ÿWPCà flá25½¶3e=Áì$  —î“æ‰èæKQéì ”q0BÊ™çBáö½=d½Ø_.RˉF%GFº¨è§¶Û„=d˜¾Á¬*ˆhÄ¡ …tVtÁ•æÚP›j:x=€Qn§´ÙÁ9MN×ý÷HE³DÆ$hÉ£¤¡‚ßUW}ŠiÈCÑïyŠƒ-Q²óŠ#”Qñ0/@þÐÍÜ|† xª[Ÿð^4þ“0c?r'—ŸTÆlz¾¤ÌâüÓ´xAªõ ÚBk(‡zèX¼#@9Ï âg"æ͇ÉØ´zfχÓy‹p,‹ÝÛb6ߌ)£a¥&1®+ånì§þÕJ#ÿº`$ʇó±ÊŒ›ls ñÉÅœÞ~mÐ R—Jbš©/†xkqGPí <ˆsùÇq00p­(Æó{x5Œç±Q’ùTŒÝìíϽwÀ"3ÉJ”K_«®~ kÏØYê}žÒ† D,bcª°äö3kÙ = %´J›Gm|Ðû!#p…Ç6ææ$K ypGyíÓakä  @¬ä»Q8öþö5 àXºS&‡a·¹ ';U6œ6­à§’!j›à_Ö]Ïölf?’gý€]e™¥Ý'Z¡À® cg&_tb %\UNb 0ˆ°U N8†Eœ¨á z‰ Ò ÷Õ ‹ÌòW 0DIÆÆSÆÆß^ ¥N±w³4·EËNÍÏÞ mà#Á÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷b¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸¸ 0ëÀÀÀÀ B«« 0¤È D3l D-Ÿ 0KÌÌ ASÆj 0¤0 0DÔ A«»(@øÐ Z‹6Times New Roman Regular(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regular Ñ ° Ñ ;Ý ƒR<$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô’´ò»»ÔÝ  ÝÔ_Ô€At€the€time€of€Mrs.€Mitchellððs€initial€1995€visit,€Dr.€Ô_ÔEnsorÔ_Ô€was€employed€as€an€internal€medicine€physicianÐ ° Ðwith€Peabody€Health€Care. žÝ ƒR<$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ô’´ò»»ÔÝ  ÝÔ_Ô€Plaintiff€Patsy€Mitchell€testified€on€direct€examination€that€she€also€sought€treatment€for€chest€pains€from€Dr.Ð ° ÐÔ_ÔEnsorÔ_Ô€on€her€January€5€visit.€€However,€plaintiffsðð€complaint€does€not€identify€chest€pains€as€a€reason€for€this€visit. ˜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 íÝ ƒR<$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô’´ò»»ÔÝ  ÝÔ_Ô€Plaintiff€Steve€Mitchell€testified€on€cross€examination€that€he€never€showed€the€paper€to€his€wife€and€that€sheÐ ° Ðwas€unaware€of€the€fact€that€he€intended€to€complain€about€her€diminished€libido€to€Dr.€Ô_ÔEnsorÔ_Ô.€€In€fact,€Mr.€MitchellÐ xÈ Ðtestified€that€he€intentionally€hid€his€complaint€from€his€wife. Ý ƒR<$ÝÓ  Óà  àòòÚ  Ú4Ú  ÚóóÔ€ô’´ò»»ÔÝ  ÝÔ_Ô€Mrs.€Mitchellððs€testimony€as€to€exactly€when€she€began€to€notice€side€effects€is€inconsistent.€€On€directÐ ° Ðexamination€at€trial,€Mrs.€Mitchell€testified€that€she€felt€a€ð ðstingingðð€sensation€when€she€urinated,€a€condition€thatÐ xÈ Ðsurfaced€roughly€three€or€four€weeks€after€the€injection.€€However,€in€her€deposition,€Mrs.€Mitchell€testified€that€the€firstÐ @ Ðtime€she€felt€any€pain€in€her€clitoris€was€during€€February€1998€intercourse€with€her€husband. èÝ ƒR<$ÝÓ  Óà  àòòÚ  Ú5Ú  ÚóóÔ€ô’´ò»»ÔÝ  ÝÔ_Ô€In€their€complaint,€plaintiffs€alleged€that€Jane€Doeððs€administration€of€Depo„Testosterone€was€negligentÐ ° Ðbecause€the€as€yet€unidentified€nurse€knew€or€should€have€known€that€the€injection€would€cause€Mrs.€Mitchell€harm.€Ð xÈ ÐPlaintiffs€later€amended€the€January€4€complaint€to€name€Lynn€Dunlap,€R.N.€as€the€ð ðJane€Doeðð€defendant.€€On€MarchÐ @ Ð15,€2001,€defendants€filed€a€motion€for€summary€judgment€to€dismiss€Dunlap€as€a€defendant€in€this€action.€€ShortlyÐ X Ðthereafter,€the€action€against€Dunlap€was€voluntarily€dismissed€by€plaintiffs.(#Ã$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 5jr-s ä]ö,ê:i¢×+003|xÿU‹ÿÀÀÀ˜HP LaserJet 4 Plus,ð,,,,,ð0- ù-(|G2<$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€õœ»»dd8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ô’´ò»»Ô d(|3ù*$££Ý ƒ£ª!ÝÑ€.ÑÑ8€õœ»»dd8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3ù*$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€õœ»»dd8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€õœ»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼õœ»»»ÔÑ8€â+XXdð»»d8ÑÑ  Ñà@ü ü ìàÔ‡î OõœÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@õõ%ìàAT€JACKSONÔ#†¼õœ»îî O #ԈРÜ, ÐÓ  ÓSeptember€17,€2002€SessionÐ X ÐÔ‡Xâ+X»¼õœÔÌò òÔ#†¼õœ»XXâ+õ#ÔPATSY€MITCHELL,€òòet€ux.óó€v.€DR.€JAMES€Ô_ÔENSORÔ_Ô,€M.D.,€òòet€alóó.Ô‡Xâ+X»¼õœÔó óÐ  ` ÐÌà@@½½ìàò òA€Direct€Appeal€from€the€Circuit€Court€for€Shelby€CountyÐ  h Ðà@@øøìàNo.€98798€T.D.€€€€€€The€Honorable€Ô_ÔD'ArmyÔ_Ô€Bailey,€JudgeÐ  X ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<×` AßÐ Ø(  ÐÌà@@TTìàNo.€W2001„01683„Ô_ÔCOAÔ_Ô„R3„CV€„€Filed€November€18,€Ô_Ô2002Ô_ÔÐ ×'  ÐÌßA€V) °°` dE<¶` AßÐ ·  Ðó óÌÓ  ÓÔ‡X¯¢XXXâ+Ôà  àPatient€brought€medical€malpractice€action€against€physician€and€medical€group,€includingÐ ¶ Ðallegations€that€physician€failed€to€obtain€the€informed€consent€of€female€patient€prior€toÐ ¢ò Ðadministration€of€a€testosterone€injection.€€The€circuit€court€entered€judgment€on€a€jury€verdict€inÐ ŽÞ Ðfavor€of€physician€and€medical€group.€€Patient€appealed.€€We€affirm€and€remand.€Ô#†Xâ+XXX¯¢!#ÔÔ#†¼õœ»XXâ+ž#ÔÔ‡Xâ+X»¼õœÔÐ zÊ ÐÓÓÌò òTenn.€R.€App.€P.€3;€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Affirmed€andÐ V¦ ÐRemandedó óÐ F– ÐÌòòÓ  ÓÔ#†¼õœ»àXâ+9#ÔÔ‡Xâ+X.¼õœÔW.€Frank€Crawford,€Ô_ÔP.J.Ô_Ô,€Ô_ÔW.S.Ô_Ôóó,€delivered€the€opinion€of€the€court,€in€which€òòAlan€E.€Ô_ÔHighersÔ_Ô,Ð &v ÐJ.óó€and€òòDavid€R.€Farmer,€J.óó,€joined.Ð f ÐÌRobert€A.€McLean,€Memphis,€For€Appellants,€Patsy€and€Steve€MitchellÐ öF ÐÌAlbert€C.€Harvey,€Elizabeth€T.€Collins,€Memphis,€For€Appellees,€Dr.€James€Ô_ÔEnsorÔ_Ô,€M.D.€andÐ Ö& ÐMemphis€Internal€Medicine,€Ô_ÔP.L.L.C.Ô_ÔÐ Æ ÐÓ ÓÌò òOPINIONó óÔ#†¼õœ»XXâ+;#ÔÔ‡Xâ+X»¼õœÔÐ ¦!ö  ÐÌòòóóÔ#†¼õœ»XXâ+ó #ÔÔ‡Xâ+X»¼õœÔÓ  ÓÑ8€¯¢XXdìXXdð8ÑÑ€Oa Ñà  àPlaintiffsðð€complaint€alleges€that€Dr.€James€Ô_ÔEnsorÔ_Ô,€M.D.,€and€his€employer,€Memphis€InternalÐ †#Ö" ÐMedicine,€committed€medical€malpractice€when€Dr.€Ô_ÔEnsorÔ_Ô€negligently€presented€and€administeredÐ v$Æ# Ða€2cc€injection€of€Ô_ÔDepoÔ_Ô„Testosterone€for€the€treatment€of€plaintiffððs€diminished€libido€and€failed€toÐ f%¶ $ Ðobtain€informed€consent€prior€to€administering€the€injection.€€Ô_ÔDepoÔ_Ô„Testosterone€is€a€male€hormoneÐ V&¦!% Ðtraditionally€ð ðindicated€for€replacement€therapy€in€the€male€in€conditions€associated€with€symptomsÐ F'–"& Ðof€deficiency€or€absence€of€endogenous€testosterone.ðð€€Quoting€from€the€complaint,€plaintiffÐ 6(†#' Ðspecifically€averred€the€following:Ð &)v$( ÐÌà8  àà8` Ð Ð àà ¸ à13.€€The€Defendant€James€K.€Ô_ÔEnsorÔ_Ô,€M.D.,€engaged€in€aÐ +V&* Ðcourse€of€conduct€that€was€inconsistent€with€and€deviated€from€thatÐ ö+F'+ Ðdegree€of€care€and€skill,€and€to€failed€[sic]€possess€that€degree€ofÐ æ,6(, Ðknowledge,€as€ordinarily€exercised€and€possessed€by€physiciansÐ Ö-&)-ý Ðengaged€in€the€practice€of€internal€medicine€in€Memphis,€ShelbyÐ ° ÐCounty,€Tennessee€and€similar€communities€engaged€in€theÐ  ð Ðadministration€of€hormone€replacement€therapy€by€failing€to€followÐ à Ðappropriate€and€accepted€procedure€for€post„menopausal€hormoneÐ €Ð Ðreplacement€therapy€in€the€following€respects:ÐpÀ` x` x ÐÌà8  àà8` Ð Ð à(a)€by€undertaking€to€administer€post„menopausal€hormone€therapyÐ P   Ðwhen€he€was€not€qualified€to€do€so€and€by€failing€to€refer€the€PlaintiffÐ @  ÐPatsy€Mitchell€to€a€physician€who€was€so€qualified;Ð0 €` x` x ÐÌà8  àà8` Ð Ð à(b)€by€not€requesting€or€performing€any€diagnostic€tests€or€Ô_ÔscreeningsÔ_ÔÐ `  Ðprior€to€the€administration€of€testosterone€therapy,€including€but€notÐ P  Ðlimited€to€a€blood€test€to€determine€the€Plaintiff€Patsy€MitchellððsÐ ð@  Ðserum€androgen€level;Ðà0 ` x` x ÐÌà8  àà8` Ð Ð à(c)€by€engaging€in€course€of€treatment€which€he€knew€or€should€haveÐ À Ðknown€would€be€harmful€to€the€Plaintiff€Patsy€Mitchell;а` x` x ÐÌà8  àà8` Ð Ð à(d)€by€ordering€an€excessive€dosage€of€Ô_ÔDepoÔ_Ô„Testosterone€under€theÐ à Ðcircumstances;ЀÐ` x` x ÐÌà8  àà8` Ð Ð à(e)€by€failing€to€adhere€to€the€manufacturerððs€guidelines€inÐ `° Ðadministering€Ô_ÔDepoÔ_Ô„Testosterone€to€the€Plaintiff€Patsy€Mitchell;ÐP ` x` x ÐÌà8  àà8` Ð Ð à(f)€by€administering€Ô_ÔDepoÔ_Ô„Testosterone€to€the€Plaintiff€Patsy€MitchellÐ 0€ Ðwhen€the€use€of€Ô_ÔDepoÔ_Ô„Testosterone€has€not€been€approved€by€theÐ  p ÐUnited€States€Food€and€Drug€Administration€under€suchÐ ` Ðcircumstances;ÐP` x` x ÐÌà8  àà8` Ð Ð à(g)€by€failing€to€counsel€the€Plaintiff€Patsy€Mitchell€on€the€risks€andÐ à0 Ðbenefits€of,€and€alternatives€to€hormone€replacement€therapy.ÐÐ ` x` x ÐÌà  àà ` àà ¸ àà  à*à0 h àà0Àh(#h(#àà0À(#À(#à*à0p(#(#àà0Èp(#p(#àà0 È(#È(#à*а"  (# (# ÐÌà8  àà8` Ð Ð àThe€Defendant€James€K.€Ô_ÔEnsorÔ_Ô,€M.D.,€failed€to€exercise€that€degreeÐ $à" Ðof€care€and€skill,€and€to€possess€that€degree€of€knowledge,€asÐ €%Ð # Ðordinarily€exercised€and€possessed€by€physicians€engaged€in€theÐ p&À!$ Ðpractice€of€internal€medicine€in€Memphis,€Shelby€County,€TennesseeÐ `'°"% Ðand€similar€communities€by€failing€to€reasonably€inform€the€PlaintiffÐ P( #& ÐPatsy€Mitchell€of€the€serious€nature€of€hormone€replacement€therapyÐ @)$' Ðand€of€the€risks€of€virility,€including€hirsutism€and€Ô_ÔclitoromegalyÔ_Ô,€thatÐ 0*€%( Ðcould€result€from€the€administration€of€male€sex€hormones€such€asÐ  +p&) ÐÔ_ÔDepoÔ_Ô„Testosterone€to€a€female€patient.