WPCM jrEB#au2A D (#lZɷs|qIGMbD&-Fm>ju;: e+[\$˗d 7 Գ.}iu*qly|jnh#c[8x$%?ްi[Ep')y#wyM_Eh敎ՑBHhh^ͧަc #fPanNߞ[շǁF PY_TݷQكu໬ԓ\ -[L; w.Q =R%M=&w@ŷ 0^tqT\@5]7ѓHefgra +Vz,Ԅ԰=f:R! ] ^R(~uVfQv"m#Գ6D;.`͂ڑZNmzKPla ɏgetK:o %^  0$U%Nw4  z-  y m{ 1u 72 9    0cQN 0U 0 D EO#Q 0 0 0 0 0 0t 0N 0% 0C 0< 0 0 0 0 0Q 0 0 0@! 0! 0"b# 0# 0Y$ 0$% 0% 0& 0s' 000( 0<`( 0( 0>Z) 0v) 0`* 0`n* 0`* 0`.+ 0`+ 08+ 0&, 02, 0*- 0:&. 0Y`. 0_. 0 / 0j"0 01 B*3 D/:3 0i3 D/4 05 065 0 6 0:(7 0^b7 0 7 0<8 1e8U6L9 B9U >9 09 D3: D-: 0K:U*,; ASV;; 0o< 0D= AW=W=>7AAADD~wEGGG6 ITAJ/ (`$.8dd8    ("  Z6Times New Roman Regularep)/b014c23|x 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 U3#37=CIQYag1.a.i.(1)(a)(i)1)a) i)Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5(;3$2#  0  .3  0  *+ (_2623  ..(#$  0  \\IB01S08T\knoxclerk4,,,,0  Ru$      4    _NeitherpartycalledanexpertwitnesstotestifyastoMrs.Coxscompetence,andthetrialcourtdidnotmake  afindingregardingMrs.Coxscompetency.Theevidencepreponderatesinfavorofafindingthatshewascompetent t tounderstandtheadmissionagreement.SeeTenn.R.App.P.13(d). *G+M (_25   /%` ` hp x /23  ..  5+ ` hp x 5  *D+M (_24   ," hp x ,23  ..  5+ ` hp x 5  *A+M (_23  ` ) hp x )23  ..  5+ ` hp x 5  *>+M (_22   &hhp x &23  ..  5+ ` hp x 5  *;+M (_21   #p x #23  ..  5+ ` hp x 5  *8+M (_20  h  p x 23  ..  5+ ` hp x 5  *5+M (_19   pp x 23  ..  5+ ` hp x 5  *2+M (_18    x 23  ..  5+ ` hp x 5  * (_1723  Ԁ*GM (_16   /%` ` hp x /23  Ԁ  5+ ` hp x 5  *DM (_15   ," hp x ,23  Ԁ  5+ ` hp x 5  *AM (_14  ` ) hp x )23  Ԁ  5+ ` hp x 5  *>M (_13   &hhp x &23  Ԁ  5+ ` hp x 5  *;M (_12   #p x #23  Ԁ  5+ ` hp x 5  *8M (_11  h  p x 23  Ԁ  5+ ` hp x 5  *5M (_10   pp x 23  Ԁ  5+ ` hp x 5  (2M &_9    x 23  Ԁ  5+ ` hp x 5  ( &_823  (GM &_7   /%` ` hp x /23   5+ ` hp x 5  (DM &_6   ," hp x ,23   5+ ` hp x 5  - -(AM &_5  ` ) hp x )23   5+ ` hp x 5  (>M &_4   &hhp x &23   5+ ` hp x 5  (;M &_3   #p x #23   5+ ` hp x 5  (8M &_2  h  p x 23   5+ ` hp x 5  (5M &_1   pp x 23   5+ ` hp x 5  &2M $_    x 23   5+ ` hp x 5  0.Normal<:Definition T<AA:Definition L , 5+ ` hp x 5  5+ ` hp x 586Definition(''&H1      (&H2  (&H3  (&H4 XXX (&H5  (&H6  20Address8MM6Blockquote , , 5+ ` hp x 5   5+ ` hp x 5,*CITE,dl*CODEKU<6X9`(Courier NewKSW\  `&Times New RomanS42Emphasis64Hyperlink    <:FollowedHype    4go2Keyboard KU<6X9`(Courier NewKSW\  `&Times New RomanS <:Preformatted/%  ,Kk %#/KU<6X9`(Courier NewKSW\  `&Times New RomanS/%  ,Kk %#/<:zBottom of 7J(X7  ?\%2A`Arial?  SW\  `&Times New RomanS7Z(X7&  d dI)1dxd<:zTop of For7L(X7  ?\%2A`Arial?  SW\  `&Times New RomanS7Z(X7I)2dxd0KS.SampleKU<6X9`(Courier NewKSW\  `&Times New RomanS0.Strong 8dl6TypewriterKU<6X9`(Courier NewKSW\  `&Times New RomanS42Variable: 8HTML MarkupB      (|G2aF$ !.8QmdXXd8         0  =2 0CommentB  "#$%&'() 35;AGMSY_11.1.1.1.1.1.1.1.<6X9`(Courier New d\  `&Times New Roman(|3AU$ !.8QmdXXd8     VVVV'dxd)!dxdx( $ Figure  1  %2A`Arial^_X`YE<<CLevel 1Level 2Level 3Level 4Level 5(|3AU$ !.8QmdXXd8     ($$   1  X[Z&OLE 2.0 Box <=8C HKKKK w Ru$      6    _Judge_Wimberly_Ԁwasobviouslyreferringto Howellv._NHC_/HealthcareFortSanders,Inc. ,109S.W.3d731  (Tenn.Ct.App.2003),whichcasewaspendingonappealwhenhedecidedtheissuenowonappealintheinstantcase. v In Howell ,Judge_Wimberly_Ԁrefusedtoordermediationandarbitrationonthegroundthattheagreementwas : unenforceable. Id. at73233.Weaffirmed. Id. at735.OnJune30,2003,theTennesseeSupremeCourtdeniedthe P defendantsdapplicationforpermissiontoappeald Id. at731. - RaF$      1  =  _Foreaseofreference,wewillreferto_NHC_ԀHealthcare/Knoxville,Inc.,asifitwerethesoledefendant.The  identityoftheotherdefendantsisnotcriticaltotheresolutionofthisappeal.Wenoteinpassing,however,thatthebrief t filedinresponsetotheappellantsbriefreflectsthatitwasfiledonbehalfofthedefendantmentionedinthisfootnote 8 aswellasthedefendant_NHC_ԀHealthcare/Knoxville,LLC.Wedonotknowtherelationshipbetweenthesetwo L defendants;butitisnotimportanttoourdispositionofthisappeal. Ru$      5    _Thisparagraphcaptionisnotinallcapitalletters. t Ru$      2    _Whenaskedwhathermothersconditionwasinlate2000,theplaintiffrespondedasfollows:    8 ` Itwasnotgood.Themainproblemwasshehadhadalotofillnessesthatthey 8 didntknowwhatwaswrongwithher....