alternative€causes€of€Mr.€Hunterððs€death.€ÓÓà x àDr.€Hays€wasÐ =Ø Ðtestifying€with€regard€to€a€possible€alternate€cause,€rather€than€identifying€a€definitive€cause€forÐ ° ÐMr.€Hunterððs€death.€Ð í ˆ ÐÓ˾Óò òó óà  àDefendants€next€present€for€review€several€issues€relating€to€opposing€counselððs€closingÐ Å ` Ðargument€to€the€jury.€€In€general,€the€control€over€the€argument€of€counsel€resides€with€the€trialÐ ± L  Ðcourt,€and€the€trial€court€has€broad€discretion€as€to€what€shall€and€shall€not€be€permitted€inÐ  8  Ðargument.€€ò òòòMcCollum€v.€Huffstutteróóó ó,€No.€M2002-00051-COA-R3-CV,€2002€WL€31247077,€atÐ ‰$  Ð*9€(Tenn.€Ct.€App.€Oct.€8,€2002).€€The€appellate€courts€generally€will€not€interfere€with€theÐ u  Ðdiscretionary€action€of€a€trial€court€in€refusing€to€grant€a€mistrial€or€a€new€trial€for€misconduct€ofÐ aü  Ðcounsel€in€argument€unless€the€argument€is€clearly€unwarranted€and€made€purely€for€the€purposeÐ Mè  Ðof€appealing€to€passion,€prejudices€and€sentiment€which€cannot€be€removed€by€sustaining€theÐ 9Ô  Ðobjection€of€opposing€counsel.€€ò òòòPerkins€v.€Sadleróóó ó,€826€S.W.2d€439,€442€(Tenn.€Ct.€App.€1991).€€€Ð %À ÐÓÓÌÓöÃÓà  àThese€issues€involve€the€repeated€reference€in€Plaintiffððs€closing€argument€to€Dr.€WittððsÐ é„ Ðtestimony€being€supported€by€the€medical€literature.€€Although€three€of€the€issues€are€waived€forÐ Õp Ðfailure€to€make€a€contemporaneous€objection,€ò òòòsee€State€v.€Littleó óóó,€854€S.W.2d€643,€651€(Tenn.Ð Á\ ÐCrim.€App.€1992),€on€retrial€the€Court€should€consider€our€earlier€finding€that€it€was€error€toÐ ­H Ðpermit€counsel€to€make€references€to€unidentified€medical€literature€in€the€examination€ofÐ ™4 Ðwitnesses.€€In€the€fourth€related€issue€concerning€argument€of€counsel,€contemporaneousÐ …  Ðobjection€was€made€and€overruled€by€the€trial€court.€Ð q  Ðò òó óÌà  àDefendants€next€issue,€as€stated€in€their€brief:Ð Iä ÐÌà8  àà8` Ð Ð àWhether€the€courtððs€retrospective€application€of€the€òòJordanóóÐ !¼ Ðdecision€allowing€the€jury€to€award€loss€of€consortium€damages€inÐ  ¨ Ðthis€case€is€unconstitutional€as€it€violates€Defendantsðð€rights€underÐ ù ” ÐArt.€I,€ðð€20€of€the€Tennessee€Constitution,€and€vested€rightsÐ å!€  Ðprotected€by€the€Due€Process€and€Equal€Protection€Clauses€of€theÐ Ñ"l! Ð14th€Amendment€to€the€Constitution€of€the€United€States.н#X"` x` x ÐÌà  àThe€cause€of€action€in€this€matter€arose€on€or€about€November€1,€1995.€€On€October€28,Ð •%0!$ Ð1998,€Plaintiff€filed€a€Motion€for€Leave€to€Amend€Complaint€adding,€in€part,€loss€of€consortiumÐ &"% Ðð ðclaimsðð€on€her€own€behalf€and€that€of€her€two€sons.€€Defendants€did€not€object€to€the€inclusionÐ m'#& Ðof€the€loss€of€consortium€claims.€€On€July€23,€2001,€Plaintiff€filed€an€Amended€ComplaintÐ Y(ô#' Ðseeking€damages€on€the€basis€of€the€aforementioned€claims.