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ÔÔ€eÔÝ  ÝÑ  Ñ›Ñ7€zXXdÈdÈ7ÑÑ\R AØ'\ÑÑ ` ÑÑ  ÑÑ , ÑÑ 5 ÑÑ  ÑÑ€f §u` ќـ€ÙßR€hjgA1-j|` Å `€€@ÿRß›Þ ÞÌà@ àCOURT€OF€APPEALS€OF€TENNESSEEÌÌà@ àAT€KNOXVILLEÌÌÌÌÌÌJACQUELINE€SUE€ROGERSà@ àà@ à)à àHAMILTON€COUNTYà àÌà@ à)à à03A01„9707„CV„00249Ìà àPlaintiff„Appellee€€€€€€€€€€€€€€€€€€€€€€€€à àà àà àà@ à)Ìà@ à)Ìà@ à)Ìà àv.à àà àà àà@ à)à àHON.à àROBERT€M.€SUMMITT,Ì€€€€€€€€€€€€€€€€€€€€€€€à@ à)à àJUDGEÌà@ à)à à€€€€€€€€€€€€€€€€€€€à@ à€ÌSAMUEL€L.€BANKS€and€CATHYà@ à)ÌJ.€STANCIL€€€€€€€€€€€€€€€€€€€€€à@ à)Ìà à€€€€€€€€€€€€€€€€€€€€€€à@ à)à àREVERSED,€DISMISSEDÌà àDefendants„Appellantsà@ à)à àand€REMANDEDÌÌÌÌÌÌE.€BLAKE€MOORE€and€JOHN€B.€BENNETT€OF€CHATTANOOGA€FOR€APPELLANTSÌÌKATHRYN€R.€LEIDERMAN€OF€JASPER€and€JOHN€O.€WIGGINS€OF€RINGGOLD,ÏGEORGIA€FOR€APPELLEEÌÌÌÌÌà àà àà àà à€€€€€òòO€P€I€N€I€O€NóóÌÌÌÌÌà àà àà àà àà àà à€€à àà àà à€€Goddard,€P.J.€ÌÌÌÌÌÓÓà àà àSamuel€L.€Banks,€a€doctor,€and€Cathy€J.€Stancil,€aÏnurse,€appeal€a€jury€verdict€rendered€against€them€in€favor€ofÍtheir€former€patient,€Jacqueline€Sue€Rogers.€€Ms.€Rogers€broughtÏtwo€actions€of€medical€malpractice€in€the€Hamilton€County€CircuitÏCourt.€€One€action€was€brought€against€Dr.€Banks,€her€treatingÏphysician.€€The€other€action€was€brought€against€Nurse€Stancil.€ÏNurse€Stancil€performed€the€majority€of€the€procedure€in€question.€ÏJudge€Robert€M.€Summitt€denied€motions€for€directed€verdict€afterÏMs.€Rogers€presented€her€case€and€again€after€Dr.€Banks€and€NurseÏStancil€presented€their€case.€€Both€actions€were€submitted€to€theÏjury.€€The€jury€returned€a€general€verdict€against€both€Dr.€BanksÏand€Nurse€Stancil€for€$60,000.€€Dr.€Banks€and€Nurse€Stancil€bothÏfiled€motions€for€judgments€œnotwith›„€standing€the€verdict€as€wellÏas€motions€for€a€new€trial.€€Judge€Summitt€overruled€these€motionsÏand€upheld€the€jury€award.€€We€now€reverse€the€judgment€below€andÏdismiss€both€suits€with€prejudice.ÌÌà àà àDr.€Banks€and€Nurse€Stancil€present€22€issues€on€appeal.€ÏHowever,€we€only€need€to€decide€two€issues€to€dispose€of€thisÏappeal.€€These€two€issues€are€(1)€whether€the€Trial€Court€erred€inÏsubmitting€Dr.€Banksðð€case€to€the€jury€in€the€absence€of€expertÏtestimony€that€he€violated€a€recognized€standard€of€acceptableÏprofessional€practice€and€that€any€medical€negligence€on€his€partÏwas€the€proximate€cause€of€Ms.€Rogersðð€injury€which€would€notÏotherwise€have€occurred;€and€(2)€whether€the€Trial€Court€erred€inÍsubmitting€Nurse€Stancilððs€case€to€the€jury€in€the€absence€ofÏexpert€testimony€that€she€violated€a€recognized€standard€ofÏacceptable€professional€practice€and€that€any€medical€negligenceÏon€her€part€was€the€proximate€cause€of€Ms.€Rogersðð€injury€whichÏwould€not€otherwise€have€occurred.ÌÌà àà àMs.€Rogers€sought€to€have€spider€veins€removed€from€herÏlegs.€€Dr.€Banks€agreed€to€perform€this€service€employingÌa€procedure€known€as€sclerotherapy.