Ð,`'*` x` x Їà  àà ` àà ¸ àà  à*à0 h àà0Àh(#h(#àà0À(#À(#à*à0p(#(#àà0Èp(#p(#àà0 È(#È(#à*а (# (# ÐÌà8  àà8` Ð Ð àAs€a€direct€and€proximate€result€of€the€Defendantsðð€negligence€and/orÐ à Ðrecklessness€in€administering€Ô_ÔDepoÔ_Ô„Testosterone€to€the€Plaintiff€PatsyÐ €Ð ÐMitchell,€the€Plaintiff€Patsy€Mitchell€has€suffered€and€will€in€theÐ pÀ Ðfuture€continue€to€suffer€signs€of€virility,€including€but€not€limited€toÐ ` ° Ðpermanent€disfigurement,€hirsutism,€Ô_ÔclitoromegalyÔ_Ô,€and€painfulÐ P   Ðintercourse,€and€psychological€injuries,€which€would€not€haveÐ @  Ðotherwise€have€occurred€in€the€absence€of€Defendantsðð€negligence.Ð0 €` x` x ÐÌà  àIn€their€answer€to€this€complaint,€Dr.€Ô_ÔEnsorÔ_Ô€and€Memphis€Internal€Medical€admitted€treatingÐ `  ÐMrs.€Mitchellððs€developing€asexual€disposition€with€a€2cc€intramuscular€injection€of€Ô_ÔDepoÔ_Ô„Ð P  ÐTestosterone.€€Defendants€denied€any€negligent€act€or€omission€in€the€care€of€Mrs.€Mitchell,€insteadÐ ð@  Ðasserting€that€ð ðthey€acted€according€to€their€best€medical€judgment€and€in€conformity€with€theÐ à0  Ðapplicable€standard€of€care.ðð€€Defendants€admitted€a€discussion€with€Mrs.€Mitchell€regarding€herÐ Ð  Ðdiminished€libido,€and€maintained€that€Dr.€Ô_ÔEnsorÔ_Ô€ð ðdiscussed€the€use€of€Ô_ÔDepoÔ_Ô„Testosteroneððwith€Mrs.Ð À ÐMitchell€prior€to€ordering€administration€of€the€injection.Ð ° ÐÌà  àPlaintiff€Patsy€Mitchell€is€a€middle„aged€woman€of€limited€education€with€a€storied€historyÐ à Ðof€medical€and€physical€ailments.€€The€following€facts€are€Ô_ÔuncontrovertedÔ_Ô.€€Mrs.€Mitchell€first€soughtÐ €Ð Ðtreatment€from€Dr.€Ô_ÔEnsorÔ_Ô€in€1995.Ô_Ô׃×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×Ô_Ô€€Over€the€course€of€roughly€four€years,€Dr.€Ô_ÔEnsorÔ_Ô€acted€as€Mrs.Ð pÀ ÐMitchellððs€primary€Ô_ÔcaregiverÔ_Ô,€treating€her€for€numerous€medical€complaints,€including€gout,Ð `° Ðosteoarthritis,€chronic€bronchitis,€hypertension,€chronic€sinus,€high€cholesterol,€and€irritable€bowelÐ P  Ðsyndrome.€€Mrs.€Mitchellððs€medical€records€indicate€that€Dr.€Ô_ÔEnsorÔ_Ô,€and€several€treating€physiciansÐ @ Ðprior€to€him,€administered€hormone€therapy€to€Mrs.€Mitchell€for€complications€potentially€relatedÐ 0€ Ðto€patientððs€menopausal€condition.€€These€records€also€reveal€that€Mrs.€Mitchell€suffered€adverseÐ  p Ðreactions€to€several€of€the€hormone€treatments.Ð ` ÐÌà  àOn€January€5,€1998,€Mrs.€Mitchell€visited€Dr.€Ô_ÔEnsorÔ_Ô€for€treatment€of€a€bloated€abdomen.Ô_Ô׃ ×Ý ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×Ô_ԀРð@ ÐAt€the€time€of€the€visit,€Dr.€Ô_ÔEnsorÔ_Ô€was€practicing€with€Memphis€Internal€Medicine.€€Mrs.€MitchellÐ à0 Ðwas€accompanied€by€her€husband,€plaintiff€Steve€Mitchell.€€During€the€visit,€Dr.€Ô_ÔEnsorÔ_Ô€examinedÐ Ð  ÐMrs.€Mitchellððs€stomach€for€the€purpose€of€evaluating€the€patientððs€complaints€of€stomach€bloating.€Ð À! ÐFrom€his€examination,€Dr.€Ô_ÔEnsorÔ_Ô€determined€that€further€tests€were€necessary€and€thereby€scheduledÐ °"  ÐMrs.€Mitchell€for€a€barium€enema€and€colon€study.Ð  #ð! ÐÌà  àThe€parties€fiercely€dispute€the€nature€of€the€events€or€conversations€immediately€precedingÐ €%Ð # Ðthe€injection.€€According€to€Mr.€Mitchellððs€testimony,€after€the€examination,€he€approached€Dr.Ð p&À!$ ÐÔ_ÔEnsorÔ_Ô€with€a€written€list€of€Mrs.€Mitchellððs€health€complaints.€€Mr.€Mitchellððs€involvement€inÐ ° Ðkeeping€a€current€list€of€Mrs.€Mitchellððs€medical€complaints€was€a€common€practice€of€the€plaintiffÐ  ð Ðcouple.€€At€the€bottom€of€the€list,€Mr.€Mitchell€had€scribbled€the€word€ð ðsex.ððÔ_Ô׃ ×Ý ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×Ô_Ô€€Mr.€Mitchell€pointedÐ à Ðto€the€word€and€asked€Dr.€Ô_ÔEnsorÔ_Ô€ð ðCan€you€give€her€something€for€this?ðð€€Dr.€Ô_ÔEnsorÔ_Ô€indicated€to€Mr.Ð €Ð ÐMitchell€that€he€could€do€something€to€help€with€this€concern.€€Soon€thereafter,€€Lynn€Ô_ÔDunlapÔ_Ô,€R.N.,Ð pÀ Ðentered€the€room€and€administered€an€injection€of€Ô_ÔDepoÔ_Ô„Testosterone€to€Mrs.€Mitchell.€€Mr.€MitchellÐ ` ° Ðtestified€that€Dr.€Ô_ÔEnsorÔ_Ô€failed€to€discuss€the€purpose€or€contents€of€the€injection€with€either€plaintiff.€Ð P   ÐMost€significantly,€plaintiffs€allege€that€Dr.€Ô_ÔEnsorÔ_Ô€failed€to€notify€Mrs.€Mitchell€of€the€known€sideÐ @  Ðeffects€of€Ô_ÔDepoÔ_Ô„Testosterone,€specifically€Ô_ÔclitoromegalyÔ_Ô.Ð 0 € ÐÌà  àIn€his€deposition€and€direct€testimony,€Dr.€Ô_ÔEnsorÔ_Ô€paints€a€distinctly€different€portrait€of€theÐ `  Ðevents€leading€up€to€the€injection.€€Dr.€Ô_ÔEnsorÔ_Ô€testified€that€after€his€examination€of€Mrs.€Mitchell,Ð P  Ðhe€was€approached€by€Mr.€Mitchell.€€While€standing€in€the€entryway€to€the€examining€room,€Mr.Ð ð@  ÐMitchell€pointed€to€the€ð ðsexðð€reference€scribbled€on€the€card.€€Dr.€Ô_ÔEnsorÔ_Ô€testified€that€Mr.€MitchellÐ à0  Ðexpressed€concern€with€regard€to€his€wifeððs€developing€asexuality,€and€asked€if€there€was€anythingÐ Ð  ÐDr.€Ô_ÔEnsorÔ_Ô€could€do€about€this€condition.€€Before€agreeing€to€treat€Mrs.€Mitchellððs€diminished€libido,Ð À ÐDr.€Ô_ÔEnsorÔ_Ô€testified€that€he€asked€Mrs.€Mitchell,€ð ðDo€you€know€what€heððs€talking€about,ðð€in€referenceÐ ° Ðto€his€conversation€with€her€husband.€€According€to€his€testimony,€Dr.€Ô_ÔEnsorÔ_Ô€believed€that€Mrs.Ð  ð ÐMitchell€was€aware€of€the€nature€of€her€husbandððs€concern€because€she€was€close€enough€to€overhearÐ à Ðthe€conversation.€€Dr.€Ô_ÔEnsorÔ_Ôððs€account€of€the€pre„injection€conversation€is€supported€by€a€statementÐ €Ð Ðin€plaintiffsðð€Complaint€that€reads:Ð pÀ ÐÌà8  àà8` Ð Ð àOn€or€about€January€5,€1998,€the€Defendant€James€K.€Ô_ÔEnsorÔ_Ô,€M.D.,Ð P  Ðasked€the€Plaintiff€Patsy€Mitchell€how€her€hormones€were€ððdoing,ðð€toÐ @ Ðwhich€she€responded€that€she€was€experiencing€a€diminished€libido.€Ð 0€ ÐThereafter,€the€Defendant€James€K.€Ô_ÔEnsorÔ_Ô,€M.D.,€told€her€that€heÐ  p Ðwould€get€her€something€for€the€problem.Ð`` x` x ÐÌDr.€Ô_ÔEnsorÔ_Ô€further€asserts,€and€plaintiffs€dispute,€that€he€explicitly€informed€Mrs.€Mitchell€of€herÐ ð@ Ðhusbandððs€concern€regarding€her€developing€asexuality.Ð à0 ÐÌà  àIn€his€testimony,€Dr.€Ô_ÔEnsorÔ_Ô€noted€that€Mrs.€Mitchell€nodded€acknowledgment€of€herÐ À! Ðunderstanding€of€Mr.€Mitchellððs€concern.€€Dr.€Ô_ÔEnsorÔ_Ô€admitted€in€his€deposition€that€he€did€not€warnÐ °"  ÐMrs.€Mitchell€about€all€conceivable€side€effects€of€Ô_ÔDepoÔ_Ô„Testosterone,€instead€advising€his€patientÐ  #ð! Ðonly€with€regard€to€the€possible€onset€of€pedal€edema€(swelling€of€the€foot),€gradual€hair€loss,€andÐ $à" Ðacne€breakout.€€The€record€indicates€that€Dr.€Ô_ÔEnsorÔ_Ô€did€not€warn€Mrs.€Mitchell€about€Ô_ÔclitoromegalyÔ_ÔÐ €%Ð # Ðas€a€possible€side€effect€of€Ô_ÔDepoÔ_Ô„Testosterone.ò òó óÐ p&À!$ Ðâ âÐ `'°"% Ðà  àThe€evidence€is€clear€that€Dr.€Ô_ÔEnsorÔ_Ô,€in€response€to€Mr.€Mitchellððs€request,€ordered€nurseÐ ° Ðâ âÔ_ÔDunlapÔ_Ô€to€administer€a€2cc€(400mg.)€injection€of€Ô_ÔDepoÔ_Ô„Testosterone€to€Mrs.€Mitchell.€€ForÐ  ð Ðapproximately€one€month€following€the€shot,€Mrs.€Mitchell€suffered€no€adverse€side€effects€to€theÐ à ÐÔ_ÔDepoÔ_Ô„Testosterone.€€Plaintiffsðð€first€became€aware€of€Mrs.€Mitchellððs€alleged€negative€reaction€toÐ €Ð Ðthe€drug€in€February€of€1998.€€While€engaged€in€intimate€relations€with€her€husband,€Mrs.€MitchellÐ pÀ Ðfelt€a€ð ðstingingðð€sensation€in€her€clitoris.€€She€asked€Mr.€Mitchell€to€look€at€what€was€causing€herÐ ` ° Ðdiscomfort.€€At€his€wifeððs€urging,€Mr.€Mitchell€made€a€closer€examination€of€Mrs.€Mitchellððs€privateÐ P   Ðregion€and€discovered€that€her€clitoris€was€enlarged€to€the€point€that€it€resembled€a€male€penis.׃ ×Ý ƒ #ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ׀Р@  ÐPlaintiffs€were€alarmed€by€Mrs.€Mitchellððs€condition,€and€telephoned€Dr.€Ô_ÔEnsorÔ_Ôððs€office€theÐ 0 € Ðfollowing€day€to€find€out€the€name€of€the€injected€drug.€€Immediately€after€obtaining€thisÐ  p  Ðinformation,€Mr.€Mitchell€drove€to€a€local€drug€store€and€obtained€a€package€insert€for€Ô_ÔDepoÔ_Ô„Ð `  ÐTestosterone.Ð P  ÐÌà  àNeither€the€manufacturerððs€package€insert€for€Ô_ÔDepoÔ_Ô„Testosterone€nor€the€discussion€in€theÐ à0  ÐPhysicians€Desk€Reference€(Ô_ÔPDRÔ_Ô)€were€introduced€as€an€exhibit€in€the€case.€€However,€the€testimonyÐ Ð  Ðelicited€from€all€of€the€expert€witnesses€is€to€the€effect€that€neither€the€package€insert€nor€the€Ô_ÔPDRÔ_ÔÐ À Ðshow€Ô_ÔclitoromegalyÔ_Ô€(clitoral€enlargement)€as€a€known€side€effect€of€the€drug.Ð ° ÐÌà  àDespite€the€discomfort€and€concern€Mrs.€Mitchell€suffered€as€a€result€of€her€condition,€sheÐ à Ðfailed€to€seek€immediate€medical€attention.€€Mrs.€Mitchell€did€not€inform€Dr.€Ô_ÔEnsorÔ_Ô€of€her€clitoralÐ €Ð Ðenlargement,€nor€did€she€return€for€further€examination.€€From€February€of€1998€through€April€ofÐ pÀ Ð1998,€Mrs.€Mitchell€sought€the€medical€attention€of€twelve€different€physicians€for€various€physicalÐ `° Ðailments€unrelated€to€her€enlarged€clitoris,€yet€Mrs.€Mitchell€never€revealed€her€condition€to€any€ofÐ P  Ðthese€doctors,€and€never€sought€treatment€specifically€for€Ô_ÔclitoromegalyÔ_Ô.