[_S]he_Ԁgottothepointwhereshewasso L weakshecouldnotmove!well,shecouldmovebutshecouldntstandup.She  wasntmobile.  Ru$      3    _TwoofthechildrenwerefromMrs.Coxsearliermarriage.Thethirdchild,DavidCox,isthesonofMr.and  Mrs.Cox. , Ru$      7    _While _Eyring_ involvedamedicaldoctor,itslanguageisbroadenoughtoencompassotherhealthcare  providers. J Ru$      8    _Wenotethat _NHC_ԀHealthcareisapartofthenameofthedefendantin Howell andalsoapartofthename  ofoneoftheappelleesintheinstantcase.Theagreementsinbothcasesareelevenpageslong;thealternativedispute v resolutionprovisionsareonpagetenofeachagreement;andneitheragreementcontainsanexplanationofhowmediation : andarbitrationwork.Wesuspectthatwearedealingwiththesamecontractinbothcases.However,wecannotbesure N becausetheopinionin Howell doesnotstatetheprecisemediationandarbitrationlanguageinthatcase. !.8QmdXXd8     _  Qm8XXdd8  0  @ (#(#UQmINTHECOURTOFAPPEALSOFTENNESSEE  0  @WW$(#(#ATKNOXVILLE#QmU #Ԉ &   0 @ August21,2003Session L XXQm0 @ #QmXX&#LYNN_RAITERI_Ԁexrel.MARYHELENCOXv._NHC_ J HEALTHCARE/KNOXVILLE,INC.,etal.XXQm   ^ 0 @ @@ InterlocutoryAppealfromtheCircuitCourtforKnoxCounty  ^ 0 @ @@No.279101Harold_Wimberly_,Jr.,Judge  J Filed_December30,2003_ "  @@*AV) ` dE<` A   0 @ @@TTNo.E200300068_COA_ԄR9CV    AV)<` dE<` A  Lynn_Raiteri_,asthedaughterandnextfriendofthelateMaryHelenCox( Mrs.Cox),sued_NHC_ i Healthcare/Knoxville,Inc.( thedefendant),aswellasothers,_d #  1      _#QmXX##XXQmԀforthewrongfuldeathofMrs.Cox, U whosedeathallegedlyresultedfromimpropercareatthedefendantsnursinghome.Wegrantedthe A plaintiffsTenn.R.App.P.9applicationforaninterlocutoryappealinordertoreviewthetrial -} courtsordergrantingthedefendantsmotiontocompelmediationandarbitrationpursuanttothe i disputeresolutionprocedurescontainedinthedefendantsnursinghomeadmissionagreement.#QmXXf#XXQmWe U reverse. A 0 @ Tenn.R.App.P.9InterlocutoryAppeal;JudgmentoftheCircuitCourt  0 @ Reversed;CaseRemanded     #QmX #XX.QmCharlesD.Susano,Jr.,J.,deliveredtheopinionofthecourt,inwhichHoustonM._Goddard_,  _P.J._,andHerschelP.Franks,J.,joined. y    `     h     RichardC.Mayand_Loring_ԀE.Justice,Knoxville,Tennessee,fortheappellant,Lynn_Raiteri_. Q! DanD.RheaandF.Michael_Fitzpatrick_,Knoxville,Tennessee,fortheappellees,_NHC_ )#y! Healthcare/Knoxville,Inc.and_NHC_ԀHealthcare/Knoxville,LLC.#QmXX #XXQm $e"   OPINION #QmXX9#XXQm %=!$ #QmXX#XXQm   '#& _  I.  A.  1   Mrs.Cox,age77,wasadmittedtoSt.MarysHospitalwithchestpainsandothersymptoms. ` Herhusband,CharlesE.Cox( Mr.Cox),age75,anticipatedthathiswifewouldreceivephysical L  therapyatSt.Maryssoshecouldregainsomeorallofhermobility;butapparentlythehospitalwas 8  notpreparedtorendertheseservicestoher.SinceMr.Coxwasphysicallyunabletoliftand $ t otherwisecareforhiswifeathome,hemadearrangementstoadmithertothedefendantsnursing  ` home.i #  2      ׀OnDecember20,2000,Mr.Coxmetatthenursinghomewiththedefendantsadmissions  L  coordinator.Mrs.Coxwasnotpresentatthemeeting.TheadmissionscoordinatoraskedMr.Cox  8  tosignthenursinghomes AdmissionandFinancialContract( theadmissionagreement)onhis $  wifesbehalf,eventhoughMrs.Coxhadnotbeendiagnosedoradjudicatedasmentallyincompetent.   Hecompliedwithherrequest.ItwastheintentionofthepartiesthatMrs.Coxwouldreceive   physicaltherapyandvocationalrehabilitationservicesatthenursinghome.     Sometimeshortlyafterhiswifesadmissiontothedefendantsfacility,Mr.Coxalsowas p admittedtothedefendantsnursinghome.OnMarch8,2001,Mr.Coxpassedaway.Mrs.Cox, \ whilestillaresidentatthenursinghome,diedonApril19,2001.Followinghermothersdeath, H theplaintifffiledsuitforMrs.Coxswrongfuldeath,allegingthatthenegligence,abuse,neglect, 4 andfraudofthedefendantcausedhermothersdeath.Inhercomplaint,theplaintiffseeks  p compensatoryandpunitivedamages.Inresponsetothecomplaint,thedefendantfiledamotion  \ seekingtocompelmediationandarbitration. H   B.     