€€Sclerotherapy€basicallyÏinvolves€using€a€very€tiny€needle€superficially€to€inject€aÏminuscule€amount€of€hypertonic€saline€into€the€spider€vein€whichÏpushes€the€unsightly€blood€out€of€the€veins€and€causes€the€veinsÏto€deteriorate,€resulting€in€their€no€longer€being€visible.€€Dr.ÏBanks€initially€examined€Ms.€Rogers€and€advised€Nurse€StancilÏwhich€spider€veins€should€be€injected.€€Nurse€Stancil€performedÏall€of€the€injections€administered.€€The€removal€of€spider€veinsÏis€usually€performed€in€sessions.€€Each€session€cannot€beÏconducted€within€either€two€to€four€weeks€of€another€session.€€Ms.ÏRogers'€first€session€occurred€on€March€30,€1994.€€She€hadÏmultiple€injections€on€that€day€without€incident.€€Ms.€RogersÏreturned€to€have€other€spider€veins€treated€in€the€same€manner€twoÏweeks€later,€on€April€13,€1994.€€The€injury€giving€rise€to€thisÏsuit€resulted€from€this€session.ÌÌà àà àThe€same€method€and€technique€of€injecting€the€spiderÏveins€was€used€in€both€sessions.€€After€Nurse€Stancil€hadÏcompleted€all€the€injections€on€April€13,€1994,€she€wrapped€Ms.ÏRogersðð€legs€in€an€Ace€bandage,€standard€procedure€for€all€spiderÏvein€treatment€sessions.€€However,€Ms.€Rogers€soon€beganÏcomplaining€to€Nurse€Stancil€that€her€legs€were€burning€and€thatÏshe€felt€strange.€€Nurse€Stancil€unwrapped€the€Ace€bandage€andÏnoticed€that€Ms.€Rogers€was€having€an€adverse€reaction€to€theÏinjections.€€Nurse€Stancil€immediately€requested€that€Dr.€BanksÏcome€to€the€treatment€room.€€Dr.€Banks€immediately€arrived€at€theÏtreatment€room€and€examined€the€injection€sites.€€He€noted€thatÏone€of€the€sites€was€grossly€different€from€all€the€others.€€Dr.ÏBanks€then€injected€ten€cubic€centimeters€of€Xylocaine,€aÏnovocaine€type€solution,€into€the€injured€area.€€He€then€massagedÏthe€area€for€a€minute€or€two.€€Ms.€Rogers€remained€at€Dr.€Banks'Ïoffice€until€the€pain€subsided.€€She€subsequently€began€to€developÏa€deep€ulcer€at€the€site€of€the€injection€that€went€awry.€€Ms.ÏRogers€suffered€for€several€months€and€underwent€two€surgeries€inÏorder€for€the€ulcer€to€heal.ÌÌà àà àSeveral€doctors€testified€as€experts€during€the€trial.€ÏEach€of€the€doctors€testified€that€the€cause€of€the€ulcer€was€thatÍa€small€amount€of€the€injected€hypertonic€saline€had€gone€deeperÏthan€the€superficial€area€of€the€skin,€where€spider€veins€areÏlocated.€€After€the€solution€reached€the€deeper€arteries,€theseÏarteries€deteriorated.€€Due€to€this€deterioration,€the€surroundingÏflesh€died,€creating€the€ulcer.€€This€process€is€referred€to€inÏthe€medical€community€as€a€vasospasm.€€Only€two€plausibleÏexplanations€were€presented€at€trial€as€to€how€this€solutionÏreached€the€deeper€arteries.€€The€first€is€that€Nurse€StancilÏdirectly€and€negligently€injected€an€arteriole.€€The€second€theoryÏis€that€the€solution€reached€the€underlying€artery€through€theÏoccurrence€of€an€AV€fistula.