WPCVT  0~p 0x 0kf 0k 0< 0~ 0T 0% 0  0 0  0 01 0C 0VB 0 0g 0  0 0r 0. 0 0 0eUB %J 0zP 0 1 0 ! 0=! 0F! 0P " 1p" 0## 0O>'E' 0}' 0x ( 0( 0j) 0e{) 0W) 0W7* 0* 0j+ 0|+ 05, 0- 0- 0r. 0f/ 0m0 0-1 0@2 03 04 0=5 05 0x6 07 07 08 09 19Y:ni: 04; BJ;4g; 0{;^< 0Jv<< 0J=(>>w@??@A 0@FB D+B D3B 0TB 0^8C 0hC 0rC 0|pD 0D 0rE 1uF 0dwFU6FB)GDC:G AO}GU*GGD IPJ 0K2Kv~}KvL AOR 0DS D/aS BS ASV& 8Document[8]Document Style0..8` ..` V8Document[4]Document Style.. . V 8Document[6]Document Style8..V 8Document[5]Document Style0..V/8Document[2]Document Style 2A.3  Ԁ   V& 8Document[7]Document Style0..0` ..` zU :Right Par[1]Right-Aligned Paragraph Numbers..2I.3  Ԁ..0..zh :Right Par[2]Right-Aligned Paragraph Numbers..` ..2A.3  Ԁ..0` ..` V?8Document[3]Document Style.. 21.3  Ԁ   z{ :Right Par[3]Right-Aligned Paragraph Numbers..` ..`  ..P 21.3  Ԁ` ..` 0 .. z :Right Par[4]Right-Aligned Paragraph Numbers..` ..`  .. .. 2a.3  Ԁ .. 0..z :Right Par[5]Right-Aligned Paragraph Numbers..` ..`  .. ..h..2(1)3  Ԁ..0h..hz :Right Par[6]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h..2(a)3  Ԁh..h0..z :Right Par[7]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....2i)3  Ԁ..0..z :Right Par[8]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....p..2a)3  Ԁ..0p..pVX8Document[1]Document Style  @..8  2I.3  Ԁ     Ԉ l2:Technical[5]Technical Document Style.. 2(1)3  Ԁ. l2:Technical[6]Technical Document Style.. 2(a)3  Ԁ. l/%:Technical[2]Technical Document Style 2A.3  Ԁ   .. l,!:Technical[3]Technical Document Style 21.3  Ԁ   .. l(!:Technical[4]Technical Document Style 2a.3  Ԁ   .. l:0:Technical[1]Technical Document Style  2I.3  Ԁ     .. l1:Technical[7]Technical Document Style.. 2i)3  Ԁ. l1:Technical[8]Technical Document Style.. 2a)3  Ԁ. <6X9`(*Courier 12pt10cpiXR& 8BibliogrphyBibliography0....jo4Tech InitInitialize Technical StyleS   1 .1 .1 .1 .1 .1 .1 .1 S CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1fp2Doc InitInitialize Document StyleS #    I. 1. A. a.(1)(a) i) a)S !"($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)x?t2PleadingHeader for Numbered Pleading Paper % z &(  &XXXXX6G''*d66G''*d6HH1HH2HH3HH4HH5HH6HH7HH8HH910111213141516171819202122232425262728  .+('2$ FT!   p4Heading 2Underlined Heading Flush LeftV4Heading 1Centered Heading@..  b* 8Bullet ListIndented Bullet List0..0` ..` B& $1Document Style0..8` ..` B $2Document Style.. . B $3Document Style8..B $4Document Style0..B-$5Document Style 23  Ԁ   B& $6Document Style0..0` ..` dS $7Right-Aligned Paragraph Numbers..23  Ԁ..0..df $8Right-Aligned Paragraph Numbers..` ..` 23  Ԁ..0` ..` B=$9Document Style.. 23  Ԁ   fy &10Right-Aligned Paragraph Numbers..` ..`  .. 23  Ԁ` ..` 0 .. f &11Right-Aligned Paragraph Numbers..` ..`  .. ..23  Ԁ .. 0..f &12Right-Aligned Paragraph Numbers..` ..`  .. ..h..h23  Ԁ..0h..hf &13Right-Aligned Paragraph Numbers..` ..`  .. ..h..h..23  Ԁh..h0..f &14Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....23  Ԁ..0..f &15Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....p..p23  Ԁ..0p..pDV!