€€Finally,€on€May€12,€1998,Ð @ ÐMrs.€Mitchell€sought€the€opinion€and€care€of€Floyd€Ô_ÔShraderÔ_Ô,€M.D.,€in€treating€her€clitoralÐ 0€ Ðenlargement.Ð  p ÐÌà  àPrior€to€her€visit€of€May€12,€1998,€Dr.€Ô_ÔShraderÔ_Ô€had€treated€Mrs.€Mitchell€on€a€regular€basisÐ P Ðfrom€1978€until€1993.€€Dr.€Ô_ÔShraderÔ_Ô€treated€Mrs.€Mitchell€as€her€general€physician,€not€as€a€specialistÐ ð@ Ðin€internal€medicine.€€The€record€provides€that€Dr.€Ô_ÔShraderÔ_Ô€had€some€training€in€internal€medicine,Ð à0 Ðbut€was€not€qualified€as€a€specialist€in€this€area.€€Ð Ð  ÐÌà  àDuring€direct€examination,€Dr.€Ô_ÔShraderÔ_Ô€noted€that€his€general€physical€examination€of€Mrs.Ð °"  ÐMitchell€revealed€that€she€ð ðhad€developed€a€clitoral€enlargement€or€a€clitoral€hypertrophy€thatÐ  #ð! Ðmeasured€about€two€inches€in€length,€and€this€is€a€markedly€enlarged€clitoris.ðð€€Dr.€Ô_ÔShraderÔ_Ô€testifiedÐ $à" Ðthat€it€was€his€opinion€that€this€condition€was€ð ðdirectly€due€to€the€large€amount€of€male€hormone€thatÐ €%Ð # Ð[Mrs.€Mitchell]€received€in€the€injection.ðð€€Upon€receiving€Dr.€Ô_ÔShraderÔ_Ôððs€diagnosis,€plaintiffsðð€soughtÐ p&À!$ Ðno€further€medical€advice€or€expertise€regarding€Mrs.€Mitchellððs€condition.Ð `'°"% Ðà  àOn€January€4,€1999,€Patsy€and€Steve€Mitchell€brought€an€action€against€Dr.€Ô_ÔEnsorÔ_Ô,€MemphisÐ ° ÐInternal€Medicine,€and€Jane€Doe,׃ ×Ý ƒ #ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€alleging€medical€malpractice€in€the€administration€of€the€Ô_ÔDepoÔ_Ô„Ð  ð ÐTestosterone€injection€and€for€failure€to€obtain€plaintiffððs€informed€consent€for€the€injection€of€theÐ à Ðdosage.€€Mr.€Mitchellððs€claim€was€loss€of€consortium€for€the€past€and€future€loss€of€his€wifeððsÐ €Ð Ðservices,€society,€and€companionship.€€A€trial€on€this€action€commenced€on€April€2,€2001.€Ð pÀ ÐDefendants€moved€for€a€directed€verdict€at€the€close€of€plaintiffsðð€proof€and€renewed€the€motion€atÐ ` ° Ðthe€conclusion€of€all€the€proof.€€The€motion€was€denied,€and€after€the€close€of€proof,€plaintiffsÐ P   Ðsubmitted€a€list€of€twelve€special€jury€instructions€to€the€court.€€Instruction€No.€10€requested€theÐ @  Ðcourt€to€instruct€the€jury€on€the€doctrine€of€informed€consent,€but€plaintiffsðð€request€for€an€informedÐ 0 € Ðconsent€instruction€was€denied.€€The€case€was€submitted€to€the€jury€on€the€negligence€theory€ofÐ  p  Ðliability€against€the€defendants€for€the€prescription€and€administration€of€the€drug.€€On€April€12,Ð `  Ð2001,€the€jury€returned€a€verdict€for€defendants,€and€the€court€subsequently€entered€judgment€on€theÐ P  Ðjury€verdict.€€Ð ð@  ÐÌà  àPlaintiffs€filed€a€motion€for€a€new€trial€pursuant€to€Rule€59.02€of€the€Tennessee€Rules€ofÐ Ð  ÐCivil€Procedure.€€In€an€order€entered€June€15,€2001,€the€trial€court€denied€plaintiffsðð€motion.€€€PatsyÐ À Ðand€Steve€Mitchell€have€appealed,€and€present€the€following€issues€as€stated€in€their€brief:Ð ° ÐÌà8  àà8` Ð Ð à1.à0¸ ` x` xàWhether€or€not€the€court€erred€when€it€refused€to€instruct€theÐ à Ðjury€on€lack€of€informed€consent.Ѐи x¸ x Ðà8  àà8` Ð Ð à2.à0¸ ` x` xàWhether€or€not€the€court€erred€when€it€failed€to€strike€theÐ pÀ Ðdirect€testimony€of€Dr.€Ô_ÔEnsorÔ_Ô€because€it€was€not€within€aÐ `° Ðreasonable€degree€of€medical€certainty.ÐP ¸ x¸ x Ðà8  àà8` Ð Ð à3.à0¸ ` x` xàWhether€or€not€the€court€erred€when€it€allowed€the€defenseÐ @ Ðexpert,€Jack€Sanford,€M.D.,€to€present€alternative€causes€forÐ 0€ ÐMrs.€Mitchellððs€condition€that€were€not€within€a€reasonableÐ  p Ðdegree€of€medical€certainty.Ð`¸ x¸ x Ðà8  àà8` Ð Ð à4.à0¸ ` x` xàWhether€or€not€the€verdict€is€contrary€to€the€weight€of€theÐ P Ðevidence.Ðð@¸ x¸ x ÐÌÓÓÓ  Óà @ àò òI.ó óÐ Ð  ÐÓ_ÓÓÓà  àThe€first€issue€we€are€asked€to€examine€is€whether€the€trial€court€erred€in€refusing€to€instructÐ °"  Ðthe€jury€regarding€the€lack€of€informed€consent.€€The€trial€court€should€instruct€the€jury€upon€everyÐ  #ð! Ðissue€of€fact€and€theory€of€the€case€raised€by€the€pleadings€and€supported€by€the€proof.€€ò òòòStreet€v.Ð $à" ÐÔ_ÔCalvertÔ_Ôóóó ó,€541€S.W.2d€576€(Tenn.€1976);€ò òòòUnderwood€v.€Ô_ÔWaterslidesÔ_Ô€of€Mid„Americaóóó ó,€823€S.W.2dÐ €%Ð # Ð171,€178€(Tenn.€Ct.€App.€1991).€€More€specifically,€where€a€requested€special€instruction€is€a€correctÐ p&À!$ Ðstatement€of€the€law,€is€not€included€in€the€general€charge,€and€is€supported€by€the€evidenceÐ ° Ðintroduced€at€trial,€the€court€should€give€the€instruction.€€ò òòòUnderwoodóóó ó,€823€S.W.2d€at€178.€€When€theÐ  ð Ðdenial€of€a€request€which€ought€to€have€been€given€prejudices€the€rights€of€the€requesting€party,€theÐ à Ðjudgment€should€be€reversed.€€òòò òNashville€C.€&€St.€L.€Ry.€Co.€v.€Jacksonó óóó,€187€Tenn.€202,€213€S.W.2dÐ €Ð Ð116€(1948).Ð pÀ ÐÌà  àDespite€the€diligent€efforts€of€their€counsel,€plaintiffs€were€twice€denied€a€jury€instructionÐ P   Ðon€the€doctrine€of€informed€consent.€€The€trial€judge€decided€to€omit€an€informed€consent€instructionÐ @  Ðfrom€the€general€charge,€voicing€two€specific€concerns€as€the€basis€for€his€refusal:Ð 0 € ÐÌà8  àà8` Ð Ð àAs€you€can€see,€Iððve€bounced€all€over€this€morning,€and€Iððm€backÐ `  Ðnow€to€saying€Iððm€not€going€to€give€the€informed€consent,€in€partÐ P  Ðbecause€of€the€uncertainty€of€the€law€as€it€relates€to€whether€youÐ ð@  Ðcould€use€it€in€medicine€administration.Ðà0 ` x` x ÐÌà8  àà8` Ð Ð àAnd,€two,€because€of€the€serious€question€that€I€do€have€as€to€whetherÐ À Ðthe€risks€complained€of€or€the€damage€complained€of€in€this€case€isÐ ° Ðeven€remotely€within€the€realm€of€the€risks€that€are€contemplated€byÐ  ð Ðthe€disclosure€charge.Ðà` x` x ÐÌà  àAfter€the€courtððs€rejection€of€the€general€informed€consent€charge,€plaintiffsðð€counselÐ pÀ Ðpresented€the€judge€with€a€special€instruction€on€informed€consent€and€medical€negligence.€Ð `° ÐAcknowledging€that€the€court€had€ruled€on€the€lack€of€informed€consent€issue,€counsel€maintainedÐ P  Ðthat€the€instruction€was€necessary€to€address€the€issue€of€Dr.€Ô_ÔEnsorÔ_Ôððs€alleged€breach€of€the€standardÐ @ Ðof€care.€€Finding€no€merit€to€plaintiffsðð€counselððs€distinction€between€the€lack€of€informed€consentÐ 0€ Ðand€medical€negligence€charges,€the€court€refused€to€allow€the€instruction.€€Plaintiffsðð€proposedÐ  p Ðinstruction€reads€as€follows:Ð ` ÐÌà8  àà8` Ð Ð àNo.€10.€€Second€Allegation€of€Negligence:€1)€Lack€of€InformedÐ ð@ ÐConsent:€It€is€the€duty€of€a€physician€to€obtain€the€consent€of€a€patientÐ à0 Ðbefore€beginning€a€course€of€treatment.€€Consent€may€be€express€orÐ Ð  Ðit€may€be€implied€from€the€conduct€of€the€parties.€€Failure€to€obtainÐ À! Ðthe€consent€makes€the€physician€responsible€for€an€injury€caused€byÐ °"  Ðthe€treatment€even€if€the€physician€is€not€otherwise€liable.€€Ô_ÔT.P.I.Ô_Ô€3€„Ð  #ð! ÐCivil€6.25.Ð$à"` x` x Ðà8  àà8` Ð Ð àà ¸ àReality€of€Consent€„€duty€to€disclose.€€A€physician€is€requiredÐ €%Ð # Ðto€disclose€the€relevant€information€necessary€to€make€an€intelligentÐ p&À!$ Ðand€informed€decision€regarding€the€proposed€treatment.€€DisclosuresÐ `'°"% Ðrequired€are€those€that€physicians€in€good€standing€under€similarÐ P( #& Ðconditions€in€the€same€or€similar€community€would€make€having€dueÐ @)$' Ðregard€for€the€patientððs€physical,€mental€and€emotional€condition.€Ð 0*€%( Ðâ âÔ_ÔT.P.I.Ô_Ô€3€„€Civil€6.30.Ð +p&)` x` x Ðà8  àà8` Ð Ð àà ¸ àThe€Mitchellððs€also€contend€that€Dr.€Ô_ÔEnsorÔ_Ô€failed€toÐ ° Ðâ âreasonably€advise€the€plaintiff,€Patsy€Mitchell,€about€theÐ  ð Ðadministration€of€a€shot€of€400€mg.€of€Ô_ÔDepoÔ_Ô„Testosterone€and€theÐ à Ðpossible€Ô_ÔmasculinizingÔ_Ô€side€effects€of€that€drug,€such€as€hair€growth,Ð €Ð Ðdeepening€of€the€voice,€clitoral€enlargement,€and€if€you€find€that€aÐ pÀ Ðreasonable€person,€in€the€same€position€as€Mrs.€Mitchell,€would€notÐ ` ° Ðhave€consented€to€the€injection€of€Ô_ÔDepoÔ_Ô„Testosterone€if€adequatelyÐ P   Ðinformed€of€one€or€more€of€these€possible€side€effects,€and€that€theÐ @  Ðshot€of€testosterone€was€the€legal€cause€of€Mrs.€Mitchellððs€injuries,Ð 0 € Ðthen€the€plaintiffs€have€met€their€burden€and€proved€negligence€byÐ  p  ÐDr.€Ô_ÔEnsorÔ_Ô.€€In€your€decision,€you€may€consider€the€characteristics€ofÐ `  ÐMrs.€Mitchell,€including€her€idiosyncrasies,€fears,€age,€and€medicalÐ P  Ðcondition.€€Ô_ÔT.P.I.Ô_Ô€3€„€Civil€3.50€Modified;€ò òòòÔ_ÔAsheÔ_Ô€v.€RadiationÐ ð@  ÐOncology€Ô_ÔAssocsÔ_Ô.óóó ó,€9€S.W.3d€119€(Tenn.€1999);€ò òòòGerman€v.Ð à0  ÐÔ_ÔNichopoulosÔ_Ôóóó ó,€577€S.W.2d€197€(Tenn.€Ct.€App.€1978),€òòò òoverruled€onÐ Ð  Ðother€groundsó óóó.ÐÀ` x` x ÐÌà  àIn€determining€whether€the€trial€judge€erred€in€denying€plaintiffsðð€request€for€an€informedÐ  ð Ðconsent€instruction,€we€must€first€ascertain€whether€the€proposed€jury€instruction€was€a€correctÐ à Ðstatement€of€the€law.