ÌÌà àà àAn€AV€fistula,€arteriovenous€anastomosis,€is€anÏanatomical€condition€where€a€direct€connection€exists€between€aÏvery€small€vein,€such€as€a€spider€vein,€and€a€very€small€artery.€ÏThis€connection€bypasses€the€capillary€network€which€usuallyÏseparates€the€small€veins€from€the€small€arteries.€€AV€fistulasÏare€exceedingly€rare€physical€anomalies.€€The€existence€of€an€AVÏfistula€can€only€be€determined€through€use€of€a€microscope€duringÏan€autopsy.€€Thus,€the€existence€of€this€condition€is€impossibleÏto€detect€by€health€care€providers.€€If€an€AV€fistula€did€exist€inÏMs.€Rogersðð€leg,€no€doctor€could€have€determined€that€she€had€theÏcondition.€€Also,€an€ulcer€will€result€if€an€AV€fistula€existsÍeven€if€a€spider€vein€injection€is€properly€performed€according€toÏthe€recognized€standard€of€acceptable€professional€practice,€alsoÏknown€as€the€standard€of€care.€ÌÌà àà àEach€doctor€testified€that€it€is€impossible€to€determineÏexactly€how€the€solution€reached€the€arteriole.€€Dr.€Robert€E.ÏClark,€Ms.€Rogersðð€expert,€testified€that€the€ulcer€probablyÏresulted€from€the€direct€injection€of€the€solution€into€anÏarteriole€while€providing€no€support€for€his€opinion.€€However,€heÏlater€testified€that€the€ulcer€could€have€occurred€due€to€an€AVÏfistula.€€Dr.€Clark€had€no€criticism€of€Nurse€Stancilððs€technique.€ÏHe€only€criticized€Nurse€Stancil€due€to€her€lack€of€knowledgeÏabout€potential€complications€resulting€from€the€spider€veinÏtreatment.ÌÌà àà àNurse€Stancil€testified€as€to€the€technique€she€used€onÏMs.€Rogers.€€Dr.€Clark€testified€that€the€technique€was€within€theÏstandard€of€care.€€Other€doctors€testified€that€if€the€procedureÏwas€performed€as€Nurse€Stancil€had€testified,€the€ulcer€could€onlyÏhave€been€caused€by€an€AV€fistula.€€Dr.€Banks€also€testified€thatÏit€is€impossible€to€inject€an€arteriole€just€under€the€skin€sinceÏthey€are€seven€times€smaller€than€the€needle€used€and€invisible€toÏthe€naked€eye.€€Dr.€Banks€further€testified€that€the€biggerÍarteries€are€below€the€skin€surface€and€ð ðmuch,€much€deeper€than€weÏcan€go€with€our€needle€[used€in€the€spider€vein€treatment].ððÌÌà àà àThe€only€issues,€as€previously€noted,€that€must€beÏaddressed€are€whether€Dr.€Banks€and€Nurse€Stancil€committedÏmedical€malpractice.€€In€Tennessee,€plaintiffs€have€a€heavy€burdenÏto€prove€that€a€health€care€provider€committed€medicalÏmalpractice.€€T.C.A.€29„26„115€provides€the€necessary€elementsÏthat€plaintiffs€must€show€in€order€to€prevail€in€a€medicalÏmalpractice€action.