&16Document Style  @..  23  Ԁ     Ԉ X/&17Technical Document Style.. 23  Ԁ. X/&18Technical Document Style.. 23  Ԁ. X-(&19Technical Document Style 23  Ԁ   .. X*$&20Technical Document Style 23  Ԁ   .. X)$&21Technical Document Style 23  Ԁ   .. X83&22Technical Document Style  23  Ԁ     .. X/&23Technical Document Style.. 23  Ԁ. X/&24Technical Document Style.. 23  Ԁ.   CRight ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3|x<6X9`(*Courier 12pt10cpiXXx6X@JQX@( T$   d "$(G.2Y$ FT!   XX     0  MARVINBERKELESLIEMcWILLIAMS($   0  HOWELLBERKEFRAYN HANNCaliaVanderbiltCrosslinAlsupGilreathWhittemoreSadekTenn.CodepodiatricsAkerman2 0Indent123  ԁLevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5 kDlmUnUoDpPqrDsetӀLevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5("$    'dxdGGGG'dxd2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23  O]^_`abc ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X<  9p`(Courier New% Line 7 dmmmm7Border 1ddVYtnC << G<  9p`(Arial  F!  #d#l  pp   YYY FILEDpX July2,1997CecilCrowson,Jr.pAppellateCourtClerk  : F!#d#l  I$l         AportionofDr.Harper'sanswerwasexcluded.Hisfullanswerwas"Thatthatinfectionwasacomplicationofherpriorsurgery." F!#d#l  I$l         Dr.Akermanisalsoapodiatrist.( $ Figure  1  PtPtHH(FG(HH(d'hStyl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   h HD: Geneva  h HD: Geneva VYC<< C($$   1  ' dxdP PdRYtZ&OLE 2.0 Box <=8C HKKKK F! . l  ݛ  7CXXdd7\RA'\ `    , 5  m u` ќVRoqnA1-j|`  `@Rߛ @ INTHECOURTOFAPPEALSOFTENNESSEE@ EASTERNSECTIONSANDRAJ.SCOTT@ @ ) ANDERSONCOUNTY@ ) 03A019608CV00270 PlaintiffAppellant  @ )@ )@ ) v.  @ ) HON.JAMESB.SCOTT,JR.,̀@ ) JUDGE@ ) @ DR.GERALDB.CALIA@ )@ ) DefendantAppellee@ ) VACATEDANDREMANDEDKENNETHK.KENNEDYOFKNOXVILLEFORAPPELLANTMARTINL.ELLISandVONDAM.LAUGHLINOFKNOXVILLEFORAPPELLEE@     OPINION         Goddard,P.J.  ThismedicalmalpracticesuitarisesoutofsurgeryperformedonSandraScottsfeetbyDr.GeraldCaliaonMay17,1989.Ms.ScottcontendsthatDr.Caliawasnegligentinhismedicalcareofher.SheinsistsonappealthattheTrialCourtwasinerrorindirectingaverdictagainstheratthecloseofherproof.  Ms.Scottraisesthefollowingtwoissuesonappeal:       I.DidthetrialcourterrinexcludingthetestimonyofDr.MarionC.Harperontheissuesofcausationundertherequirementsof2926115,Tenn.CodeAnn.,1996?II.WasthetrialcourtssuaspontegrantofdirectedverdictproperunderTennesseeRulesofCivilProcedure50.01?         InApril1989Ms.ScottsoughttreatmentfromDr.Calia,apodiatrist,tocorrectavarietyofailmentsafflictingherfeet.Ms.ScottagreedtohaveDr.Caliaperformsurgeryonherfeet.Dr.CaliaperformedfiveseparatesurgicalproceduresoneachofMs.Scottsfeet.Ms.ScottcontinuedtovisitDr.Caliaforpostoperativeevaluations.DespitefollowingDr.Caliasinstructionsforthecareofhersurgicalwoundsthatremainedafterthesurgery,thesurgicalwoundonherrightgreattoefailedtoheal.  