€€Trial€in€this€matter€began€on€AprilÐ E)à$( Ð22,€2002,€and€a€jury€verdict€returned€on€May€2,€2002.Ð 1*Ì%) Ðâ âÐ +¸&* Ðà  àIn€ò òòòJordan€v.€Baptist€Three€Rivers€Hosp.óóó ó,€984€S.W.2d€593,€600„02€(Tenn.€1999),€theÐ e Ðâ âTennessee€Supreme€Court€held,€ò òòòinter€aliaóóó ó,€that€loss€of€consortium€damages€are€recoverable€by€aÐ Qì Ðdecedentððs€family€as€part€of€the€pecuniary€value€of€the€deceasedððs€life.׃×Ý ƒ #ÃÝòòÚ  Ú7Ú  ÚóóÝ  Ý×  ×€€The€following€year,€inÐ =Ø Ðò òòòHill€v.€City€of€Germantownóóó ó,€31€S.W.3d€234€(Tenn.€2000),€the€Court€considered,€òòò òinter€aliaó óóó,€theÐ )Ä Ðspecific€issue€of€ð ðwhether€[òòò òJordanó óóó]€applies€retroactively€to€this€case€to€permit€loss€of€consortiumÐ ° Ðdamages€to€be€awarded€to€the€plaintiffs.ðð€€ò òòòIdóóó ó.€at€235.Ð  œ ÐÌà  àIn€ò òòòHillóóó ó,€plaintiff„family€members€filed€separate€wrongful€death€actions€against€the€City€ofÐ Ù t ÐGermantown€and€a€police€officer€for€deaths€resulting€from€a€high„speed€chase.€€òòò òIdó óóó.€at€236.€€TheÐ Å ` Ðtrial€court,€sitting€without€a€jury,€entered€judgment€for€plaintiffs.€€ò òòòIdóóó ó.€€The€court€applied€theÐ ± L  Ðstatutory€damages€cap€imposed€by€the€Tennessee€Governmental€Tort€Liability€Act€(ð ðGTLAðð),Ð  8  Ðand€ð ðawarded€$130,000.00€for€each€of€the€wrongful€death€claims,€the€maximum€amount€ofÐ ‰$  Ðrecovery€permitted€under€the€GTLA.ðð€€òòò òIdó óóó.Ð u  ÐÌà  àPlaintiffs€appealed,€and€the€Tennessee€Court€of€Appeals€affirmed€the€trial€courtððsÐ Mè  Ðdecision€in€all€respects.€€òòò òIdó óóó.€€The€Supreme€Court€granted€review,€holding,€in€partò òòòóóó ó:Ð 9Ô  ÐÌà8  àà8` Ð Ð àWe€òòò òó óóóhold€that€òòò òJordan€ó óóóapplies€retrospectively€to:€(1)€all€cases€triedÐ ¬ Ðor€retried€after€[January€25,€1999,]€the€date€of€our€decision€inÐ ý˜ Ðòòò òJordanó óóó;€and€(2)€to€all€cases€pending€on€appeal€in€which€the€issueÐ é„ Ðdecided€in€òòò òJordanó óóó€was€raised€at€an€appropriate€time.ÐÕp` x` x ÐÌòòò òIdó óóó.€at€240.׃â×Ý ƒ #ÃÝòòÚ  Ú8Ú  ÚóóÝ  Ý×  ×Ð ­H ÐÌà  àApplying€the€holding€in€òòò òHilló óóó,€we€find€that€the€trial€court€did€not€err€in€allowing€retroactiveÐ …  Ðapplication€of€the€ò òòòJordanóóó ó€decision€to€the€case€at€bar.€€Trial€in€this€matter€began€on€April€22,Ð q  Ð2002.€€Plaintiff€properly€and€timely€amended€her€complaint€to€include€a€claim€for€loss€ofÐ ]ø Ðconsortium€damages,€and€defendants€entered€no€objection€to€said€amendment.€€We€therefore€findÐ Iä Ðdefendantsðð€issue€without€merit.Ð 5Ð ÐÌà  àDefendants€next€issue€asks€us€to€consider€the€following€question:Ð  ¨ ÐÌà8  àà8` Ð Ð àWhether€the€court€violated€Defendantsðð€guaranty€to€trial€by€juryÐ å!€  Ðunder€the€Tennessee€Constitution€by€commenting€upon€theÐ Ñ"l! Ðevidence€during€the€jury€charge€that€this€case€was€ð ða€veryÐ ½#X" Ðinteresting€and€difficult€case,ðð€and€that€the€jury€would€findÐ e ÐQuestion€#1€on€the€verdict€form€(were€the€Defendants€at€fault?)