€€This€statute€provides€that:ÌÌÒ  ÒÒ  ÒÓÓ(a)€In€a€malpractice€action,€the€claimant€shall€have€theÏburden€of€proving€by€evidence€as€provided€by€subsectionÏ(b)[qualified€experts]:ÌÌ(1)€The€recognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€the€specialty€thereof,€ifÏany,€that€the€defendant€practices€in€the€community€inÏwhich€he€practices€or€in€a€similar€community€at€the€timeÏthe€alleged€injury€or€wrongful€action€occurred;ÌÌ(2)€That€the€defendant€acted€with€less€than€or€failed€toÏact€with€ordinary€and€reasonable€care€in€accordance€withÏsuch€standard;€andÌÌ(3)€As€a€proximate€result€of€the€defendantððs€negligentÏact€or€omission,€the€plaintiff€suffered€injuries€whichÏwould€not€otherwise€have€occurred.ÌÌÒ ° ÒÒ ° ÒÓÓT.C.A.€29„26„115(a).€€All€three€elements€must€be€shown€by€aÏpreponderance€of€the€evidence€for€a€plaintiff€to€prevail.€€T.C.A.Ï29„26„115(d).€€The€statute€also€provides€that€there€ð ðshall€be€noÍpresumption€of€negligence€on€the€part€of€the€defendantðð€due€to€theÏfact€of€injury€alone.€€T.C.A.€29„26„115€(c)€&€(d).ÌÌà àà àDr.€Banks€and€Nurse€Stancil€contend€that€Ms.€RogersÏfailed€to€show€two€of€the€required€elements.€€They€argue€that€Ms.ÏRogers€did€not€show€a€deviation€from€the€recognized€standard€ofÏacceptable€professional€practice€or€that€any€medical€negligenceÏwas€the€proximate€cause€of€Ms.€Rogersðð€injury€which€would€notÏotherwise€have€occurred.ÌÌà àà àIn€òòWard€v.€United€Statesóó,€838€F.2d€182€(6th€Cir.1988),Ïthe€6th€Circuit€Court€of€Appeals€summarized€its€understanding€ofÏthe€Tennessee€rule€as€to€violation€of€standard€of€care.€€TheÏTennessee€Court€of€Appeals,€in€òòHurst€by€Hurst€v.€Doughertyóó,€800ÏS.W.2d€183,€185€(Tenn.App.1990),€subsequently€adopted€the€òòWardóóÏsummary€of€the€law€as€follows:€€ÌÌÒ  ÒÒ  ÒÓÓ[A]€physicianððs€duty€is€to€exercise€reasonable€care€andÏdiligence.€€He€must€exercise€his€best€judgment€regardingÏtreatment,€and€is€not€guilty€of€malpractice€if€heÏchooses€a€course€of€treatment€supported€by€otherÏphysicians€in€good€standing.€€òòTruan€v.€Smithóó,€578€S.W.2dÏ73,€75„76€(Tenn.1979).€€A€physician€is€not€the€insurorÏof€the€patient;€he€is€only€liable€for€negligence,€andÏnegligence€is€not€presumed€from€the€fact€that€theÏtreatment€is€unsuccessful.€€Liability€for€malpracticeÏdepends€on€whether€or€not€the€physician€is€lacking€inÏand€fails€to€exercise€the€reasonable€degree€of€learning,Ískill,€and€experience€that€is€ordinarily€possessed€byÏothers€of€his€profession.€€òòWatkins€v.€United€Statesóó,€482ÏF.Supp.€1006,€1012€(M.D.Tenn.1980).€€ÌÌÌÌÒ ° ÒÒ ° ÒÓÓà àà àIn€òòWardóó,€the€doctor€accidentally€injected€Teflon€pasteÏtoo€deeply€into€an€artery.€€This€accident€caused€the€patient€toÏsuffer€a€stroke.€€There€was€no€question€in€the€case€that€theÏdoctorððs€act€was€the€proximate€cause€of€the€injury.€€However,€theÏCourt€held€that€the€doctor€was€not€liable€since€he€exercised€dueÏcare€in€making€the€injection.ÌÌà àà àDr.€Banks€trained€Nurse€Stancil€for€an€extended€periodÏof€time.€€He€required€her€to€use€specific€procedures€whenever€sheÏperformed€spider€vein€injection€treatments.€€These€procedures€areÏcustomary€in€the€field€for€the€removal€of€spider€veins.€€Dr.