Eightmonthsafterhersurgery,Ms.ScottsoughttheopinionofDr.MarionC.Harper,anorthopedistassociatedwithVanderbiltHospitalinNashville,Tennessee.Dr.HarperperformedasecondsurgeryinFebruary1990tocombataninfectionthathadinvadedtheboneofMs.Scottsgreatrighttoe.Dr.HarperalsolaterperformedathirdsurgerytoclosethewoundonMs.ScottsgreatrighttoethathadbeenopensincetheMay1989surgeryperformedbyDr.Calia.  TherequirementsnecessaryforaplaintifftoestablishaprimafaciecaseofmedicalmalpracticeissetoutinT.C.A.2926115.Wequotethepertinentprovisionsasfollows:        2926115.Claimant'sburdeninmalpracticeactionExperttestimonyPresumptionofnegligenceJuryinstructions. 󀄄(a)Inamalpracticeaction,theclaimantshallhavetheburdenofprovingbyevidenceasprovidedbysubsection(b): (1)Therecognizedstandardofacceptableprofessionalpracticeintheprofessionandthespecialtythereof,ifany,thatthedefendantpracticesinthecommunityinwhichhepracticesorinasimilarcommunityatthetimetheallegedinjuryorwrongfulactionoccurred; (2)Thatthedefendantactedwithlessthanorfailedtoactwithordinaryandreasonablecareinaccordancewithsuchstandard;and (3)Asaproximateresultofthedefendantsnegligentactoromission,theplaintiffsufferedinjurieswhichwouldnototherwisehaveoccurred.         Tosatisfythestatutoryrequirements,Ms.ScotthadDr.IvanCooper,apodiatristsurgeonfromEastTennessee,testifyattrial.Dr.CoopertestifiedthatDr.Caliabreachedthestandardofcareforpodiatrists.First,Dr.Coopertestifiedthathebreachedthestandardofcarebyperformingtoomanysurgicalproceduresduringoneoperation.Second,Dr.Coopertestifiedthathebreachedthestandardofcarebynottakingaculturetodetermineifaninfectionwaspresentintheopenwound.Finally,Dr.Coopertestifiedthathebreachedthestandardofcarebynotperformingasecondsurgerytocoveranexposedwound.However,Dr.CoopertestifiedthathehadonlyseenMs.ScottontwooccasionsandwasnotinapositiontotestifyaboutanydamagesthatmayhaveresultedfromDr.Calia'snegligence.  ThepartiesdonotdisputethatDr.CooperstestimonysatisfiedthestandardofcarerequirementssetoutinT.C.A.2926115(1)and(2),butthathistestimonydidnotsatisfythecausationrequirementsetoutinT.C.A.2926115(3).Ms.ScottattemptedtosatisfythisstatutoryrequirementwiththetestimonyofDr.MarionHarperwho,asstatedearlier,becameMs.Scottstreatingphysician.Dr.CaliamadeamotioninliminetoexcludeanyreferencetocausationasitrelatestoanyallegeddeviationonthepartofDr.CaliabecauseDr.Harperreadilyadmittedthathelackedanyknowledgeconcerningtherecognizedstandardofacceptable,professionalpracticeintheprofessionandspecialtyofpodiatry.TheTrialCourtgrantedDr.CaliasmotioninlimineastosomeofDr.Harper'stestimonybecausehewasunfamiliarwiththestandardofcare.Ms.ScottinsiststhatshecouldhavesatisfiedthecausationrequirementthroughthedepositiontestimonyofDr.Harper.  ContrarytotheholdingoftheTrialCourt,aplaintiffinamedicalmalpracticesuitmaysatisfythecausationrequirementfoundinT.C.A.2926115(3)withtestimonyfromadoctorunfamiliarwiththestandardofcare.Forexample,adoctor,whoisunfamiliarwiththestandardofcare,mayneverthelesstestifythataspecificactofthedefendant,suchasprescribingacertaindrugtowhichtheplaintiffisallergic,causedtheplaintifftosufferinjurieswhichwouldnothaveoccurrediftheplaintiffhadnottakenthedrug.Thus,wemustreviewthedepositiontestimonyofDr.HarpertodeterminewhethertheTrialCourtproperlygrantedadirectedverdictforDr.Calia.  