Beforerulingonthedefendantsmotion,thetrialcourtheldanevidentiaryhearing.The  defendantsadmissionscoordinatorwastheonlywitnessforthedefendant.Shetestifiedthatshe  metwithMr.CoxandthathereadandsignedtheadmissionagreementasMrs.Coxs legal  representative.Whileacknowledgingthatshehandledsome360admissionsayear,sheclaimed l thatsherememberedthatMr.Coxreadtheadmissionagreement.Whenaskedifandhowshecould X  rememberatthetimeofthehearing!onSeptember4,2002!thatMr.Coxhadreadtheadmission D! agreementsometwoyearsearlier,sheresponded, Idobecauseallofmyadmissionsreadthe 0"  contract.Iseetothat. #l!   ItisundisputedthatMr.Coxcanread.Althoughtheadmissionagreementspecifically $D # definestheterm legalrepresentativeas anyoneauthorizedbythe[patient]toactonthe_[patients] %0!$ behalf,theadmissionscoordinatoradmittedthatshedidnotreceiveanyindicationfromeitherof  theCoxesthatMr.CoxwasauthorizedtosignonMrs.Coxsbehalf.Shestatedthatshedidnot  knowifMr.Coxhadhiswifesauthorizationtoactonherbehalf.Shetestifiedthatsheallowedhim  tosigntheadmissionagreementsimplybecausehewasMrs.Coxshusband.Theadmissions t coordinatorwentontotestifythatshebelievedMrs.CoxwascompetentwhenMr.Coxsignedthe ` admissionagreement.DespiteMrs.Coxsunquestionedmentalcapacity,theadmissionscoordinator L  didnotdiscusstheadmissionagreementwithher;furthermore,shedidnotgiveMrs.Coxacopyof 8  thatdocument.ShestatedthatshedidnotknowwhetherMrs.Coxwasevermadeawareofthe $ t termsandconditionsoftheadmissionagreement.Significantly,theadmissionscoordinator  ` acknowledgedthatMrs.Cox wascapableofunderstandingit,i.e.,theadmissionagreement.One  L  ofherchildrendescribedheras finementallyand verycompetent.  8    TheadmissionscoordinatorconfirmedthatMrs.CoxwouldnothavebeenadmittedifMr.   Coxhadrefusedtosigntheadmissionagreementorhadrefusedtoassenttothetermsofthedispute   resolutionproceduresintheagreement,whichprovisionsincludedonewaivingMrs.Coxsrightto   ajurytrial.TheadmissionscoordinatoralsotestifiedthatsheinformedMr.Coxofhisrightto   revoketheentireadmissionagreementwithin30days;however,thewitnessadmittedthatMr.Cox p couldonlyrevoketheentireagreement,notjusttheprovisionsdealingwiththedisputeresolution \ procedures.SheclaimedthatsheexplainedtheadmissionagreementtoMr.Coxandencouraged H himtoaskquestions;inresponsetoaquestion,shestatedthatshedidnottellMr.Coxthathehad 4 therighttoconsultwithanattorneybeforesigningtheadmissionagreement.Theadmissions  p coordinatoralsoadmittedthatshetoldMr.Coxthatanyclaimwouldbesettledquicklyifitwas  \ handledviathedisputeresolutionproceduresintheadmissionagreement. H   Attheevidentiaryhearing,Mrs.Coxsthreechildrenj #  3      ׀testifiedfortheplaintiff.Allthree   childrenstatedthattheybelievedtheirmotherwasfullycompetentwhenMr.Coxsignedthe   admissionagreement. #  4      ׀NoneofMrs.Coxsthreechildrenwereawareofanydocumentsignedby  Mrs.Coxoranyotherconductonherpartauthorizingherhusbandtoactonherbehalfortosign  documentsforher.Thethreechildrenagreedthattheirmotherwas sharpmentally.Itisclear  fromthetestimonythatthechildrenconsideredhermorementallycompetentthanherhusband. l   ContrarytotheadmissionscoordinatorstestimonythatMr.Coxwasawareofwhathewas D! doing,theplaintifftestifiedthatherstepfather wasveryupset,veryagitated,[and]veryconfused 0"  afterhesignedtheagreement.Theplaintiffalsotestifiedthatherstepfathertoldherthathis only #l! choicewastohavehiswifeadmittedtothenursinghomebecausehewasphysicallyunabletotake $X" careofher.SandraNelson,theplaintiffssister,alsotestifiedthatshesawMr.Coxafterhesigned $D # theadmissionagreementandthathe wasveryupset, distraught,and wasjustabsolutely %0!$ bawling.DavidCoxalsospoketohisfatherthatdayandconfirmedthathisfatherwascryingand  upsetabouthisinabilitytocareforhiswifeandthenecessityforadmittinghertoanursinghome.    