€ClarkÏtestified€that€it€was€acceptable€to€have€a€nurse€perform€theÏinjections€if€properly€trained,€so€long€as€the€doctor€is€in€chargeÏand€available€for€immediate€consultation.€€Drs.€Banks,€RodneyÏSusong,€and€John€Cranwell€all€testified€that€it€is€within€theÏstandard€of€care€for€a€nurse€to€perform€spider€vein€injections.€ÏAllowing€nurses€to€perform€these€injections€is€allowable€so€longÏas€the€nurse€possesses€the€training€and€skill€to€recognize€when€aÏcomplication€has€occurred€and€immediately€notifies€the€supervisingÍdoctor€of€any€such€complications.€€We€cannot€require€nursingÏpersonnel€to€possess€all€the€training€of€medical€doctors.ÌÌà àà àFurther,€several€doctors€testified€that€it€was€withinÏthe€standard€of€care€for€hypertonic€saline€to€be€used€in€theÏspider€vein€treatment.€€Hypertonic€solution€is€actually€the€mostÏcommonly€used€solution€in€performing€this€procedure.€€This€is€theÏcase€even€though€the€Food€and€Drug€Administration€has€not€approvedÏthe€use€of€the€solution€in€sclerotherapy.€€Ms.€Rogers€presented€noÏproof€that€use€of€this€solution€violated€the€standard€of€care.ÌÌà àà àMs.€Rogers€also€contended€that€Dr.€Banks€violated€theÏstandard€of€care€by€not€taking€adequate€counter„measures.€€Dr.ÏClark€testified€that€an€appropriate€counter„measure€is€vigorouslyÏmassaging€the€area€of€a€vasospasm.€€Dr.€Cranwell€also€testifiedÏthat€vigorous€massage€and€injecting€Xylocaine€were€bothÏappropriate€counter„measures€and€within€the€standard€of€care.€ÏDrs.€Susong,€Cranwell,€and€Banks€further€testified€that€noÏcounter„measures€taken€could€stop€the€vasospasm€nor€the€resultantÏulcer.€€Thus,€Dr.€Banksðð€actions€were€within€the€recognizedÏstandard€of€acceptable€professional€practice.ÌÌà àà àDr.€Banksðð€actions,€with€regard€to€Ms.€Rogersðð€spiderÏvein€treatment,€did€not€violate€the€recognized€standard€ofÏacceptable€professional€practice.€€This€conclusion€is€supported€byÏall€the€expert€testimony€proffered€at€trial.€€Ms.€Rogers€presentedÏno€material€evidence€to€the€contrary.€€Therefore,€we€hold€that€Dr.ÏBanks€did€not€commit€medical€malpractice€because€Ms.€Rogers€didÏnot€introduce€proof€as€to€each€of€the€three€required€elementsÏunder€T.C.A.€29„26„115.€€The€Trial€Courtððs€decision€to€submit€theÏcase€to€the€jury€is€overturned€and€the€claim€is€accordinglyÏdismissed.ÌÌà àà àWe€now€turn€our€attention€to€Ms.€Rogersðð€medicalÏmalpractice€claim€against€Nurse€Stancil.€€Ms.€Rogers€initiallyÏargued€at€trial€that€Nurse€Stancil€violated€the€recognizedÏstandard€of€acceptable€professional€practice.€€Nurse€StancilÏtestified€that€she€used€the€same€procedure€on€Ms.€Rogers€as€sheÏhad€on€every€other€spider€vein€treatment€patient.€€In€the€spiderÏvein€treatment,€Nurse€Stancil€and€Dr.€Banks€use€a€bent€needle€soÏthe€needle€is€parallel€to€the€skin.€€Nurse€Stancil€testified€thatÏone€can€actually€see€the€needle€in€the€spider€vein€since€it€is€soÏclose€to€the€surface€of€the€skin.