€The€trial€judge,€in€explaining€his€decision€to€deny€plaintiffsðð€instruction,€notedÐ €Ð Ðthat€he€was€not€convinced€that€this€case€even€involved€the€issue€of€informed€consent.€€Ð pÀ ÐÌà  àPlaintiffsðð€instruction€generally€outlines€a€medical€malpractice€action€premised€on€theÐ P  Ðdoctrine€of€informed€consent€and€appears€to€be€a€correct€statement€of€the€law.€€Ð @ ÐÌà  àÔ_ÔT.C.A.Ô_Ô€ðð€29„26„118€provides:Ð  p ÐÌà8  àà8` Ð Ð àò òProving€inadequacy€of€consent.ó 󀄀In€a€malpractice€action,€theÐ P Ðplaintiff€shall€prove€by€evidence€as€required€by€ðð€29„26„115(b)€thatÐ ð@ Ðthe€defendant€did€not€supply€appropriate€information€to€the€patient€inÐ à0 Ðobtaining€informed€consent€(to€the€procedure€out€of€which€plaintiffððsÐ Ð  Ðclaim€allegedly€arose)€in€accordance€with€the€recognized€standard€ofÐ À! Ðacceptable€professional€practice€in€the€profession€and€in€the€specialty,Ð °"  Ðif€any,€that€the€defendant€practices€in€the€community€in€which€theÐ  #ð! Ðdefendant€practices€and€in€similar€communities.Ð$à"` x` x ÐÌÌà  àIn€òòò òÔ_ÔAsheÔ_Ô€v.€Radiation€Oncology€Ô_ÔAssocsÔ_Ô.ó óóó,€9€S.W.3d€119,121€(Tenn.€1999),€the€CourtÐ `'°"% Ðdistinguished€a€lack€of€informed€consent€claim€from€a€medical€battery€claim€involving€theÐ P( #& Ðperformance€of€an€unauthorized€medical€procedure.€€According€to€the€Court,€ð ð[a]€lack€of€informedÐ @)$' Ðconsent€claim€typically€occurs€when€the€patient€was€aware€that€the€procedure€was€going€to€beÐ 0*€%( Ðperformed€but€the€patient€was€unaware€of€the€risk€associated€with€the€procedure.ðð€€ò òòòIdóóó ó.€(quotingÐ  +p&) Ðò òòòBlanchard€v.€Ô_ÔKellumÔ_Ôóóó ó,€975€S.W.2d€522,€524€(Tenn.€1998)).€€Tennessee€courts€have€consistentlyÐ ,`'* Ðrecognized€the€distinction€drawn€in€ò òòòÔ_ÔAsheÔ_Ôóóó ó€that€a€physicianððs€failure€to€inform€a€patient€of€risksÐ ° Ðassociated€or€inherent€in€the€treatment€provides€the€foundation€for€a€lack€of€informed€consent€claim.€Ð  ð Ðòòò òSee€Church€v.€Ô_ÔPeralesÔ_Ôó óóó,€39€S.W.3d€149,€159€(Tenn.€Ct.€App.€2000);€ò òòòMitchell€v.€Ô_ÔKayemÔ_Ôóóó ó,€54€S.W.3dÐ à Ð775,€779€(Tenn.€Ct.€App.€2001).Ð €Ð ÐÌà  àIt€is€well€established€in€Tennessee€that€an€objective€standard€is€to€be€applied€in€assessingÐ ` ° Ðcausation€in€medical€malpractice€informed€consent€cases.€€ò òòòSee€Ô_ÔAsheÔ_Ôóóó ó,€9€S.W.3d€at€123„24.€€Under€theÐ P   Ðobjective€standard,€the€court€must€consider€informed€consent€from€the€perspective€of€a€reasonableÐ @  Ðperson€in€the€patientððs€position,€and€òòò òóóó ówhether€ð ða€reasonable€person€in€the€patientððs€position€wouldÐ 0 € Ðhave€consented€to€the€procedure€or€treatment€in€question€if€adequately€informed€of€all€significantÐ  p  Ðperils.ðð€€ò òòòId.ó óóó€at€124.€€As€drafted,€plaintiffsðð€charge€properly€instructs€the€jury€to€apply€an€objectiveÐ `  Ðstandard€in€assessing€whether€informed€consent€was€present.Ð P  ÐÌà  àThe€record€indicates€that€the€trial€court€refused€to€charge€on€the€doctrine€of€informed€consentÐ à0  Ðfor€two€reasons:€(1)€the€doctrine€of€informed€consent€does€not€apply€to€therapeutic€treatment€asÐ Ð  Ðannounced€in€òòò òCary€v.€Arrowsmithó óóó,€777€S.W.2d€8,€21€(Tenn.€Ct.€App.€1989);€and€(2)€for€lack€of€proofÐ À Ðthe€defendants€were€not€required€to€inform€of€the€risk€of€the€plaintiffsðð€resulting€injury.€Ð ° ÐÌà  àThe€plaintiff€in€òòò òCaryó óóó€brought€a€malpractice€action€against€a€treating€physician€for€negligenceÐ à Ðand€failure€to€obtain€plaintiffððs€informed€consent€to€radial€Ô_ÔkeratotomyÔ_Ô€surgery.€€ò òòòIdóóó ó.€at€10.€€AdoptingÐ €Ð Ðthe€rational€articulated€in€a€Pennsylvania€Superior€Court€decision,€the€Tennessee€Court€of€Appeals,Ð pÀ ÐMiddle€Section€concluded€that€plaintiffððs€issue€of€whether€the€trial€court€erred€by€refusing€to€allowÐ `° Ðthe€jury€to€consider€informed€consent,€on€the€basis€that€the€ð ðuse€of€prescription€medications€orderedÐ P  Ðfor€the€care€and€treatment€of€a€patient€by€his€physician€cannot€form€the€basis€for€an€action€againstÐ @ Ðthe€physician€for€lack€of€informed€consent,ðð€was€without€merit.€€ò òòòIdóóó ó.€at€21.€€The€courtððs€ruling€on€thisÐ 0€ Ðissue€was€rooted€in€the€following€excerpt€€from€the€Pennsylvania€decision.Ð  p ÐÌà8  àà8` Ð Ð àà ¸ àTo€now€expand€the€doctrineððs€current€applicability€to€casesÐ P Ðinvolving€the€administration€of€therapeutic€drugs€would€be€toÐ ð@ Ðradically€depart€from,€and€indeed€obliterate,€the€foundation€uponÐ à0 Ðwhich€the€[battery€theory€of€informed€consent]€stands.€€Not€only€areÐ Ð  Ðwe€unpersuaded€that€such€expansion€is€unnecessary...ÐÀ!` x` x ÐÌà8  àà8` Ð Ð àà ¸ à[Ô_ÔW]eÔ_Ô€are€also€of€the€particular€opinion€that,€in€the€light€of€theÐ  #ð! Ðday„to„day€realities€of€providing€professional€medical€care,€traditionalÐ $à" Ðmedical€malpractice€actions,€sounding€in€negligence,€are€an€adequateÐ €%Ð # Ðlegal€medium€for€compensating€patients€for€the€injuriousÐ p&À!$ Ðconsequences€of€therapeutic€drug€treatment.Ð`'°"%` x` x ÐÌò òòòIdóóó ó.€(quoting€òòò òBoyer€v.€Smithó óóó,€345€Pa.€Super.€66,€497€A.2d€646,€649€(Pa.€Super.€Ct.€1985)).Ð @)$' ÐÌThe€court€concluded€its€examination€of€the€informed€consent€instruction€issue€by€adopting€aÐ  +p&) Ðmodified€version€of€the€Pennsylvania€Superior€Courtððs€rule:€Ð ,`'* ÐÑOa Ñâ âÑ°°Ñâ âÑ  ÑÌà8  àà8` Ð Ð àWe€are€of€the€opinion€that€the€better€rule€is€that€a€treating€physicianÐ  ð Ðmust€obtain€the€patientððs€informed€consent€for€the€medical€treatmentÐ à Ðof€the€patient€and€not€for€each€component€part€of€the€treatmentÐ €Ð Ðprocess.€€The€patient€has€an€adequate€legal€remedy,€ò òòòi.e.óóó ó,€a€malpracticeÐ pÀ Ðaction€sounding€in€negligence,€for€the€injurious€consequence€ofÐ ` ° Ðtherapeutic€drug€treatment.ÐP  ` x` x ÐÌòòò òCaryó óóó,€77€S.W.2d€at€21.Ð 0 € ÐÌà  àAfter€reviewing€ò òòòCaryóóó ó€and€òòò òBoyeró óóó,€we€cannot€agree€with€defendantsðð€argument€that€theÐ `  Ðdoctrine€of€lack€of€informed€consent€is€strictly€limited€to€operative€surgical€procedures.€€In€ò òòòBoyeróóó ó,Ð P  Ðthe€courtððs€limitation€of€the€doctrine€was€premised€on€its€interpretation€of€the€Pennsylvania€SupremeÐ ð@  ÐCourtððs€decision€in€òòò òGray€v.€Ô_ÔGrunnagleÔ_Ôó óóó,€423€Pa.€144,€155,€223€A.2d€663€(Pa.€1966).€€The€courtÐ à0  Ðinterpreted€ò òòòGrayóóó ó€as€a€decision€by€the€Pennsylvania€Supreme€Court€to€expressly€ground€ð ðits€adoptionÐ Ð  Ðof€the€informed€consent€doctrine€upon€the€legal€theory€that€the€performance€of€a€medical€procedureÐ À Ðwithout€a€patientððs€informed€consent€constitutes€a€technical€assault€or€battery.ðð€€òòò òBoyeróóó ó,€345€Pa.Ð ° ÐSuper.€66,€497€A.2d€at€649€(construing€ò òòòGrayó óóó,€423€Pa.€144,€155,€223€A.2d€663€(Pa.€1966)).ò òòòóóó ó€Ð  ð ÐAccording€to€the€court,€ð ðto€now€expand€the€doctrineððs€current€applicability€to€cases€involving€theÐ à Ðadministration€of€therapeutic€drugs€would€be€to€radically€depart€from,€and€indeed€obliterate,€theÐ €Ð Ðfoundation€upon€which€the€òòò òGrayó óóó€decision€stands.ððòòò ò€€Boyeróóó ó,€345€Pa.€Super.€66,€497€A.2d€at€649Ð pÀ Ð(construing€ò òòòGrayóóó ó,€423€Pa.€144,€155,€223€A.2d€663€(Pa.€1966)).Ð `° ÐÌà  àAs€noted,€the€evidence€in€the€record€indicates€that€Mrs.€Mitchellððs€primary€claim€is€one€ofÐ @ Ðlack€of€informed€consent.€€Our€Supreme€Court€has€distinguished€the€claims€of€battery€and€lack€ofÐ 0€ Ðinformed€consent,€in€òòò òÔ_ÔAsheÔ_Ôóóó ó€ò òòòv.€Radiation€Oncology€Ô_ÔAssocsÔ_Ô.óóó ó,€9€S.W.3d€119,€121€(Tenn.€1999).€€OurÐ  p ÐSupreme€Court€stated:€ò òòòÐ ` ÐÌà8  àà8` Ð Ð àà ¸ àóóó óThis€Court€recently€enunciated€a€distinction€between€a€lack€ofÐ ð@ Ðinformed€consent€case€and€a€pure€medical€battery€case.òòò ò€€ó óóóIn€ò òòòBlanchardÐ à0 Ðv.€Ô_ÔKellumÔ_Ôó óóó,€975€S.W.2d€522€(Tenn.€1998),€this€Court€defined€Ô_ÔamedicalÔ_ÔÐ Ð  Ðbattery€as€a€case€in€which€a€doctor€performs€an€unauthorizedÐ À! Ðprocedure.€€ò òòòId.ó óóó€at€524.€€A€medical€battery€may€typically€occur€when:Ð °"  Ð(1)€a€professional€performs€a€procedure€that€the€patient€was€unawareÐ  #ð! Ðthe€doctor€was€going€to€perform;€or€(2)€the€procedure€was€performedÐ $à" Ðon€a€part€of€the€body€other€than€that€part€explained€to€the€patient€(i.e.,Ð €%Ð # Ðamputation€of€the€wrong€leg).€€ò òòòIdó óóó.€A€lack€of€informed€consent€claimÐ p&À!$ Ðtypically€occurs€when€the€patient€was€aware€that€the€procedure€wasÐ `'°"% Ðgoing€to€be€performed€but€the€patient€was€unaware€of€the€riskÐ P( #& Ðassociated€with€the€procedure.€€ò òòòId.Ð@)$'` x` x ÐÌId.ó óóó€at€121.Ð  +p&) ÐÐ ,`'* Ðòòò òó óóóIt€is€at€least€questionable€if€ò òòòCary,óóó ó€in€reliance€upon€ò òòòBoyeróóó ó,€is€applicable€to€the€case€at€bar.€€As€statedÐ ° Ðby€the€Pennsylvania€Superior€Court,€Pennsylvaniaððs€limitation€of€the€doctrine€of€informed€consentÐ  ð Ðis€grounded€in€the€theory€that€performance€of€a€medical€procedure€without€consent€is€a€battery.