€toÐ Qì Ðbe€a€ð ðdeceptively€simple€questionðð€and€one€to€which€there€wasÐ =Ø Ðð ðobviously€not€a€simple€answer.ððÐ)Ä` x` x ÐÌà  àDuring€the€course€of€jury€instructions,€the€trial€judge€made€several€comments€to€whichÐ  œ Ðdefendants€now€object€and€specifically€challenge€as€improper€and€in€violation€of€the€TennesseeÐ í ˆ ÐConstitutionððs€guaranty€to€trial€by€jury.€€We€quote€at€length€from€the€trial€transcript€so€as€toÐ Ù t Ðpresent€the€courtððs€comments€in€their€proper€context:Ð Å ` ÐÌà8  àà8` Ð Ð àà ¸ àAnd€I€do€want€to€say€that,€even€though€it€was€a€very€longÐ  8  Ðtwo€weeks,€you€were€ð!ð€if€you€were€going€to€have€sat€through€aÐ ‰$  Ðtwo„week€trial,€this€was€certainly€one€of€the€better€presented€trialsÐ u  Ðthat€I€have€seen€from€both€sides.€€And€you€can€see€that€ð!ð€just€twoÐ aü  Ðof€our€many€boxes€down€there€ð!ð€you€can€see€that€this€was€a€veryÐ Mè  Ðinteresting€and€difficult€case€and€why€you€are€now€in€the€positionÐ 9Ô  Ðof€having€to€make€a€decision€in€this€case.Ð%À` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************Ðý˜` x` x ÐÌà8  àà8` Ð Ð àà ¸ àNow,€now€weððre€getting€into€trying€to€define€a€little€bitÐ Õp Ðmore€concisely€what€the€answer€to€Question€Number€1€is€on€yourÐ Á\ Ðverdict€form.€€I€think€you€can€even€remember€that.ЭH` x` x ÐÌà8  àà8` Ð Ð àà ¸ àð ðIs€Dr.€Ura€or€Nashville€Anesthesia€Services€at€fault?ðð€Ð …  ÐOkay.€€Simple€question.€€Obviously€not€a€simple€answer.€€Okay.Ðq ` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************ÐIä` x` x ÐÌà8  àà8` Ð Ð àà ¸ àSo€all€of€the€instructions€ð!ð€not€the€general€ones,€but€all€theÐ !¼ Ðones€about€fault€ð!ð€all€are€contained€in€you€consideration€ofÐ  ¨ ÐQuestion€Number€1,€which€is€a€deceptively€simple€question,€okay?€Ð ù ” Ðð ðYes€or€No.ðð€€No€explanations.€€You€just€get€ð ðYes€or€No.ððÐå!€ ` x` x ÐÌò òó óà8  àà8` Ð Ð à******************************************************н#X"` x` x ÐÌà8  àà8` Ð Ð àSo€I€simply€encourage€those€of€you€who€are€very€strong€in€yourÐ •%0!$ Ðopinions€to€perhaps€sit€back,€okay?€€Those€of€you€who€are€a€littleÐ &"% Ðless€used€to€expressing€your€opinion€right€at€the€beginning,€this€isÐ m'#& Ðan€opportunity€for€you€to€really€be€a€part€of€this€whole€group,Ð Y(ô#' Ðokay?ÐE)à$(` x` x ÐÌà8  àà8` Ð Ð àà ¸ àWe€choose€13€persons€for€a€reason.€€Okay?€€If€we€were€onlyÐ +¸&* Ðgoing€to€have€one€person€making€the€decision,€obviously€thatððsÐ  ,¤'+ Ðwhat€I€get€paid€to€do,€in€other€kinds€of€case[s],€okay?€€So€we€wantÐ e Ðto€make€sure€that€weððre€getting€the€full€measure€of€this€entire€juryÐ Qì Ðto€make€this€difficult€decision.Ð=Ø` x` x ÐÌà8  àà8` Ð Ð àà ¸ àOkay.