€€Nurse€Stancil€and€Dr.€BanksÏalso€use€a€test€to€determine€if€the€needle€is€in€the€vein.€€NurseÏStancil€testified€that€she€injects€a€small€amount€of€air€into€theÍvein€to€insure€the€needle€is€in€the€vein.€€When€she€injects€theÏair,€blood€comes€out€of€the€injection€site,€insuring€theÏpractitioner€that€the€needle€is€in€the€vein.€€Immediately€afterÏinjecting€the€air€and€without€removing€the€needle€from€the€vein,Ïthe€hypertonic€saline€solution€is€injected€into€the€spider€vein€toÏcomplete€the€treatment.€€ÌÌà àà àAs€already€noted,€Nurse€Stancil€testified€that€she€usesÏthis€procedure€on€every€spider€vein€injection€she€performs€and€didÏso€with€Ms.€Rogers.€€Each€of€the€experts,€all€doctors,€testifiedÏthat€Nurse€Stancilððs€technique€was€properly€within€the€standard€ofÏcare€and€that€it€was€also€within€the€standard€of€care€for€nurseÏpractitioners€to€perform€these€injections.€€No€expert€testimonyÏwas€presented€by€Ms.€Rogers€that€Nurse€Stancil€deviated€from€theÏstandard€of€care.€€Thus,€Nurse€Stancilððs€actions€taken€with€regardÏto€Ms.€Rogers€were€well€within€the€standard€of€care.ÌÌà àà àMs.€Rogers€claimed€in€the€alternative€that€not€knowingÏall€potential€complications€of€the€spider€vein€treatment€was€aÏviolation€of€the€standard€of€care.€€Two€experts€testified€that€aÏpractitioner€performing€the€spider€vein€treatment€must€know€allÏpotential€complications€and€appropriate€counter„measures.€€OtherÏdoctors€testified€that€it€was€within€the€standard€of€care€if€aÍnurse€did€not€know€all€potential€complications€or€the€counter„measures€on€one€condition.€€This€condition€is€that€the€nurse€haveÏthe€requisite€skill€to€recognize€when€a€complication€is€occurring,Ïeven€if€the€nurse€does€not€know€the€source€of€the€actualÏcomplication,€and€that€the€supervising€doctor€be€nearby€andÏavailable€for€immediate€consultation.€€Thus,€a€contradiction€inÏexpert€testimony€was€presented€as€to€what€the€actual€standard€ofÏcare€was€for€nurse€practitioners€performing€spider€veinÏtreatments.€€While€we€are€inclined€to€hold€that€a€nurse€is€notÏrequired€to€possess€all€the€knowledge€of€a€medical€doctor,€we€doÏnot€need€to€decide€the€issue.€€Even€if€Nurse€Stancilððs€actionsÏviolated€the€standard€of€care,€Ms.€Rogers€failed€to€prove€thatÏNurse€Stancilððs€actions€were€the€proximate€cause€of€Ms.€RogersððÏinjury€and€that€it€would€not€otherwise€have€occurred.ÌÌÌà àà àWhile€the€injury€obviously€resulted€from€the€injection,Ïthis€does€not€satisfy€the€proximate€cause€requirement€set€forth€inÏT.C.A.€29„26„115.€€Ms.€Rogers€must€produce€proof€that€as€aÏproximate€result€of€Nurse€Stancilððs€negligent€act€or€omission,€Ms.ÏRogers€suffered€injuries€which€would€not€otherwise€have€occurred.€ÏT.C.A.€29„26„115(a)(3).€€Ms.€Rogers'€proof€must€include€thisÏelement€for€her€to€prevail€in€her€medical€malpractice€actionÍagainst€Nurse€Stancil.€€As€set€forth€above,€Ms.