Ms.Nelsonpointedoutthatshehadtoadmitherstepfathertothenursinghomesoonafter t hehadsignedtheadmissionagreementforhiswife.Atthetimeofhisadmission,hewasdiagnosed ` with pneumonia,malnutrition,dehydration,and[highbloodsugar].Ms.Nelsonalsometwiththe L  admissionscoordinator,whotoldMs.Nelsonthatshecouldlegallysignforherstepfather,even 8  thoughMs.Nelsondidnothaveexplicitauthoritytodoso.OnlyafterMs.Nelsonsignedthe $ t admissionagreementdidtheadmissionscoordinatorarrangetohavepowersofattorneyexecuted  ` bytheCoxessoMs.Nelsoncouldactonbehalfofhermotherandstepfather.  L    Ms.Nelsontestifiedthat,whenshecommentedthatreadingtheadmissionagreementwould $  takealongtime,theadmissionscoordinatorsaid Thatsquiteallright.Iwillexplain[theadmission   agreement]toyou.Despitetheadmissionscoordinatorsassurances,Ms.Nelsonclaimedthatthe   admissionscoordinatornevermentionedmediationorarbitrationorpointedouttoherthat,by   signingthedocument,shewaswaivingMr.Coxsrighttoajurytrial.Instead,Ms.Nelsonclaimed   thattheadmissionscoordinatorgaveonesentenceexplanationswhilequicklyflippingthroughthe p document. `     h  \   0 @ C. H 2  Theadmissionagreementwasadmittedintoevidence.Thedisputeresolutionprocedures  p readasfollows:  \    ` 0   ` DISPUTERESOLUTIONPROCEDURE: 4(#(# 0  8` (#(# 1.InitialGrievanceProcedure: g #  5      ׀ThepartiesagreetofollowtheGrievance   proceduredescribedinthePatientRightsBookletforanyclaimsordisputes  arisingoutoforinconnectionwiththecarerenderedtoPatientbyCenter  and/oritsemployees.PatientshouldknowthatCenterispreparedtomediate  anyconcernsatanytimeuponpatientrequest(paragraph2below)p` `  0  8` (#(# 2.MEDIATION: Intheeventthereisadisputeand/ordisputesarisingout H! oforrelatingto(_i_)thiscontractorthebreachthereoforanytortclaim;or(ii) 8"  whetherornottherehadbeenaviolationofanyrightorrightsgrantedunder $#t! statelaw,andthepartiesareunabletoresolvesuchdisputethrough $`" negotiation,thenthepartiesagreeingoodfaithtoattempttosettlethedispute $L # bymediationadministeredbytheAlternativeDisputeResolutionServiceof %8!$ theAmericanHealthLawyersAssociationbeforeresortingtoarbitration. &$"% TheAdministrativeFeeandmediatorscompensationshallbepaidbythe '#& center.(#'` `   )$( 0  8` (#(# 3.ARBITRATION: Anydisputesnotsettledbymediationwithin60days  afteramediatorisappointedshallberesolvedbybindingarbitration  administeredbytheAlternativeDisputeResolutionServiceoftheAmerican  HealthLawyersAssociation,andjudgmentmaybeenteredinanycourt x havingjurisdictionthereof.Thearbitrator(s)shallbeselectedfromapanel d havingexperienceandknowledgeofthehealthcareindustry.Thesame P  personshallnotserveasboththemediatorandthearbitrator.Theplaceof <  arbitrationshallbewheretheCenterislocated,or,ifthatisnotpractical,then ( x asclosetotheCenteraspractical.Thisagreementshallbegovernedbyand  d interpretedinaccordancewiththelawsoftheState.Theawardshallbemade  P  withinninemonthsofthecommencementofthearbitrationproceedingsand  <  thearbitratorsshallagreetocomplywiththisschedulebeforeaccepting (  appointment.However,thistimelimitmaybeextendedbyagreementofall   thepartiesorbythearbitrator(s)ifitisabsolutelynecessary,butnotto   exceedsixmonths.Thearbitrator(s)mayawardcompensatoryandpunitive   damages,andwithrespecttopunitivedamagesarisingunderStatestatutes   shallcomplywiththeprovisionsofStatestatute.Byagreeingtoarbitration t ofalldisputes,bothpartiesarewaivingajurytrialforallcontract,tort, ` statutoryandotherclaims.Theawardofattorneysfeesandcostsofthe L arbitrationshallbedeterminedbythearbitrator(s)inaccordancetostatelaw. 8 TheAdministrativeFeeandArbitratorscompensationshallbepaidforby $t thecenter.`` `  8  8`     ` x` x (Boldprintandcapitalizationinoriginal).Immediatelyfollowingtheseprovisionsisthesignature 8 ofMr.CoxdatedDecember20,2000. $   Theadmissionagreementiselevenpageslong.Themediationandarbitrationprovisions  beginatthebottomofpagenineandcontinueonpageten.Thedisputeresolutionproceduresare  printedinthesamecolorink,fontsize,andfonttypeastherestoftheadmissionagreement.The  mediationandarbitrationprovisionsdonotincludeastatementtothepatientencouraginghimor p hertoaskquestions.However,asinseveralotherareasintheadmissionagreement,thepatientor \  thepatientslegalrepresentativeisrequiredtosignimmediatelyfollowingthetext,inadditionto H! hisorhersignatureattheendofthedocument. 