€€WeÐ à Ðconclude€that€òòò òCaryó óóó€is€not€controlling€and€an€action€for€lack€of€informed€consent€in€malpracticeÐ €Ð Ðactions€premised€on€a€physicianððs€failure€to€advise€of€associated€treatment€risks€is€not€foreclosed.€Ð pÀ ÐMoreover,€ò òòòóóó óthe€court€stated€its€rule€to€require€a€treating€physician€to€obtain€a€patientððs€informedÐ ` ° Ðconsent€for€medical€treatment,€but€not€for€each€component€part€of€the€treatment€process.€€ò òòòCary€v.Ð P   ÐArrowsmithóóó ó,€777€S.W.2d€8,€21€(Tenn.€Ct.€App.€1989).€€The€court€proceeded€to€assert€that€a€patientÐ @  Ðwho€sustains€injury€from€therapeutic€drug€treatment€has€a€ð ðmalpractice€action€sounding€inÐ 0 € Ðnegligence.ðð€€€The€ò òòòCaryó óóó€Court€appears€to€limit€its€ruling€to€cases€where€the€treatment€process€at€issueÐ  p  Ðconsists€of€multiple,€distinct€component€parts.€€Ð `  ÐÌà  àWe€also€note€that€several€cases€in€Tennessee€succeeding€ò òòòCary€óóó óhave€incorporated€languageÐ ð@  Ðsuggesting€that€informed€consent€applies€to€both€operative€procedures€and€the€administration€ofÐ à0  Ðmedication.€€ò òòòSee€Ô_ÔShadrickÔ_Ô€v.€Ô_ÔCokerÔ_Ôóóó ó,€963€S.W.2d€726,€732€(Tenn.€1998)€(ð ðAccordingly,€the€lawÐ Ð  Ðrecognizes€that€a€health€care€provider,€such€as€a€physician€or€surgeon,€who€proposes€a€treatment€orÐ À Ðsurgical€procedure€has€a€duty€to€provide€the€patient€with€enough€information€about€the€nature€of€theÐ ° Ðtreatment€or€procedure€involved€to€enable€the€patient€to€make€an€intelligent€decision€and€therebyÐ  ð Ðgive€an€informed€consent€to€the€treatment€or€procedure.ðð)€(citation€omitted);€ò òòòÔ_ÔHoushÔ_Ô€v.€Morrisóóó ó,€818Ð à ÐS.W.2d€39,€41€(Tenn.€Ct.€App.€1991)€(ð ðA€cause€of€action€based€on€the€lack€of€informed€consentÐ €Ð Ðstems€from€the€basic€premise€that€a€patient€should€be€allowed€to€form€an€intelligent€choice€about€theÐ pÀ Ðsurgical€and/or€treatment€procedures€that€he/she€undertakes.ðð)€(citations€omitted);€òòò òBryant€v.Ð `° ÐÔ_ÔMcCordÔ_Ôó óóó,€No.€01A01„9801„CV„00046,€1999€WL€10085,€at€*7€(Tenn.€Ct.€App.€Jan.€12,€1999)€(ð ðItÐ P  Ðis€well€established€in€Tennessee€that€a€physician€has€a€duty€to€obtain€the€informed€consent€of€his€orÐ @ Ðher€patient€before€administering€a€treatment€or€performing€a€surgical€procedure€on€the€patient.ðð)Ð 0€ Ð(citations€omitted).€€While€none€of€these€cases€specifically€deal€with€therapeutic€drug€treatment€orÐ  p Ðthe€administration€of€medication,€we€can€infer€€that€the€carefully€chosen€language€of€these€courtsÐ ` Ðevinces€an€intent€that€the€doctrine€of€informed€consent€can€be€applied€to€cases€involving€theÐ P Ðadministration€of€medication€as€well€as€surgical€procedures.Ð ð@ ÐÌà  àAs€noted,€the€trial€court€also€refused€to€charge€the€jury€on€the€doctrine€of€informed€consent,Ð Ð  Ðbecause€the€proof€did€not€warrant€such€a€charge.Ð À! ÐÌà  àð ðWhen€the€health€care€provider€performs€the€treatment€or€procedure€without€the€requisiteÐ  #ð! Ðinformed€consent€of€the€patient,€liability€attaches€for€the€òòresulting€injuriesóó€regardless€of€whetherÐ $à" Ðthose€injuries€resulted€from€negligence.ðð€€ò òòòÔ_ÔShadrickÔ_Ô€v.€Ô_ÔCokerÔ_Ôó óóó,€963€S.W.2d€726€(Tenn.€1998)Ð €%Ð # Ð(emphasis€supplied).€€In€ò òòòÔ_ÔShadrickÔ_Ôó óóó,€the€Court€said:Ð p&À!$ ÐÌà8  àà8` Ð Ð àà ¸ àThis€is€not€to€suggest,€however,€that€a€health€care€provider€isÐ P( #& Ðrequired€to€enumerate€in€detail€every€aspect€of€the€proposed€treatmentÐ @)$' Ðor€procedure€or€discuss€every€possible€thing€that€might€go€wrong€inÐ 0*€%( Ðan€effort€to€obtain€the€patientððs€informed€consent.€€ð ðIn€the€first€place,Ð  +p&) Ðto€do€so€is€humanly€impossible.€€In€the€second€place,€if€all€the€goryÐ ,`'* Ðdetails€of€a€proposed€surgery€were€graphically€explained€to€everyÐ ° Ðpatient€and€all€possible€medical€maladies€that€might€result€wereÐ  ð Ðenumerated€we€doubt€that€a€lay€person€would€have€the€stomach€toÐ à Ðlisten€to€it€all;€and€if€the€patient€did,€would€probably€be€in€such€aÐ €Ð Ðfearful€state€that€no€rational€decision€could€be€made.ðð€€ò òòòÔ_ÔLongmireÔ_Ô€v.Ð pÀ ÐÔ_ÔHoeyÔ_Ôó óóó,€512€S.W.2d€307,€310€(Tenn.€Ct.€App.€1974).€€Accordingly,Ð ` ° Ðhealth€care€providers€are€generally€not€required€to€disclose€risks€thatÐ P   Ðare€not€material,€such€as€those€that€are€extremely€unlikely€to€occur€orÐ @  Ðone€that€a€reasonable€patient€would€not€care€to€know€due€to€itsÐ 0 € Ðinsignificance;€risks€that€are€obvious€or€already€known€by€the€patient;Ð  p  Ðrisks€that€are€unforeseeable€or€unknowable;€or€where€the€patientððsÐ `  Ðmedical€condition€renders€discussion€of€the€risks€and€benefits€of€theÐ P  Ðtreatment€or€procedure€impossible€or€medically€inadvisable,€such€asÐ ð@  Ðin€an€emergency€where€the€patient€is€unconscious€or€otherwiseÐ à0  Ðincapable€of€consenting,€or€where€full€disclosure€would€beÐ Ð  Ðdetrimental€to€the€patientððs€total€care,€i.e.,€the€patient€is€undulyÐ À Ðalarmed€or€apprehensive€to€start€with€and€additional€informationÐ ° Ðwould€overload€the€patient€and€jeopardize€his€or€her€physical€orÐ  ð Ðemotional€well„being.Ðà` x` x ÐÌ963€S.W.2d€at€733€(citations€omitted).€€Ð pÀ ÐÌà  àIn€the€instant€case,€the€proof€established€that€an€enlarged€clitoris€has€never€been€reported€asÐ P  Ða€side€effect€in€medical€literature€as€a€result€of€one€injection€of€any€strength€of€testosterone.€€TheÐ @ Ðexperts€that€testified€on€behalf€of€the€defendant€noted€that€they€had€never€seen€or€known€of€such€aÐ 0€ Ðside€effect€occurring€from€such€a€procedure.€€The€plaintiffsðð€expert,€Dr.€Ô_ÔShraderÔ_Ô,€agreed€that€he€wasÐ  p Ðnot€able€to€find€any€medical€literature€that€described€a€case€such€as€the€present€case€and€characterizedÐ ` Ðthe€plaintiffððs€condition€as€ð ða€rare€condition.ðð€€Dr.€Ô_ÔShraderÔ_Ô€did€not€testify€that€it€was€essential€thatÐ P Ðthe€plaintiff€be€advised€of€clitoral€enlargement€in€order€for€her€to€consent€to€the€treatment.€€We€quoteÐ ð@ Ðfrom€his€cross„examination€in€the€record:€Ð à0 ÐÌà8  àà8` Ð Ð àQ.€€The€standard€of€care€does€not€require€a€physician€to€list€each€andÐ À! Ðeverything€thatððs€possible€because€itððs€a€multitude€of€things,€right?а" ` x` x ÐÌà8  àà8` Ð Ð àA.€€That€is€correct.Ð$à"` x` x ÐÌà8  àà8` Ð Ð àQ.€€So€what€you€do€is€explain€the€likely€risks?Ðp&À!$` x` x ÐÌà8  àà8` Ð Ð àA.€€Thatððs€correct.ÐP( #&` x` x ÐÌà8  àà8` Ð Ð àQ.€€Not€something€that€occurs€rarely€or€only€one€time€in€a€thousand?Ð0*€%(` x` x Ðâ âÐ  +p&) Ðà8  àà8` Ð Ð àA.€€Thatððs€correct.€€But,€again,€the€standard€of€care€requires€that€you,Ð ° Ðâ âyou€know,€when€you€initiate€a€drug€that€you€do€this.€€And€in€Mrs.Ð  ð ÐMitchellððs€case,€it€was€not€done.€She€wasnððt€informed€of€any€risks€ofÐ à Ðthe€Ô_ÔDepoÔ_Ô„Testosterone.ЀÐ` x` x ÐÌà8  àà8` Ð Ð àQ.€€If€the€condition€is€as€rare€as€you€say€it€is,€Doctor,€no€physicianÐ ` ° Ðwould€warn€a€patient€of€that?ÐP  ` x` x ÐÌà8  àà8` Ð Ð àA.€€But€you€do€it€in€the€general€way€of€if€youððre€going€to€give€a€maleÐ 0 € Ðhormone€to€a€female.€€It€behooves€us€to€say€this€is€a€male€hormone,Ð  p  Ðthese€are€male€things€that€may€happen€to€you.€€Now,€no,€Iððm€notÐ `  Ðsaying€I€would€tell€every€one€of€my€patients€youððre€going€to€have€aÐ P  Ðclitoris€that€grows€two€and€a€half€inches,€but€I€would€tell€them€of€theÐ ð@  Ðhair,€the€male€changes.Ðà0 ` x` x ÐÌà8  àà8` Ð Ð àAnd€in€my€experience,€over€30€years€now,€in€dealing€with€a€lot€ofÐ À Ðwomen€in€menopause,€you€tell€them€the€male€things€and€if€they€ð!ðÐ ° Ðmost€of€them€will€not€want€to€take€the€drug€in€the€first€place.€€AndÐ  ð Ðthen€those€who€do€choose€the€drug,€discuss€it€with€them,€what€kindÐ à Ðof€male€things.€€So€thatððs€how€you€get€informed€consent.ЀÐ` x` x ÐÌà  àUnder€the€state€of€the€record€before€us,€we€conclude€that€the€trial€court€correctly€deniedÐ `° Ðplaintiffsðð€special€request€for€instruction€concerning€the€lack€of€informed€consent.Ð P  ÐÌÓ  Óò òII.à @ àó óÐ 0€ ÐÌÓÈÓà  àIn€their€second€issue€for€review,€plaintiffs€ask€us€to€determine€whether€the€trial€court€erredÐ ` Ðwhen€it€failed€to€strike€the€direct€testimony€of€Dr.€Ô_ÔEnsorÔ_Ô€regarding€the€applicable€standard€of€care,Ð P Ðand€whether€or€not€he€breached€this€standard€because€the€testimony€was€not€based€on€a€reasonableÐ ð@ Ðdegree€of€medical€certainty.€€Plaintiffs€further€assert€that€the€trial€court€improperly€re„opened€directÐ à0 Ðexamination,€after€plaintiffsðð€motion€to€strike,€to€allow€defendants€to€correctly€found€Dr.€Ô_ÔEnsorÔ_ÔððsÐ Ð  Ðtestimony€on€a€reasonable€degree€of€medical€certainty.€€Plaintiffs€contend€that€Dr.€Ô_ÔEnsorÔ_Ôððs€testimonyÐ À! Ðabout€the€standard€of€care€and€his€alleged€breach€of€the€standard€was€drawn€from€outside€expertiseÐ °"  Ðand€experience,€and€not€solely€from€his€treatment€of€Mrs.€Mitchell.€€On€this€basis,€plaintiffs€argueÐ  #ð! Ðthat€Dr.€Ô_ÔEnsorÔ_Ô€was€testifying€as€an€expert,€not€as€the€treating€physician,€and€therefore,€his€testimonyÐ $à" Ðmust€have€been€premised€upon€a€reasonable€degree€of€medical€certainty.