€€So€you€need€to€listen€to€each€other,€and€you€need€toÐ ° Ðdiscuss€with€each€other,€and€you€need€to€be€respectful€of€eachÐ  œ Ðother.€€And€I€know€that€you€will€do€that,€because€you€just€seem€likeÐ í ˆ Ðthe€kind€of€jury€that€will€be€doing€that,€okay?ÐÙ t` x` x ÐÌò òó óà  àOur€law€is€clear€that€a€trial€judge€shall€avoid€expressing€his€or€her€opinions€to€a€jury€inÐ ± L  Ðany€manner€concerning€matters€to€be€passed€upon€by€the€jury.€€òòò òPridemark€Custom€Plating,€Inc.Ð  8  Ðv.€Upjohn€Co.,€Inc.ó óóó,€702€S.W.2d€566,€577€(Tenn.€Ct.€App.€1985)€(citing€òòò òMcCay€v.€Mitchelló óóó,€62Ð ‰$  ÐTenn.€App.€424,€463€S.W.2d€710€(1970).€€ð ð[Judges]€must€refrain€from€making€statements€thatÐ u  Ðmight€reflect€on€the€weight€of€the€evidence€or€the€credibility€of€the€witnesses€or€that€mightÐ aü  Ðotherwise€influence€the€jury€concerning€the€facts.ðð€€ò òòòMercer€v.€Vanderbilt€Univ.,€Inc.óóó ó,€No.Ð Mè  ÐM2000„00801„COA„R3„CV,€2002€WL€31728864,€at€*4€(Tenn.€Ct.€App.€Dec.€5,€2002)€(citingÐ 9Ô  Ðò òòòState€v.€Suttlesóóó ó,€767€S.W.2d€403,€406-07€(Tenn.€1989);€ò òòòMcBride€v.€Allenóóó ó,€720€S.W.2d€459,Ð %À Ð462-63€(Tenn.€Ct.€App.€1979)).€€€Ð ¬ ÐÌà  àFrom€our€reading€of€the€trial€judgeððs€comments€to€the€jury,€we€are€unable€to€conclude€thatÐ é„ Ðthe€judgeððs€statements€constituted€error.€€Perhaps€the€court€said€more€than€necessary€but€there€isÐ Õp Ðnothing€to€indicate€an€expression€of€opinion€as€to€the€weight€of€the€evidence€or€any€attempt€toÐ Á\ Ðinfluence€the€jury.€€We€therefore€find€defendantsðð€issue€without€merit.Ð ­H Ðò òó óÓÓÌÓ;îÓà  àDefendantsðð€final€issue€asks€this€Court€to€consider€ð ð[w]hether€the€cumulative€effect€of€allÐ q  Ðthe€errors€complained€of€in€this€appeal€denied€Defendants€a€fair€trial€by€a€fair€and€impartial€jury.ðð€Ð ]ø ÐAlthough€we€have€held€that€the€trial€courtððs€error€in€granting€Plaintiff€eight€peremptoryÐ Iä Ðchallenges€alone€necessitates€a€remand€for€new€trial,€we€note€that€the€cumulative€effect€of€thisÐ 5Ð Ðprocedural€error,€along€with€the€several€errors€already€addressed,€deprived€defendants€of€a€fairÐ !¼ Ðtrial,€thereby€constituting€harmful€error€sufficient€to€warrant€a€new€trial.€€Ð  ¨ Ðò òó óÌà  àIn€light€of€our€holding€remanding€this€case€for€new€trial,€we€pretermit€all€other€issues.Ð å!€  ÐÌò òó óà  àIn€conclusion,€the€trial€courtððs€judgment€on€the€jury€verdict€is€vacated€and€the€case€isÐ ½#X" Ðremanded€for€a€new€trial.€€Costs€of€the€appeal€are€assessed€one„half€to€plaintiff,€Sherry€Hunter,Ð ©$D # ÐAdministratrix€of€the€estate€of€Lawrence€Hunter,€deceased,€and€one„half€to€defendants,€JayÐ •%0!$ ÐMichael€Ura,€M.D.€and€Nashville€Anesthesia€Services,€and€their€sureties.€€Ô‡XGIXXXGIÔÐ &"% ÐÔ#†XGIXXXGIUó#ÔÔ#†¼½»XXGI#ÔÔ€XGIX»¼½ÔÌÌà  àà ` àà ¸ àà  àà h à__________________________________________Ð E)à$( Ðà  àà ` àà ¸ àà  àà h àW.€FRANK€CRAWFORD,€PRESIDING€JUDGE,€W.S.