4"    Thearbitrationprovisionsdonotexpresslystatewhoisresponsibleforchoosingthe  $\" arbitrator;instead,thetextonlystatesthatthe arbitrator(s)shallbeselectedfromapanelhaving $H # experienceandknowledgeofthehealthcareindustry.Thearbitrationprovisionsstatethat [_b]y_ %4!$ agreeingtoarbitrationofalldisputes,bothpartiesarewaivingajurytrial....(Emphasisadded). & "%   Accordingtotheadmissionagreement,theterm partiesreferstothepatientand/orthe (#' patientslegalrepresentativeandthedefendant.Aspreviouslynotedinthisopinion,theterm legal )$( representativeisdefinedintheadmissionagreementas anyoneauthorizedbythe[patient]toact *%) onthe[patients]behalf.Thedisputeresolutionproceduresdonotexplaininanydetailhow l+&* mediationorarbitrationworks;however,theprovisionsdoexplainwheretheprocesswilloccurand  whowilladministerit.Intheeventofmediationorarbitration,thedefendantisrequiredtopaythe  feesassociatedwiththeprocess.  !D. ` `K    Followingtheevidentiaryhearing,thetrialcourtgrantedthedefendantsmotiontocompel 8  mediationandarbitration.Initsorder,thetrialcourtdidnotaddresswitnesscredibility;nordidit $ t makespecificfindingsoffact.Inrelevantpart,theorderprovidesasfollows:  ` 8  8`   Afterhavingconsidered...theothercaseinvolvingthesametypeof  8  agreement,_c #  6      _ԀtheCourtfeels...that[,]unliketheCourtsprevious $  decisionwhichwasbaseduponthefactthatthemanwhosignedthe   paperwasilliterateandobviouslysoandwasnottoldaboutthe   consequencesofwhathewassigning[]eventhoughthepeople   undertooktotellhimandexplainittohim,inthisparticularcase   Ѐ...,basedupontherulingsoftheSupremeCourtandthelaw,the p Courtrulesthatarbitrationisrequired....Nousetogointo \ philosophythattheCourtfeelstheSupremeCourthasadopted,but H thatsmyconclusion.4` x` x 8  8`   So...,thisobviouslyneedstobepresentedtotheCourtofAppeals  \ alsoandwedhopethatcouldbedoneasquicklyaspossiblesowe H candeterminewhattodoonthisandothercases.4` x` x Thetrialcourtsubsequentlygrantedtheplaintiffsmotionforaninterlocutoryappeal.     II.  R  WXGXXXGTennesseehasadoptedaversionoftheUniformArbitrationAct.TheTennesseeversion l provides,inrelevantpart,that aprovisioninawrittencontracttosubmittoarbitrationany X  controversythereafterarisingbetweenthepartiesisvalid,enforceableandirrevocablesaveupon D! suchgroundsasexistatlaworinequityfortherevocationofanycontract.Tenn.CodeAnn.29 0"  5302(a)(2000);seealso  _Buraczynski_Ԁv._Eyring_ ,919S.W.2d314,318(Tenn.1996); Howellv. #l! _NHC_ԀHealthcareFortSanders,Inc. ,109S.W.3d731,733(Tenn.Ct.App.2003)#XGXXWXGR#WXGXXXG.#XGXXWXG$V# $X"   TheSupremeCourtin _Buraczynski_Ԁv._Eyring_Ԁ heldthatarbitrationagreementsbetween %0!$ physiciansandtheirpatientsare notvoidasagainstpublicpolicy,andarethereforeenforceable &"% undertheTennesseeArbitrationAct. Id .at316.TheHighCourtpointedoutthat undertheterms  ofthe[TennesseeArbitrationAct],arbitrationagreementsgenerallyareenforceableunlessgrounds  fortheirrevocationexistinequityorincontractlaw. Id .at318.Thecourtnotedawordofcaution:    8 ` Wecaution,however,thatsuchagreementsmayconstitutecontracts ` ofadhesionwhichmustbecloselyscrutinizedtodetermineif L  unconscionableoroppressivetermsareimposeduponthepatient 8  whichpreventenforcementoftheagreement.$ t` x` x  Id .at316.  L    Afterdeterminingthatno facialfeatures,  inthearbitrationagreementunderdiscussion $  wouldpreventenforcement,thecourtstatedthatthisdidnotendtheinquiry. Id .Thecourt   explainedwhatitmeantbythiscomment:     8 ` Wemustexaminetheagreementsinquestiontodeterminewhether   theyarecontractsofadhesion,andifso,whethertheycontainsuch p unconscionableoroppressivetermsastorenderthemunenforceable.\` x` x  Id .Alludingtocasesfromotherjurisdictions,thecourtindicatedthatithadtodecidewhether such 4 [arbitration]agreementsareunenforceablecontractsofadhesion. Id. (emphasisadded).Quoting  p directlyfromBlacksLawDictionary40(6thed.1990),theSupremeCourtdefinedacontractof  \ adhesionas H   8 ` astandardizedcontractformofferedtoconsumersofgoodsand   servicesonessentiallya takeitorleaveitbasis,withoutaffording   theconsumerarealisticopportunitytobargainandundersuch  conditionsthattheconsumercannotobtainthedesiredproductor  serviceexceptbyacquiescingtotheformofthecontract.