Ð €%Ð # ÐÌà  àAfter€reviewing€plaintiffsðð€objection€at€trial€and€their€presentation€of€this€issue€in€their€brief,Ð `'°"% Ðwe€are€persuaded€that€plaintiffsðð€argument€is€premised€not€on€whether€Dr.€Ô_ÔEnsorÔ_Ô€was€entitled€toÐ P( #& Ðtestify€as€to€the€applicable€standard€of€care€or€his€alleged€breach,€but€solely€on€the€assertion€that€heÐ @)$' Ðfailed€to€incorporate€the€magic€words€ð ðto€a€reasonable€degree€of€medical€certaintyðð€into€hisÐ 0*€%( Ðâ âtestimony.€€While€we€agree€that€an€expert€in€a€medical€malpractice€case€is€not€allowed€to€baseÐ  +p&) Ðcausation€opinions€upon€possibility€or€pure€speculation,€use€of€the€ð ðmagic€languageðð€that€the€opinionÐ ° Ðis€to€a€reasonable€degree€of€medical€certainty€is€not€necessary€for€admissibility.€€Ð  ð Ðâ âÌà  àA€pair€of€workersðð€compensation€opinions€decided€by€a€Special€Workersðð€CompensationÐ €Ð ÐAppeals€Panel€of€the€Tennessee€Supreme€Court€guide€our€decision.€€In€ò òòòÔ_ÔKayserÔ_Ô„Roth€Hosiery,€Inc.Ð pÀ Ðv.€Johnsonóóó ó,€No.€03S01„9212„CH„00109,€1994€WL€901454,€at€*1€(Tenn.€Sp.€Workers€Comp.€Apr.Ð ` ° Ð5,€1994),€the€defendant€appealed€a€trial€court€decision€on€the€sole€issue€of€whether€€the€evidenceÐ P   Ðpresented€at€trial€was€sufficient€to€establish€the€cause€and€permanency€of€defendantððs€injury€andÐ @  Ðwhether€the€trial€court€should€have€allowed€supplemental€testimony€to€determine€the€extent€ofÐ 0 € Ðimpairment€when€the€defendantððs€attorney€failed€to€ask€proper€questions€at€the€attending€physicianððsÐ  p  Ðdeposition.€€Defendant€asserted€that€he€began€to€experience€back€problems€as€a€result€of€his€dutiesÐ `  Ðas€an€employee€of€plaintiff.€€ò òòòIdóóó ó.€€The€attending€physician€in€this€case€testified€at€deposition€that€ððitÐ P  Ðwas€perhaps€the€event€at€Ô_ÔKayserÔ_Ô€Roth€that€was€maybe€the€straw€that€broke€the€camelððs€back.ðð€€ò òòòIdóóó ó.Ð ð@  Ðat€4.€€The€court€attached€the€following€footnote€to€the€physicianððs€statement:Ð à0  ÐÌà8  àà8` Ð Ð àAlthough€it€has€become€the€accepted€practice€for€the€medical€expertÐ À Ðto€testify€that€his€opinions€are€accurate€to€a€ððreasonable€degree€ofÐ ° Ðmedical€certainty,ðð€there€is€nothing€in€the€statute€or€the€case€law€thatÐ  ð Ðmakes€the€recitation€of€such€language€the€sine€qua€non€of€recovery,Ð à Ðwhen€the€medical€evidence€and€other€testimony€sufficiently€establishÐ €Ð Ðcausation.ÐpÀ` x` x ÐÌò òòòIdóóó ó.€at€*4€n.4.Ð P  ÐÌThe€court€considered€the€physicianððs€testimony€as€support€for€its€finding€ð ðthat€the€medical€and€layÐ 0€ Ðevidence€in€the€record€is€sufficient€to€establish€causation€and€that€the€medical€testimony€in€the€recordÐ  p Ðis€sufficient€to€determine€that€the€disability€is€permanent.ðð€€ò òòòIdóóó ó.€at€*3„4.Ð ` ÐÌà  àThe€panelððs€decision€in€ò òòòBreeden€v.€Universal€Bedroom€Furniture,€Ô_ÔLTDÔ_Ô.óóó ó,€No.€03S01„9808„Ð ð@ ÐCV„00094,€2000€WL€949364,€at€*1€(Tenn.€Sp.€Workers€Comp.€July€5,€2000),€provides€furtherÐ à0 Ðguidance€on€this€issue.€€In€ò òòòBreedenóóó ó,€the€plaintiff„employee€initiated€a€workersðð€compensation€actionÐ Ð  Ðto€recover€medical€and€disability€benefits€for€injuries€allegedly€suffered€as€a€result€of€an€accident€atÐ À! Ðdefendant„employerððs€place€of€business.€€ò òòòIdóóó ó.€at€*1„2.€€Defendant€responded€by€filing€a€motion€forÐ °"  Ðpartial€summary€judgment.€€ò òòòIdóóó ó.€at€*1.€€Before€rendering€a€judgment€on€the€motion,€the€trial€courtÐ  #ð! Ðallowed€or€directed€the€plaintiff€to€conduct€a€supplemental€deposition€of€the€attending€physician,€Dr.Ð $à" ÐÔ_ÔMegibowÔ_Ô,€to€ð ðsee€whether€or€not€[Dr.€Ô_ÔMegibowÔ_Ô]€would€state€within€a€reasonable€degree€of€medicalÐ €%Ð # Ðcertainty€that€the€plaintiffððs€psychological€(mental)€condition€was€either€aggravated€or€caused€by€theÐ p&À!$ Ð[alleged€work]€accident....ðð€€ò òòòIdóóó ó.Ð `'°"% ÐÌà  àAfter€reviewing€Dr.€Ô_ÔMegibowÔ_Ôððs€supplemental€deposition€testimony,€the€court€grantedÐ @)$' Ðdefendantððs€motion€for€partial€summary€judgment.€€ò òòòIdóóó ó.€at€*3„4.€€According€to€its€order,€the€trial€courtÐ 0*€%( Ðgranted€defendantððs€motion€because€Dr.€Ô_ÔMegibowÔ_Ô€failed€to€ð ðuse€the€exact€phrase€ððto€a€reasonableÐ  +p&) Ðdegree€of€medical€certainty,ðððð€in€testifying€about€the€cause€of€plaintiffððs€psychological€injury.€€ò òòòIdóóó ó.Ð ,`'* Ðat€*4.€€The€trial€court€determined€that€the€following€exchange€between€plaintiffððs€counsel€and€Dr.Ð ° ÐÔ_ÔMegibowÔ_Ô€did€not€satisfy€the€reasonable€degree€of€medical€certainty€standard€for€expert€opinions.Ð  ð ÐÌà8  àà8` Ð Ð àA.à0¸ ` x` xàAnd€the€question€was,€with€any€degree€of€medical€certaintyÐ €Ð Ðcan€I€say€this€in€fact€is€true?ÐpÀ¸ x¸ x Ðà8  àà8` Ð Ð àQ.à0¸ ` x` xàYes.Ð` °¸ x¸ x Ðà8  àà8` Ð Ð àA.à0¸ ` x` xàI€would€say,€yes,€very€much€so.ÐP  ¸ x¸ x ÐÌò òòòIdóóó ó.Ð 0 € ÐÌà  àOn€appeal,€the€panel€found€that€the€trial€court€erred€in€granting€defendantððs€motion€for€partialÐ `  Ðsummary€judgment.€€ò òòòIdóóó ó.€at€*6.€€Asserting€that€the€Tennessee€Court€of€Appeals€has€never€clearlyÐ P  Ðenunciated€whether€the€ð ðmagic€wordsðð€must€be€uttered€by€an€expert€physician€in€order€to€allow€theÐ ð@  Ðadmission€of€his€or€her€testimony,€the€panel€relied€upon€a€dissenting€opinion€from€a€medicalÐ à0  Ðmalpractice€case€and€an€opinion€from€the€Tennessee€Court€of€Criminal€Appeals€to€find€that€the€trialÐ Ð  Ðcourt€improperly€granted€defendantððs€motion.€€òòò òIdó óóó.€at€*4„6.€€The€court€cited€the€following€passageÐ À Ðfrom€Judge€William€Kochððs€dissenting€opinion€in€òòò òMoore€v.€Ô_ÔWalwynÔ_Ôó óóó,€No.€01A01„9507„CV„00295,Ð ° Ð1996€WL€17143,€at€*12€(Tenn.€Ct.€App.€Jan.€19,€1996)€(Koch,€J.,€dissenting):Ð  ð ÐÌà8  àà8` Ð Ð àThis€Court€has€admonished€lawyers€to€couch€their€medical€expertððsÐ €Ð Ðconclusions€in€the€language€of€Ô_ÔT.C.A.Ô_Ô€ðð€29„26„115€in€order€to€avoidÐ pÀ Ðjust€the€sort€of€interpretive€disputes€that€are€involved€in€this€case.€Ð `° Ðò òòòÔ_ÔGambillÔ_Ô€v.€Middle€Tennessee€Medical€Ô_ÔCentrÔ_Ô.óóó ó,€751€S.W.2d€145,€148Ð P  Ð(Tenn.€Ct.€App.€1988).€€Careful€practitioners€have€heeded€this€advice,Ð @ Ðbut€it€is€not€always€possible€to€frame€expert€conclusions€in€the€preciseÐ 0€ Ðwords€of€the€statute€because€of€differences€in€the€medical€and€legalÐ  p Ðvocabularies€and€frames€of€reference.Ð`` x` x ÐÌà8  àà8` Ð Ð àTennessee€Code€Annotated€ðð€29„26„115€is€not€ððholy€writ,ðð€and€itÐ ð@ Ðshould€never€be€so€rigidly€applied€that€it€requires€the€ritualisticÐ à0 Ðincantation€of€its€precise€terms€in€order€to€permit€an€injured€party€toÐ Ð  Ðmaintain€a€malpractice€claim€against€a€health€care€provider.€€TheÐ À! Ðcourts€should€expect€substantial€adherence€to€the€language€of€Ô_ÔT.C.A.Ô_ÔÐ °"  Ððð€29„26„115€but€should€never€abandon€their€judicial€powers€ofÐ  #ð! Ðreasonable€interpretation€and€construction.Ð$à"` x` x ÐÌòòò òBreedenó óóó,€2000€WL€949364,€at€*5€(quoting€òòò òMooreó óóó,€1996€WL€17143,€at€*12).Ð p&À!$ ÐÌà  àThe€court€also€relied€on€Judge€Wadeððs€opinion€in€ò òòòState€of€Tennessee€v.€Youngóóó ó,€No.€01C01„Ð P( #& Ð9605„CC„00208,€1998€Tenn.€Ô_ÔCrimÔ_Ô.€App.€LEXIS€566,€at€*1€(Tenn.€Ô_ÔCrimÔ_Ô.€App.€May€22,€1998),€asÐ @)$' Ðsupport€for€the€conclusion€that€the€admissibility€of€expert€medical€testimony€does€not€hinge€on€theÐ 0*€%( Ðutterance€of€seven€magic€words.Ð  +p&) ÐÐ ,`'* Ðà8  àà8` Ð Ð àIn€criminal€cases,€experts€have€at€times€testified€to€the€cause€ofÐ ° Ðinjuries€or€other€conditions€close€ððto€a€reasonable€degree€of€medicalÐ  ð Ðcertainty.ðð€€However,€nothing€in€Tennessee€law€requires€that€those€orÐ à Ðany€other€specific€words€be€recited€in€order€for€expert€testimony€to€beÐ €Ð Ðadmissible.ÐpÀ` x` x ÐÌò òòòÓÓBreedenóóó ó,€2000€WL€949364,€at€*6€(quoting€ò òòòYoungóóó ó,€1998€Tenn.€Ô_ÔCrimÔ_Ô.€App.€LEXIS€566,€at€*62„63).€Ð P   ÐÓÓà  àIt€is€settled€law€in€Tennessee€that€ð ðquestions€regarding€the€admissibility,€qualifications,Ð 0 € Ðrelevancy€and€competency€of€expert€testimony€are€left€to€the€discretion€of€the€trial€court.ðð€€òòò òÔ_ÔMcDanielÔ_ÔÐ  p  Ðv.€Ô_ÔCSXÔ_Ô€Transp.,€ó óóó955€S.W.2d€257,€263€(Tenn.€1997).€€The€ruling€of€a€trial€court€on€any€or€all€of€theseÐ `  Ðquestions€may€only€be€overturned€on€appeal€where€there€is€a€proven€abuse€of€discretion.€€òòò òIdó óóó.€€On€theÐ P  Ðbasis€of€the€law€set€forth€above,€we€find€that€a€medical€expert€is€not€required€to€explicitly€state€thatÐ ð@  Ðhis€opinion€is€ð ðto€a€reasonable€degree€of€medical€certainty.ðð€€Therefore,€we€hold€that€the€trial€judgeÐ à0  Ðdid€not€commit€an€abuse€of€discretion€when€he€overruled€plaintiffsðð€motion€to€strike€the€testimonyÐ Ð  Ðof€Dr.€Ô_ÔEnsorÔ_Ô€relating€to€the€applicable€standard€of€care€and€his€alleged€breach€of€this€standard.€€TheÐ À Ðtrial€judge€did€not€err€or€commit€an€abuse€of€discretion€by€re„opening€direct€examination€to€permitÐ ° Ðdefendants€the€opportunity€to€establish€Dr.