€Rogers€presentedÏno€material€testimony€that€Nurse€Stancil€acted€negligently€inÏperforming€the€injections€other€than€an€unsupported€statement€byÏDr.€Clark,€Ms.€Rogersðð€expert,€that€the€vasospasm€probablyÏresulted€from€an€injection€of€hypertonic€Ìsaline€into€an€arteriole.€€However,€Dr.€Clark's€hypothesis€losesÏits€validity€in€light€of€Nurse€Stancil's€unimpeached€testimony€toÏthe€contrary.× ƒk ××  ×€€Moreover,€Dr.€Clark€later€conceded€that€Ms.€Rogers'Ïinjuries€could€have€resulted€from€the€existence€of€an€AV€fistula.€ÏOther€doctors€confirmed€that€if€an€AV€fistula€did€exist,€Ms.ÏRogers'€injuries€would€have€resulted€irrespective€of€anyÏnegligence€on€the€part€of€Nurse€Stancil.€€In€addition,€Dr.ÏCranwell€testified€that€if€Nurse€Stancil€performed€the€injectionsÏas€she€testified,€then€the€only€way€Ms.€Rogersðð€injury€could€haveÏoccurred€is€by€the€existence€of€an€AV€fistula.€€Dr.€Clark€alsoÏtestified€that€he€had€no€criticism€of€Nurse€Stancilððs€technique.€ÏSince€Ms.€Rogers€failed€to€prove€that€the€injury€would€notÏotherwise€have€occurred€in€the€absence€of€negligence€and€since€sheÏfailed€to€prove€that€Nurse€Stancil€acted€negligently,€we€hold€thatÍNurse€Stancilððs€action€was€not€the€proximate€cause€of€Ms.€RogersððÏinjury.€ÌÌà àà àMs.€Rogers€also€proffers€the€position€that€NurseÏStancilððs€failure€to€know€the€source€of€the€vasospasm€orÏappropriate€counter„measures€was€a€proximate€cause€of€Ms.€RogersððÏinjury.€€However,€Drs.€Banks,€Susong,€and€Cranwell€testified€thatÏno€counter„measures€could€have€prevented€Ms.€Rogersðð€injury.€ÏFurther,€we€believe€that€lack€of€knowledge€of€counter„measuresÏcould€be€a€proximate€cause€of€injuries€in€some€cases.€€However,Ïsince€no€counter„measure€could€have€prevented€Ms.€Rogersðð€injury,Ïwe€hold€that€Nurse€Stancilððs€lack€of€knowledge€of€counter„measuresÏwas€likewise€not€the€proximate€cause€of€Ms.€Rogersðð€injury.ÌÌà àà àOne€final€issue€needs€to€be€addressed.€€Dr.€Banks€andÏNurse€Stancil€insist€that€because€they€were€entitled€to€a€reversalÏof€the€Trial€Court's€judgment€against€them€and€dismissal€of€Ms.ÏRogers'€complaint,€the€award€of€discretionary€costs€was€improper.€ÏOn€the€other€hand,€Ms.€Rogers€insists€that€such€an€award€wasÏproper€because€a€verdict€was€rendered€in€her€favor.€€In€light€ofÏour€disposition€of€the€principal€issue€raised€in€this€appeal,Ïwhich€results€in€dismissal€of€Ms.€Rogers'€complaint,€the€award€ofÏdiscretionary€costs€is€also€reversed.Ìà àà àFor€the€foregoing€reasons€the€judgment€below€is€reversedÏand€Ms.€Rogers'€claim€dismissed.€€The€cause€is€remanded€forÏcollection€of€costs€below,€which€are,€as€are€costs€of€appeal,Ïadjudged€against€Ms.€Rogers.ÌÌÓÓà àà àà àà àà àà à_______________________________Ìà àà àà àà àà àà àHouston€M.€Goddard,€P.J.€ÌÌÌCONCUR:ÌÌÌÌ________________________________ÌHerschel€P.€Franks,€J.ÌÌÌÌ________________________________ÌWilliam€H.€Inman,€Sr.J.Ì