` x` x  Id .Thecourtnotedthatthe distinctivefeatureofacontractofadhesion isthattheweakerparty X  [i.e.,theconsumer]hasnorealisticchoiceastoitsterms. Id. (quoting _Broemmer_Ԁv.Abortion D! _Servs_.ofPhoenix,Ltd. ,173Ariz.148,840P.2d1013,1016(1992));seealso _Leong_Ԁv.Kaiser 0"  Found.Hosp. ,71Haw.240,788P.2d164,168(1990); Wheelerv.St.JosephHosp. ,63Cal.App. #l! 3d345,356,133Cal._Rptr_.775,783(1976).TheSupremeCourtemphasized,however,thata $X" contractofadhesionisnotautomaticallyunenforceable. _Eyring_ ,919S.W.2dat320. $D #   Thecourtin _Eyring_ concludedthatthetwoidenticalarbitrationagreementsbeforeitwere &"% contractsofadhesion.Itgaveitsrationaleforthisconclusion: '#&   8 ` Theagreementsarestandardizedformcontractspreparedbythe )$( contractingpartywithsuperiorknowledgeofthesubjectmatter!the |*%) renditionofmedicalservices.Theagreements,by_Eyring_sown h+&* admission,wereofferedtothepatientsona takeitorleaveitbasis.  Hadthesepatientsrefusedtosigntheagreements,_Eyring_Ԁwouldnot  havecontinuedrenderingmedicalcaretothem.Althoughthe  patientscouldhaverefusedtosignthearbitrationagreementsand t soughtoutanotherphysicianinthearea,thatactionwouldhave ` terminatedthephysicianpatientrelationship(ordinarilyoneoftrust) L  andinterruptedthecourseofthepatientstreatment.Tomakeany 8  choicewouldbedifficult;buttochoosenottosignwouldresultin $ t thelossofthedesiredservice!medicaltreatmentfrom_Eyring_. `` x` x  Id .(emphasisinoriginal).Thecourtnext  turnedtothequestionofwhethercontractsofadhesion  8  areenforceable,statingthat $    8 ` [_e]nforceability_Ԁgenerallydependsuponwhetherthetermsofthe   contractarebeyondthereasonableexpectationsofanordinary   person,oroppressiveorunconscionable. ` x` x  Id .(citationomitted).Afterreviewingcasesfromotherjurisdictions,thecourtstatedthat, \   8 ` ingeneral,courtsarereluctanttoenforcearbitrationagreements 4 betweenpatientsandhealthcareproviders_m #  7      _Ԁwhentheagreementsare  p hiddenwithinothertypesofcontractsanddonotaffordthepatients  \ anopportunitytoquestionthetermsorpurposeoftheagreement. H Thisissoparticularlywhentheagreementsrequirethepatientto 4 choosebetweenforeverwaivingtherighttoatrialbyjuryor   foregoingnecessarymedicaltreatment,andwhentheagreementsgive   thehealthcareprovideranunequaladvantageinthearbitration  processitself.` x` x  Id .at321. l   TheSupremeCourtin _Eyring_ determinedthattheagreementsbeforeitwereenforceable. D!  Id. TheHighCourtreasonedthatnothingintheagreementswasunconscionable,oppressive,or 0"  outsidethereasonableexpectationsofthepartiesinthatcase. Id. Thecourtmentionedthe #l! followingfactsassupportiveofitsconclusion:(1)theagreementwasa separate,onepage $X" document[]...entitledPhysicianPatientArbitrationAgreement;(2)theagreementhadan $D # attached shortexplanationthatencouragedthepatienttoaskquestions;(3)thephysiciandidnot %0!$ haveanunfairadvantageinthearbitrationprocedure;(4)thepatientwasclearlyinformedin ten &"% point,capitalletterredtypethat bysigningthiscontractyouaregivingupyourrighttoajuryor '#& courttrial;(5)thetermsoftheagreementareclearly laidoutandarenotburied,includingthe (#' termthatbindsthepatientsspouseandheirstotheagreement;(6)apatientmayrevokethe  agreementwithin30daysand regaintherighttoatrialbyjury;and(7)thearbitrationagreement   merely[shifts]thedisputestoadifferentforum,ratherthanlimitingliability. Id.     In Howellv._NHC_/Healthcare!FortSanders,Inc. ,109_S.W._Ԁ3d731(Tenn.Ct.App.2003), ` weappliedtheholdingin _Eyring_ anddeterminedthatamediationandarbitrationprovision L  containedinanursinghomesadmissionagreementwasunenforceable.WXGXXXGSee Howell ,109S.W.3d 8  at73435.  #XGXXWXGw#ԀThehusbandin Howell executedanadmissionagreementforhiswifebeforeshewas $ t admittedtothedefendantsnursinghome. Id. at732.Thewifehadtobeplacedinthenursinghome  ` quickly,  andtheadmissionagreementhadtobeexecutedbeforeshecouldbeadmitted. Id. Because  L  thepatientshusbandcouldnotread,theadmissionscoordinatorundertooktoexplainthetermsof  8  theagreementtohim. Id. Theestateofthepatientsubsequentlysuedthenursinghome,claiming $  abuseandneglect,aswellas inflictionofphysicalsufferingandmentalanguish. Id. at731.The   nursinghomefiledamotiontocompelmediationandarbitration. Id .Beforeruling,thetrialcourt   conductedanevidentiaryhearingwheretheadmissionscoordinator,thepatientshusband,andthe   patientschildrentestified. Id .at732.     Thetrialcourtin Howell, which,aspreviouslynoted,isthesamecourtasintheinstantcase, \ refusedtoordermediationorarbitration. Id .Itsrefusalwasbaseduponitsdeterminationthatthe H admissionagreementwasunenforceablebecause(1)thepatientshusbandcouldnotreadand(2)the 4 admissionscoordinatorfailedtoexplainthatbysigningtheagreementhewaswaivinghiswifes  p righttoajurytrial. Id. at735.Weaffirmedthetrialcourtin Howell becausethenursinghome  \  _ha[d_]notdemonstratedthatthepartiesbargainedoverthearbitrationterms,orthatit[sic]was H withinthereasonableexpectationsofanordinaryperson. Id. 󀀀 4   Weheldin Howell thatthepartyseekingtoenforceanalternativedisputeresolution   agreementmustshowthattheparties actuallybargainedoverthearbitrationprovisionorthatit  wasareasonabletermconsideringthecircumstances. Id. at734(quoting Brownv._Karemor_Ԁ_Intl_,  Inc. ,C/ANo.01A019807CH00368,1999WL221799,at*3(Tenn.Ct.App.M.S.,filedApril  19,1999)). p   In Howell, werelieduponthefollowingfactsindecidingtheagreementtherewasnot H! enforceable:(1)theagreementwaselevenpageslongandthemediationandarbitrationprovisions 4"  wereonpageten;(2)thearbitrationandmediationprovisionswere buriedinthelarger  #p! admissionagreement, [_r]ather_Ԁthanbeingastandalonedocument;(3)thearbitrationandmediation  $\" provisionswereprintedinthesamefontsizeastheothertextintheagreement;(4) thearbitration $H # paragraphdoesnotadequatelyexplainhowthearbitrationprocedurewouldwork,exceptaswho %4!$ wouldadministerit;  (5)thepatienthadtobeadmittedinanursinghome expeditiouslyandthe & "% admissionagreementhadtobesignedfirst;(6)theadmissionagreementwaspresentedtothe ' #& patientshusbandona takeitorleaveitbasis;(7)thepatientshusband hadnorealbargaining (#' power;and(8)thepatientshusbandcouldnotreadandthenursinghomerepresentativedidnot )$(  adequatelyexplainthe  provisionthatwaivedthepatientsrighttoajurytrial. Id .at73435. *%)   l+&*   III.      Theplaintiffintheinstantcasemakesnumerousargumentsonappeal.Sheassertsthatthe  mediationandarbitrationlanguageintheinstantcaseisidenticaltothelanguagethatwasdeclared t unenforceablein Howell ._n #  8      _Ԁ  Next,shearguesthatthemediationandarbitrationprovisionsinthiscase ` containtermsthattheSupremeCourtdeclaredunenforceablein _Eyring_ .Shefurtherarguesthatthe L  agreementisnotenforceablebecauseMr.Coxdidnothaveauthoritytowaiveanyofhiswifes 8  rightsorbindhertothedisputeresolutionprocedures.ShecontendsthatMr.Coxdidnothave $ t authorityorcapacitytoconsenttoarbitrationbecausehedidnot knowinglyandintelligentlywaive  ` hiswifesrighttoajurytrial.Shealsoarguesthattheadmissionagreementisvoidand  L  unenforceablebecauseitviolatesfederallawprohibiting anursinghomefromtakinganyadditional  8  considerationapartfromMedicare/Medicaidreimbursementaspartoftheadmissionsprocessfor $  residence.See  42U.S.C.1396r(c)(5)(A)(iii);42_C.F.R._Ԁ483.12(d)(3),489.30.Lastly,she   arguesthatthe presumptioninfavorofarbitrationdoesnotapplywhenthereisa questionof   whetheravalidarbitrationagreementexists. WefindpersuasivetheplaintiffsargumentsthatMr.   Coxdidnothavetheexpressorapparentauthoritytosigntheadmissionagreementforhiswifeand   thatthealternativedisputeresolutionprovisionsareotherwiseunenforceable.Wewilladdressthe p latterofthesetwoargumentsfirst. \   Weholdthattheadmissionagreementintheinstantcaseisacontractofadhesionbecause 4 theadmissionscoordinatorofferedittoMr.Coxonatakeitorleaveitbasis,i.e.,Mr.Coxhadto  p signtheagreementaswrittenorhiswifewouldnotbeadmitted.See _Eyring_ ,919_S.W._Ԁ2dat320.  \  Mr.Cox,astheweakerparty,wasnotaffordedanopportunitytobargainoverthetermsofthe H agreement.Hecertainlyhadnoopportunitytobargainoverthemediationandarbitrationprovisions. 4 Hewashandedaformcontract,under,whatwasforhim,verytryingcircumstances,i.e.,hisneed   toquicklyfindaccommodationsforhisailingwife.Itisclearhehadtwooptions:signtheform   contractaspresentedtohimbythedefendant,therebyclearingthewayforhiswifesadmissionto  thedefendantsfacilityorrefusetosignthecontractandthereaftertrytomakearrangementsforhis  wifesshelterandrelatedaccommodations.Thisisaclassiccaseofacontractofadhesion.    Followingtheteachingsof _Eyring_ and Howell ,weholdthatthemediationandarbitration X  provisionsareunenforceable.Insoholding,werelyuponthefollowingfacts:unlike _Eyring_ , the D! disputeresolutionproceduresinthiscaseareapartofanelevenpagecontractdealingwithmany 0"  issues,includingfinancialarrangementsandconsenttocare,ratherthanbeingsetforthinaseparate #l! standalonedocument; thedisputeresolutionproceduresdonotcontainanytypeof short $X" explanationencouragingpatientstoaskquestions; essentialtermsinthemediationandarbitration $D # provisionsare buriedandnotclearly laidout;therearenoprovisionsaddressinghowmediation %0!$ andarbitrationwork;mostsignificantly,theprovisionwaivingapatientsrighttoajurytrialis &"% buried!andinnowayhighlighted!inthethirdparagraphofthemediationandarbitration  provisions;thedisputeresolutionproceduresseemtoimplythatthedefendantaloneisresponsible  forchoosingthearbitrator;and,unlikethearbitrationagreementin d_Eyring_ ,dthedisputeresolution  proceduresbeforeus,includingtheprovisionwaivingajurytrial,areprintedinthesamefontsize, t type,andcolorastherestoftheagreement. `   Asastandalonebasisforourdecision,weconcludethattheevidencebeforeus 8  preponderatesagainstthetrialcourtsimplicitdecisionthatMr.Coxhadauthoritytosignthe $ t admissionagreementonbehalfofhiswife.Thereisabsolutelynoevidencethathehadherexpress  ` authoritytosignforher.Wealsoholdthatthedefendantcannotrelyupontheconceptofapparent  L  authority.TheevidencereflectsthatMrs.Coxhadhermentalfaculties,was sharperthanher  8  husband,andwasotherwiseinapositiontoindicatewhethersheassentedtothetermsofthese $  significantcontractprovisions.Therecordisalsodevoidofanyexigentcircumstancesthatwould   clotheMr.Coxwithapparentauthoritytobindhiswifetotheadmissionagreement,particularlythe   alternativedisputeresolutionprovisions.Wecertainlyfindnothingintherecordbeforeus,either   factuallyorlegally,warrantingaholdingthatMr.Coxhadtherighttowaivehiswifesveryvaluable   constitutionalrighttoajurytrialtoadjudicateherrightsinthismatter.Astheadmissions p coordinatoracknowledged,Mrs.Cox wascapableofunderstandingtheadmissionagreement.The \ admissionscoordinatordidnotadequatelyexplainwhyshedidnotinsistuponMrs.Coxsigningthe H admissionagreement,or,ataminimum,whyshedidnotaskMrs.Coxtoratifywhatherhusband 4 hadpurportedtodoonherbehalf.  p @ll)IV.  Insummary,weholdthatMr.CoxdidnothavetheactualorapparentauthoritytobindMrs.   Coxtothealternativedisputeresolutionprovisionsintheadmissionagreement.Furthermore,these   provisions,especiallythewaiveroftherighttoajurytrial,areoutsidethereasonableexpectations  ofareasonableconsumer,and,hence,unenforceable.Following _Eyring_ and Howell ,weholdthat  thetrialcourterredwhenitdecreedthatthemediationandarbitrationtermswereenforceable.  Therefore,weconcludethatthejudgmentbelowmustbereversed. p   Inviewofourholding,wedonotfinditnecessarytoreachtheplaintiffsargumentbased H! uponherinterpretationof42U.S.C.1396r(c)(5)(A)(iii)and42_C.F.R._Ԁ483.12(d)(3),489.30. 4"    0 @ V.  $\"     Theorderofthetrialcourtgrantingthedefendantsmotiontocompelmediationand %4!$ arbitrationpursuanttothedisputeresolutionproceduresinthenursinghomeadmissionagreement & "% isreversed.Costsonappealaretaxedtotheappellees,_NHC_ԀHealthcare/Knoxville,Inc.and_NHC_ ' #& Healthcare/Knoxville,LLC.Thiscaseisremandedforfurtherproceedingsconsistentwiththis (#' opinion. )$(  l+&* 0   `     h      p _______________________________(#(# 0   `     h      p CHARLESD.SUSANO,JR.,JUDGE