€Ô_ÔEnsorÔ_Ôððs€testimony€to€a€reasonable€degree€of€medicalÐ  ð Ðcertainty.€€Ð à ÐÌà  àPlaintiffsðð€second€issue€is€without€merit.Ð pÀ ÐÌà@^^(ìàò òIII.ó óˆÐ P  ÐÌà  àThe€third€issue€for€review€is€whether€the€trial€court€committed€an€abuse€of€discretion€byÐ 0€ Ðallowing€defense€expert,€Dr.€Sanford,€to€testify€as€to€alternate€causes€of€Mrs.€Mitchellððs€condition.€Ð  p ÐPlaintiffs€argue€that€Dr.€Sanfordððs€testimony€was€speculative,€and€therefore€not€within€a€reasonableÐ ` Ðdegree€of€medical€certainty€as€required.€€In€their€brief€to€this€court,€plaintiffs€specifically€assert€thatÐ P Ð(1)€Dr.€Sanfordððs€ð ðspeculativeðð€opinions€did€not€substantially€assist€the€trier€of€fact€pursuant€toÐ ð@ ÐTennessee€Rule€of€Evidence€702€because€he€did€not€have€an€opinion€as€to€the€actual€cause€of€Mrs.Ð à0 ÐMitchellððs€condition€and€such€opinions€lacked€the€requisite€scientific€basis€mandated€by€TennesseeÐ Ð  ÐRule€of€Evidence€703;€(2)€the€trial€judge€incorrectly€reasoned€that€Dr.€Sanfordððs€alternate€causesÐ À! Ðtestimony€was€presented,€not€to€persuade€the€jury€that€one€of€the€alternate€causes€was€the€actualÐ °"  Ðcause€of€Mrs.€Mitchellððs€condition,€but€only€to€educate€the€jury€as€to€the€context€of€the€scientificÐ  #ð! Ðevidence€surrounding€the€condition€at€issue;€and€(3)€the€judgeððs€limiting€instruction€was€insufficientÐ $à" Ðto€overcome€the€prejudice€suffered€by€plaintiffs€as€a€result€of€the€admitted€testimony.Ð €%Ð # ÐÌà  àTennessee€Rule€of€Evidence€702€permits€an€expert€to€testify€ð ðin€the€form€of€an€opinion€orÐ `'°"% Ðotherwise,ðð€only€where€the€ð ðscientific,€technical,€or€other€specialized€knowledgeðð€offered€by€theÐ P( #& Ðwitness€will€substantially€assist€the€trier€of€fact.€€Tenn.€R.€Ô_ÔEvidÔ_Ô.€702.€€Rule€703€requires€an€expertððsÐ @)$' Ðopinion€to€be€supported€by€trustworthy€facts€or€data€ð ðof€a€type€reasonably€relied€upon€by€experts€inÐ 0*€%( Ðthe€particular€field€in€forming€opinions€or€inferences€upon€the€subject.ðð€€Tenn.€R.€Ô_ÔEvidÔ_Ô.€703.€€Ð  +p&) ÐÐ ,`'* Ðà  àPlaintiffs€assert€that€Dr.€Sanfordððs€admission€that€he€did€not€know€the€specific€cause€of€Mrs.Ð ° ÐMitchellððs€condition€rendered€the€expertððs€testimony€speculative,€and€therefore€incapable€ofÐ  ð Ðsubstantially€assisting€the€jury.€€Further€fueling€plaintiffsðð€argument€is€their€belief€that€Dr.€SanfordððsÐ à Ðð ðalternate€causeðð€theories€were€trenched€in€possibility€rather€than€probability.€€Plaintiffs€contend€thatÐ €Ð Ðð ð[a]€doctorððs€testimony€that€a€certain€thing€is€òòò òpossibleó óóó€is€no€evidence€at€all.ðð€€ò òòòLindsey€v.€MiamiÐ pÀ ÐDevelopment€Corp.óóó ó,€689€S.W.2d€856,€862€(Tenn.€1985)€(quoting€ò òòòPalace€Bar,€Inc.€v.€Ô_ÔFearnotÔ_Ôóóó ó,€269Ð ` ° ÐInd.€405,€381€N.E.2d€858,€864€(Ind.€1978))€(emphasis€supplied).€€ð ðThe€mere€possibility€of€a€causalÐ P   Ðrelationship,€without€more,€is€insufficient€to€qualify€as€an€admissible€expert€opinion.ðð€€òòò òLindseyó óóó,€689Ð @  ÐS.W.2d€at€862€(quoting€ò òòòÔ_ÔKirschnerÔ_Ô€v.€Ô_ÔBroadheadÔ_Ôóóó ó,€671€F.2d€1034,€1039€(7th€Cir.€Ind.€1982)).Ð 0 € ÐÌà  àWe€disagree€with€plaintiffsðð€assertion€that€Dr.€Sanfordððs€opinions€as€to€alternate€causesÐ `  Ðamounted€to€inadmissible€speculation.€€Additionally,€we€take€issue€with€plaintiffsðð€classification€andÐ P  Ðinterpretation€of€Dr.€Sanfordððs€testimony€as€alternate€cause€theory€aimed€at€convincing€the€jury€thatÐ ð@  Ðone€of€the€causes€addressed€was€accountable€for€Mrs.€Mitchellððs€condition.€€While€it€is€undisputedÐ à0  Ðthat€Dr.€Sanford€did€not€have€an€opinion,€based€on€a€reasonable€degree€of€medical€certainty,€as€toÐ Ð  Ðthe€exact€cause€of€Mrs.€Mitchellððs€enlarged€clitoris,€his€opinions€were€not€offered€to€prove€causationÐ À Ðin€this€case.€€We€agree€with€the€judgeððs€interpretation€of€Dr.€Sanfordððs€testimony,€whereby€he€noted:Ð ° ÐÌà8  àà8` Ð Ð àSo,€if€that€be€the€case,€then€it€would€put€the€defense€in€the€posture€ofÐ à Ðsaying,€well,€we€donððt€know€what€caused€it,€period,€and€I€donððt€knowÐ €Ð Ðif€thatððs€fair€in€terms€of€the€evidence,€because€while€they€donððt€knowÐ pÀ Ðwhat€caused€it,€this€expert€has€some€scientific€opinions€as€to€possibleÐ `° Ðcauses,€not€that€he€is€trying€to€convince€the€jury€as€to€these€beingÐ P  Ðpossible€causes,€but€he€is€trying€to€educate€the€jury€to€the€currentÐ @ Ðknowledge€from€his€perspective€as€a€scientist€as€to€how€this€conditionÐ 0€ Ðmight€arise€ð!ð€not€to€convince€them€of€the€ultimate€fact,€but€simply€toÐ  p Ðput€it€into€context€the€nature€of€this€scientific€phenomenon.Ð`` x` x ÐÌà  àOur€classification€of€Dr.€Sanfordððs€alternate€cause€testimony€as€being€rendered€for€the€sakeÐ ð@ Ðof€bringing€to€light€other€potential€explanations€for€Mrs.€Mitchellððs€condition,€but€not€to€proveÐ à0 Ðultimate€causation,€is€supported€by€Dr.€Sanfordððs€trial€responses.€€At€no€point€during€his€direct€orÐ Ð  Ðcross€examination€testimony€did€Dr.€Sanford€assert€or€opine€that€Mrs.€Mitchellððs€clitoral€enlargementÐ À! Ðwas€caused€by€the€alternate€causes€to€which€he€testified.€€Dr.€Sanford€testified€that€clitoralÐ °"  Ðenlargement€is€the€known€potential€result€of€late€onset€congenital€adrenal€hyperplasia,€theÐ  #ð! Ðoverproduction€of€androgens€by€the€ovaries,€or€an€ovarian€tumor.€€He€discussed€each€of€theseÐ $à" Ðconditions€generally,€but€never€specifically€associated€Mrs.€Mitchellððs€clitoral€enlargement€with€anyÐ €%Ð # Ðof€these€causes.€Ð p&À!$ ÐÌà  àThe€case€law€cited€by€plaintiffs€to€support€their€argument€that€Dr.€Sanfordððs€testimony€wasÐ P( #& Ðinadmissible€speculation€is€distinguishable€from€the€case€at€bar.€€In€their€brief,€plaintiffs€rely€heavilyÐ @)$' Ðon€the€law€set€forth€in€òòò òLindsey€v.€Miami€Development€Corp.óóó ó,€689€S.W.2d€856€(Tenn.€1985).€€InÐ 0*€%( Ðâ âò òòòLindseyóóó ó,€the€attending€physician€was€questioned€at€trial€about€whether€immediate€medical€care€couldÐ  +p&) Ðhave€prevented€plaintiffððs€death.€€ò òòòIdóóó ó.€at€861.€€The€Tennessee€Supreme€Court€deemed€the€followingÐ ° Ðtestimony€speculative€and€inadmissible.Ð  ð Ðâ âÌà8  àà8` Ð Ð àQ.€€All€right,€do€you€hold€any€opinions€as€to€whether€or€not€a€delayÐ €Ð Ðof€any€specified€period€of€time€would€have€made€any€difference€in€theÐ pÀ Ðfinal€analysis?Ð` °` x` x ÐÌà8  àà8` Ð Ð àA.€€I€can€only€speculate€because€we€donððt€have€the€final€informationÐ @  Ðwhich€an€autopsy€would€have€provided€as€to€where€exactly€the€injuryÐ 0 € Ðto€the€brain€was,€how€excessive€it€was€and€whether€it€was€an€injuryÐ  p  Ðwhich€would€ð!ð€in€any€event€be€Ô_ÔnonsurvivableÔ_Ô,€whether€it€would€beÐ `  Ðjust€a€few€hours€or€maybe€a€day€or€two.ÐP ` x` x ÐÌò òòòIdóóó ó.Ð à0  ÐÌà  àThe€physicianððs€testimony€in€ò òòòLindseyóóó ó€is€directed€at€the€actual€cause€or€aggravation€ofÐ À Ðplaintiffððs€injuries.€€Counsel€specifically€asked€the€expert€to€offer€his€opinion€as€to€whetherÐ ° Ðimmediate€medical€aid€could€have€prevented€plaintiffððs€death.€€ò òòòId.ó óóó€€Because€the€physician€was€unableÐ  ð Ðto€introduce€evidence€to€afford€a€reasonable€basis€for€his€opinion,€the€Supreme€Court€ruled€theÐ à Ðtestimony€inadmissible.€€ò òòòId.ó óóó€at€862.Ð €Ð ÐÌà  àPlaintiffs€also€cite€in€their€brief€to€the€cases€of€ò òòòÔ_ÔPrimmÔ_Ô€v.€Ô_ÔWickesÔ_Ô€Lumber€Co.óóó ó,€845€S.W.2dÐ `° Ð768€(Tenn.€Ct.€App.€1992),€and€ò òòòReel€v.€Crawleyóóó ó,€1994€WL€399566,€at€*1€(Tenn.€Ct.€App.€Aug.€2,Ð P  Ð1994).€€In€each€of€these€cases,€the€court€found€the€testimony€of€the€physician€expert€inadmissibleÐ @ Ðbecause€it€offered€little€more€than€a€possibility€upon€which€the€jury€could€speculate.€€òòò òSee€Ô_ÔPrimmÔ_Ôó óóó,Ð 0€ Ð845€S.W.2d€at€771;€ò òòòReelóóó ó,€1994€WL€399566,€at€*2.€€However,€in€both€cases,€the€physician€expert€wasÐ  p Ðspecifically€asked€whether€the€two€events€at€issue€were€causally€connected.€€ò òòòSee€Ô_ÔPrimmÔ_Ôóóó ó,€845€S.W.2dÐ ` Ðat€769„770;€òòò òReeló óóó,€1994€WL€399566,€at€*1€(ð ðDoctor,€do€you€associate€Mr.€Reelððs€irregular€heartbeatÐ P Ðin€any€fashion€to€the€accident,€the€trauma€or€stress€of€that€accident?ðð).€€Both€physicians€respondedÐ ð@ Ðwith€vague€explanations€of€causation.€€òòò òSee€Ô_ÔPrimmÔ_Ôóóó ó,€845€S.W.2d€at€769„770;€òòò òReeló óóó,€1994€WL€399566,Ð à0 Ðat€*1€(ð ðI€think€that€irregular€heart€rhythms€can€develop€due€to€any€form€of€stress€and€being€in€anÐ Ð  Ðautomobile€accident€could€have€contributed€to€him€having€more€irregular€heart€rhythms.ðð).Ð À! ÐÌà  àUnlike€the€testifying€physicians€in€ò òòòLindseyóóó ó,€òòò òÔ_ÔPrimmÔ_Ôó óóó,€and€ò òòòReelóóó ó,€Dr.€Sanford€was€never€asked,Ð  #ð! Ðand€never€offered,€his€opinion€as€to€whether€Mrs.€Mitchellððs€enlarged€clitoris€was€causally€connectedÐ $à" Ðto€the€alternate€causes€he€addressed€on€direct€examination.€€This€distinction€prevents€Dr.€SanfordððsÐ €%Ð # Ðtestimony€from€crossing€the€line€of€inadmissible€opinion€drawn€in€the€aforementioned€cases.