Uponconsiderationofamotionfordirectedverdict,thetrialcourtmustlooktoalltheevidence,takethemostlegitimateviewofitinfavoroftheopponentofthemotion,andallowallreasonableinferencesfromitinhisfavoranddiscardallcountervailingevidence.Adirectedverdictisonlyproperwhenthereisnocontroversyastoanymaterialfactthatwouldbedeterminativeofthecase.SeeCrosslinv.Alsup,594S.W.2d379(Tenn.1980).Wheretheprofferedevidenceleavestospeculationadeterminativefactinalawsuit,thepartyhavingtheburdenofprovingthefactmustsuffertheloss.Leonardv.Gilreath,625S.W.2d722(Tenn.App.1981),citingReserveLifeInsuranceCo.v.Whittemore,59Tenn.App.495,442S.W.2d266(1969).Acasedoesnothavetobesubmittedtoajurywheretheplaintiffsverdictwouldbebasedonspeculation,conjecture,oramereglimmerofevidence.Sadekv.NashvilleRecyclingCo.,751S.W.2d428(Tenn.App.1988).  DuringdirectexaminationofDr.Harperinhisdepositionthefollowingtestimonywaselicited:       Q Doctor,haveyouformedanopinionbaseduponareasonabledegreeofmedicalcertaintyastowhetherornotthatdiagnosisofchronicosteomyelitis[infectionofthebone]wascausallyrelatedtothesurgeryperformedbyDr.Caliaon51789? ....A Yes,Ibelieveitwasrelated. ....Q Okay.Whataboutthegreatrighttoe,Doctor?Whatdiditlooklikepriortosurgerycorrectivesurgerybyyou?A Itassumedapositionofextension,i.e.,itwastendingtocockupandalsodeviatetowardthemidline,towardthemidportionofthebody.Q Isthatnormal?A No.Q Whatwasthecauseofthat,please,Doctor,withinareasonabledegreeofmedicalcertainty?A Thepriorsurgery. ....Q Okay.On2590,Doctor,thefirsttimeyouperformedadebridementordebridementonher,werethereanykindofpathologyreportsatthattime?A Yes.Q Whatdidtheyreveal,please?A Thesurgicalpathologynotedated2590,orreferringtothespecimenobtainedon2590,isreadoutasfinaldiagnosisbeingbonedebridementofrightgreattoe,colon,focalacuteinflammationcompatiblewithosteomyelitis,grampositivecoccipresent.Q Okay.Doctor,again,baseduponareasonabledegreeofmedicalcertainty,haveyouformedanopinionastotheetiologyorcauseofthatpathologyreport? ....A Yes.Q Okay.Andwhatisthat,please,Doctor?A Priorsurgery. r           InlightoftheforegoingweconcludetherewassufficientevidencepresentedastocausationtoprecludetheTrialCourtdirectingaverdict.  Moreover,althoughcounselforMs.ScottseemedtoconcedeDr.Cooper'stestimonydidnotmeetthecausationrequirement,webelieveitdid:        Q Allright.Let'sgoon,Doctor.Youkeeptalkingaboutinfection,andthefailuretorecognizethatinfectionwasnegligence,thatyou'refamiliarwiththestandardofcarepracticedinpodiatricsinKnoxCounty,andthatthedeviationcausedsomedamage.Idon'tseeanywhereinthereDoctor,thatyoucriticizedDr.Caliaaboutthetype,orthenumber,ofproceduresheperformedonMs.Scott;haveIreaditcorrectly? A Iguess,itthebottomlineishedidtoomuchinonearea. Q AndIdon'tseethatanywhereinthisaffidavit. A