€€Ð p&À!$ ÐÌà  àThe€precise€point€in€plaintiffsðð€assertion€of€error€was€considered€by€the€Court€of€Appeals€ofÐ P( #& ÐKentucky€in€ò òòòÔ_ÔSaklerÔ_Ô€v.€Anesthesiology€Ô_ÔAssocsÔ_Ô.,€Ô_ÔP.S.C.Ô_Ôó óóó,€50€S.W.3d€210€(Ky.€Ct.€App.€2001).€€ò òòòÔ_ÔSaklerÔ_Ôó óóóÐ @)$' Ðis€a€medical€malpractice€case€by€the€plaintiffs€for€Mrs.€Ô_ÔSaklerÔ_Ôððs€vocal€cord€paralysis€which€wasÐ 0*€%( Ðclaimed€to€be€caused€by€the€negligence€of€the€defendant€in€the€use€of€an€Ô_ÔintubationÔ_Ô€tubeÔ#†¼õœ»XXâ+Q #ÔÔ‡Xâ+X»¼õœÔ€duringÐ  +p&) Ðsurgery.€€After€a€jury€trial,€the€jury€returned€a€verdict€for€the€defendant,€and€on€appeal€the€Ô_ÔSaklerÔ_ÔððsÐ ,`'* Ðfirst€argument€ð ðis€that€the€trial€court€committed€reversible€error€by€permitting€a€defense€expertÐ ° Ðwitness€to€render€an€expert€medical€opinion€based€on€ððspeculationðð€and€ððpossibilityðð€rather€thanÐ  ð Ðreasonable€medical€probability.ðð€€ò òòòId.ó óóó€at€212.€€€The€defense€expert€testified€that€there€were€multipleÐ à Ðconditions€that€could€cause€vocal€cord€paralysis€and€there€is€a€possibility€that€any€one€of€a€numberÐ €Ð Ðof€these€things€caused€the€problem.€€The€plaintiffs€argued€that€the€opinion€of€a€medical€expert€mustÐ pÀ Ðbe€based€on€reasonable€medical€probability€and€not€speculation.€€The€Court€affirmed€the€ruling€ofÐ ` ° Ðthe€trial€court€that€the€expert€testimony€at€issue€was€admissible€on€behalf€of€defendant€in€a€medicalÐ P   Ðmalpractice€case.€€In€so€holding,€the€Court€said:€€Ð @  ÐÌà8  àà8` Ð Ð àWe€conclude€that€defendants€in€medical€malpractice€actions€mayÐ  p  Ðintroduce€expert€witness€testimony€to€rebut€a€plaintiffððs€expertÐ `  Ðwitness€testimony€couched€in€terms€of€ð ðreasonable€medicalÐ P  Ðprobability,ðð€even€though€the€defendantððs€expert€witnessððs€testimonyÐ ð@  Ðis€couched€only€in€terms€of€ð ðpossibility.ðð€€In€so€deciding,€we€areÐ à0  Ðpersuaded€by€the€reasoning€of€the€United€States€Court€of€Appeals€forÐ Ð  Ðthe€First€Circuit€in€the€case€of€ò òòòWilder€v.€Ô_ÔEberhartÔ_Ôó óóó,€977€F.2d€673€(1òòstóóÐ À ÐCir.€1992),€cert.€denied€508€U.S.€930€113€S.€Ct.€2396,€124€L.€Ed.€2dÐ ° Ð297€(1993).Рð` x` x ÐÌà8  àà8` Ð Ð àà ¸ àIn€ò òòòWilderó óóó,€a€plaintiff€patient€filed€suit€against€her€defendantÐ €Ð Ðdoctor€and€clinic€for€medical€malpractice,€alleging€the€doctorððsÐ pÀ Ðsurgical€procedure€caused€her€to€suffer€an€esophageal€injury.€€At€trial,Ð `° Ðthe€Ô_ÔplantiffÔ_Ôððs€expert€witness€testified€that€her€injury€was€caused€by€theÐ P  Ðdefendantsðð€medical€negligence.€€Expert€medical€testimony€on€behalfÐ @ Ðof€the€defendants,€however,€was€ruled€inadmissible€by€the€trial€courtÐ 0€ Ðbecause€it€could€not€be€expressed€in€terms€of€ð ðprobabilityðð€asÐ  p Ðdistinguished€from€ð ðmedical€possibility.ðð€€In€holding€the€trial€courtÐ ` Ðerred€in€excluding€this€testimony,€the€First€Circuit€reasoned€asÐ P Ðfollows:Ðð@` x` x ÐÌà8  àà8` Ð Ð àà8¸ ` x` xàProximate€causation€between€negligence€and€theÐ Ð  Ðinjury€complained€of€in€a€medical€malpractice€caseÐ À! Ðmust€be€established€by€expert€testimony.€€(CitationÐ °"  Ðomitted.)€€On€the€other€hand,€the€defendant€need€notÐ  #ð! Ðdisprove€causation.€€Rather,€he€must€produce€credibleÐ $à" Ðevidence€which€tends€to€discredit€or€rebut€theÐ €%Ð # Ðplaintiffððs€evidence.€(Citation€omitted.)€€As€the€NewÐ p&À!$ ÐHampshire€Supreme€Court€recently€stated€in€Ô_ÔTzimasÔ_ÔÐ `'°"% Ð[v.€ò òòòCoiffures€by€Michaeló óóó,€135€N.H.€498,€606€A.2dÐ P( #& Ð1082,€1084€(N.H.€1992)],€the€plaintiff€in€a€negligenceÐ @)$' Ðaction€bears€the€burden€of€producing€evidence€ð ðtoÐ 0*€%( Ðprove€that€it€is€more€likely€than€not€that€[plaintiffððs]Ð  +p&) Ðinjury€was€ð ðcaused€by€the€defendantððs€negligence.€Ð ,`'* Ð(Citation€omitted.)€€Defendant€need€not€prove€anotherÐ ° Ðcause,€he€only€has€to€convince€the€trier€of€fact€that€theÐ  ð Ðalleged€negligence€was€not€the€legal€cause€of€injury.€Ð à Ð(Citation€omitted.)€€In€proving€such€a€case,€aÐ €Ð Ðdefendant€may€produce€other€ð ðpossibleðð€causes€of€theÐ pÀ Ðplaintiffððs€injury.€€These€other€possible€causes€needÐ ` ° Ðnot€be€proved€with€certainty€or€more€probably€thanÐ P   Ðnot.€€To€fashion€such€a€rule€would€unduly€tie€aÐ @  Ðdefendantððs€hands€in€rebutting€a€plaintiffððs€case,Ð 0 € Ðwhere€as€here,€plaintiffððs€expert€testifies€that€no€otherÐ  p  Ðcause€could€have€caused€plaintiffððs€injury.€€TheÐ `  Ðburden€would€then€shift€and€defendant€would€thenÐ P  Ðbear€the€burden€of€positively€proving€that€anotherÐ ð@  Ðspecific€cause,€not€the€negligence€established€byÐ à0  Ðplaintiffððs€expert,€caused€the€injury.€€Certainly,€this€isÐ Ð  Ðmuch€more€than€what€should€be€required€of€aÐ À Ðdefendant€in€rebutting€a€plaintiffððs€evidence.а¸ ¸  ÐÌà8  àà8` Ð Ð àà8¸ ` x` xàà  àWere€we€to€accept€plaintiffððs€argument€thatÐ à Ðonce€a€plaintiff€puts€on€a€prima€facie€case,€a€defendantÐ €Ð Ðcannot€rebut€it€without€proving€another€cause,€theÐ pÀ Ðresulting€inequities€would€abound.€€For€example€ifÐ `° Ðninety„nine€out€of€one€hundred€medical€experts€agreedÐ P  Ðthat€there€were€four€equally€possible€causes€of€aÐ @ Ðcertain€injury,€A,€B,€C€and€D,€and€plaintiff€producesÐ 0€ Ðthe€one€expert€who€conclusively€states€that€A€was€theÐ  p Ðcertain€cause€of€his€injury,€defendant€would€beÐ ` Ðprecluded€from€presenting€the€testimony€of€any€of€theÐ P Ðother€ninety„nine€experts,€unless€they€would€testifyÐ ð@ Ðconclusively€that€B,€C,€or€D€was€the€cause€of€injury.€Ð à0 ÐEven€if€all€of€defendantððs€experts€were€prepared€toÐ Ð  Ðtestify€that€any€of€the€possible€causes€A,€B,€C€or€D,Ð À! Ðcould€have€equally€caused€plaintiffððs€injury,€so€longÐ °"  Ðas€none€would€be€prepared€to€state€that€one€particularÐ  #ð! Ðcause,€other€than€that€professed€by€plaintiff€moreÐ $à" Ðprobably€than€not€caused€plaintiffððs€injury,€thenÐ €%Ð # Ðdefendantððs€experts€would€not€be€able€to€testify€at€allÐ p&À!$ Ðas€to€causation.Ð`'°"%¸ ¸  ÐÌà8  àà8` Ð Ð àò òòòWilderó óóó,€977€F.2d€at€676„677.€n5€€€We€agree€with€the€First€Circuit€thatÐ @)$' Ðexpert€testimony€of€this€nature€is€admissible€on€behalf€of€defendantsÐ 0*€%( Ðin€medical€malpractice€cases€in€order€to€rebut€the€testimony€ofÐ  +p&) Ðplaintiffs€upon€whom€the€burden€of€proof€rests.Ð,`'*` x` x Їò òòòId.ó óóó€at€213„214.Ð ° ÐÌà  àThe€opinion€in€ò òòòWilderó óóó€is€well€reasoned€and€we,€like€the€Kentucky€Court€of€Appeals€inÐ à Ðò òòòÔ_ÔSaklerÔ_Ôó óóó,€are€persuaded€by€this€reasoning.€€Accordingly,€we€adopt€the€holding€expressed€in€ò òòòWilder€ó óóóandò òòòÐ €Ð ÐÔ_ÔSaklerÔ_Ôó óóó€as€Ô_ÔdispositiveÔ_Ô€of€this€issue.Ð pÀ ÐÌà@}})ìàò òIVó óˆÐ P   ÐÌà  àThe€final€issue€presented€for€review€is€whether€the€juryððs€verdict€was€contrary€to€the€weightÐ 0 € Ðof€the€evidence.€€Ð  p  ÐÌà  àIn€ò òòòBarnes€v.€Goodyear€Tire€&€Rubber€Co.ó óóó,€48€S.W.3d€698€(Tenn.€2000),€our€Supreme€CourtÐ P  Ðreiterated€the€long€established€rule€concerning€review€of€a€jury€verdict.€€The€Court€said:Ð ð@  ÐÌà8  àà8` Ð Ð àà ¸ àThe€standard€of€appellate€review€when€reviewing€a€juryÐ Ð  Ðverdict€approved€by€a€trial€court€is€whether€there€is€any€materialÐ À Ðevidence€to€support€the€verdict.€€Tenn.€R.€App.€P.,€Rule€13(d).€€WhenÐ ° Ðaddressing€whether€there€is€material€evidence€to€support€a€verdict,€anÐ  ð Ðappellate€court€shall:€(1)€take€the€strongest€legitimate€view€of€all€theÐ à Ðevidence€in€favor€of€the€verdict;€(2)€assume€the€truth€of€all€evidenceÐ €Ð Ðthat€supports€the€verdict;€(3)€allow€all€reasonable€inferences€to€sustainÐ pÀ Ðthe€verdict;€and€(4)€discard€all€[countervailing]€evidence.€€ò òòòÔ_ÔCrabtreeÔ_ÔÐ `° ÐMasonry€Co.€v.€C€&€R€Constr.,€Inc.ó ó,€óó575€S.W.2d€4,€5€(Tenn.€1978);Ð P  Ðòòò òBlack€v.€Quinnó óóó,€646€S.W.2d€437,€439„40€(Tenn.€Ct.€App.€1982).€Ð @ ÐAppellate€courts€shall€neither€Ô_ÔreweighÔ_Ô€the€evidence€nor€decide€whereÐ 0€ Ðthe€preponderance€of€the€evidence€lies.€€If€the€record€contains€ð ðanyÐ  p Ðmaterial€evidence€to€support€the€verdict,€[the€juryððs€findings]€must€beÐ ` Ðaffirmed;€if€it€were€otherwise,€the€parties€would€be€deprived€of€theirÐ P Ðconstitutional€right€to€trial€by€jury.ðð€€ò òòòÔ_ÔCrabtreeÔ_Ô€Masonry€Co.ó óóó,€575Ð ð@ ÐS.W.2d€at€5.Ðà0` x` x ÐÌò òòòId.ó óóó€at€704„705.Ð À! ÐÌà  àThere€is€material€evidence€in€this€record€to€support€the€juryððs€verdict€and,€accordingly,€weÐ  #ð! Ðfind€this€issue€without€merit.€Ð $à" ÐÌà  àThe€judgment€of€the€trial€court€on€the€jury€verdict€is€affirmed.€€The€case€is€remanded€to€theÐ p&À!$ Ðtrial€court€for€such€further€proceedings€as€may€be€necessary.€€Costs€of€the€appeal€are€assessed€to€theÐ `'°"% Ðappellants,€Patsy€Mitchell€and€Steve€Mitchell,€and€their€surety.Ô#†¼õœ»XXâ+s$#ÔÔ€Xâ+X»¼õœÔÐ P( #& ÐÌÌà  àà ` àà ¸ àà  àà h àà À à__________________________________________Ð +h&) Ðà  àà ` àà ¸ àà  àà h àà À àW.€FRANK€CRAWFORD,€PRESIDING€JUDGE,€Ô_ÔW.S.Ô_Ô