Yeah.Butthat'swhathappened.Imean,Iknowyou'retalkingfromthewordsandthingsnowjustthat'swhatwentwrong.Ifhehadn'tdonesomuchinthatonearea,thentheinfectionwouldn'thavehadachancetostartbecausethehealingwouldn'thavebeenhamperedsomuchbyallthelittlebloodvesselsandallthethingsthatwereviolated. .... Q Youtoldmeinoneofyourdepositionsthatitwouldhavebeenbettertobreakthesesurgeriesupifyou'regoingtodotheseprocedures,Dr.Calia,youshouldbreakthemupintotwoorthreeorfourdifferentproceduresdifferentoperations,differenttimes.Doyourecallthattestimony? A Yes,sir. Q AndhaveyoubeentoldthatDr.Akerman s   ׀isoftheopinionthatthatwouldnotbeagoodideabecauseyouwouldexposethepatienttomultipleopportunitiesforinfectionthattheonlyreasontodomultiplesurgerieswouldbetocreateabiggerfee?Haveyoubeenadvisedofthat,Dr.Cooper? A Well,letmeaddressthatasecond. Q Doctor,canyouanswer"yes"or"no"?Thenfeelfreetoexplain. A Yes,Iamawarethatshehassaidthat,butsheiswrong.Theproof'sinthepudding.ForyoutoreallyunderstandwhatImeanbythatisthattohaveaninfectioninayoungindividualafterfootsurgeryisrare.Itisunusual,especiallyofgreatmagnitudebecause,ifitwereanythingotherthanunusual,thenwhowantstostartwithsomethingthatwouldendwiththismuchofahassle?It'stheriskIthinkyesterdayItalkedaboutthestandardofcare.Theriskofdoingallofwhatwasdone,intheareathatitwasdone,justwastoomuchforthisfoottohealfrom.Anditputtoomuchburdenonit,andit'snotbeyondanykindofreasonablethinkingtounderstandhowallthisinjurysurgicaltraumatothisareaevenifitweredonemeticulously.Imean,justthereweretoomanybloodvesselsviolated.Therewasjusttoomuchdoneinasmallarea.SoI'mnotreallyopposedtomultipleprocedures.It'swherethey'redoneandthemultiplicityinanarea.Q Okay.Doctor,haveyouformedanopinionbaseduponareasonabledegreeofmedicalcertaintyastowhetherornotthispermanentpartialdisabilityratingwhichyouhaveassessedheriscasuallyrelatedorconnectedtothesurgerythatDr.Caliaperformedonheron51789?A Yes.         Ms.ScottalsocomplainsthattheCourtsuaspontedirectedaverdictagainstherinthiscase.Thelawseemsclearthatatrialjudgehastheright,althoughheshoulduseitsparingly,todirectaverdictsuasponte.Burnv.TennValRealty,Inc.,anunreportedopinionofthisCourt,filedinKnoxvilleonJanuary28,1986.Inthecaseatbar,aftertheTrialCourthasindicatedtocounselhisintenttograntadirectedverdict,counselforDr.Caliabelatedly,andapparentlyasanafterthought,stated"andIguessfortherecord,Idomovefordirectedverdict,justsoit'sintherecord."  InviewoftheforegoingwebelievetheTrialJudgedidinfactdirectaverdictsuaspontebut,underBurn,weareobligatedtosustainhisactionunlessdirectingofaverdictundertheproofadducedwasimproper.  HavingconcludedthattheTrialCourtwasinerrorindirectingaverdict,wevacatethejudgmententeredthereon.Thecauseisremandedforfurtherproceedingsnotinconsistentwiththisopinion.CostsofappealareadjudgedagainstDr.Calia.      _______________________________      HoustonM.Goddard,P.J.CONCUR:________________________________DonT.McMurray,J.________________________________CharlesD.Susano,Jr.,J.