ÿWPC- O ÏË.(È€-kš&Ý'5$(Ê€ôÓï;þ¿iÑZ4Ö̹/¹åmkç'T`òÆ/éáÞØŽŪPJHñ‡/\ÐÇv¦ÅWÇÓ£oCÆ‹ ?=}°A¿jÝ/Ï4ÜhÇÂMô“Є³ªÎømcg£Î%aGæÖ}/WÇÂNXÉ)”ê=‚˜ Àc©N¨ðteQ ì; oůÕa«zñ"'K4°óÔD>$ÆF„U¢0TúÌ1Ô¸¦§t¥¶³(°þ‘CõV#Â’¸ûwðöLˆçe0¦maØïàAAÅs{½®öfºÅ‘«1„.sýœ-'ƒ¤†+²Hmê¶Œ–aØôÅéM ¯ªà¼EÇ‚“[ pÓãI›@À}˜õ´cÍ}‘2QŠì¿{Ò+=‰ixÊ~àeG‡†©gƀȤºŒTT}2È6cfZBRîÔcV4,ðÏÂ>VF©­cG¡`¾/ÅPrE/iá*€Ð×/+`~¥MˆºÔõ’ÒÉ’*gߓϛ¼¸Â”ƺ4¹Qƒ¬z“g„ëÄV/J©Ã5î€Ô7œÙ„Цy¶¿S½ê,eEäŠ Ëjÿ"?EÌFýˆ‰Ô9à]^S_•'¿Ú:e͵b#É\ %% + 0ˆ3 UN» ^ w z Ò“ 4e y ˆ mŠ Æ¡ Æg Æ-Æób¹N 0D¿aE                        b"""""""""""""""""""""""""""""""""""" 0ë**** B 0¤2 D3Ö D-  0K66 ASÆÔ 0¤š 0D> A«‚˜\\IB01S01\CLERK1NASÈÈ,,,,ÈÈ0» (`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman RegularJ‰f/Ï  ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt–ƒd/B011C83|xÿU‹ÿÀÀÀLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5 XÝ ƒRm4$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ôúò»»ÔÝ  ÝÔ_ÔApparently€an€entire€state€may€be€a€ð ðcommunityðð€within€the€meaning€of€the€Connecticut€locality€rule.€€òòSeeÐ ° ÐÔ_ÔFitzmauriceÔ_Ô€v.€Flynnóó,€356€A.2d€887€(Conn.€1975). (#Ã$òòÚ  Ú0Ú  Úóó µÝ ƒRm4$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ôúò»»ÔÝ  ÝÔ_ÔIf€the€historic€underpinnings€of€the€locality€rules€are€accurately€analyzed€in€òòÔ_ÔShilkretÔ_Ôóó,€it€would€seem€somewhatÐ ° Ðparadoxical€that,€in€the€treatment€of€a€broken€ankle€the€testimony€of€a€Johnson€City€physician,€presumably€himselfÐ tÄ Ðsubject€to€a€less€restrictive€standard€of€care€cannot€opine€as€to€minimum€standards€for€Nashville€more€stringent€becauseÐ 8ˆ Ðof€the€size€and€sophistication€of€its€medical€facilities.€€òòC/F€Robinson€v.€Ô_ÔLecorpsÔ_Ôóó.- ù-(|G2m4$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€L »»dd8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ôúò»»Ô d(|3Çt$££Ý ƒ£ª!ÝÑ€.ÑÑ8€L »»dd8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3Çt$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€L »»dd8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€L »»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼L »»»ÔÑ8€YXXdì»»d8ÑÑ  Ñà@ü ü ìàÔ‡î@œî»¼L ÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#†¼L »îî@œ #ԈРÖ& ÐÓ  ÓSeptember€5,€2002€SessionÐ üL ÐÔ‡XYX»¼L ÔÌÌò òÔ#†¼L »XXYö#ÔLAURA€C.€Ô_ÔTOTTYÔ_Ô,€òòet€al.óó€v.€JOHN€THOMPSON,€M.D.,€òòet€alóó.Ô‡XYX»¼L Ôó óÐ æ 6 ÐÌà@@½½ìàò ò€Appeal€from€the€Circuit€Court€for€Williamson€CountyÐ æ 6 Ðà@@øøìàNo.€I„2K177€€€€€€R.E.€Lee€Davies,€Judge€Ð Ò " ÐÌÌÌà@@ìì*ìàßA€V) °°` d€÷E<` AßÐ ‚Ò  ÐÌà@@TTìàNo.€M2001„02539„Ô_ÔCOAÔ_Ô„R3„CV€„€Filed€January€9,€Ô_Ô2003Ô_ÔÐ }Í  ÐÌßA€V) °°` dE<T` AßÐ U¥ Ðó óÌÓ  ÓIn€this€medical€malpractice€case,€Plaintiff€appeals€summary€judgment€based€upon€the€failure€ofÐ P  ÐPlaintiffððs€medical€expert€to€establish€the€requisite€familiarity€with€the€standard€of€care€in€theÐ <Œ Ðcommunity€in€which€Defendant€practices€or€in€a€similar€community.€€We€affirm€the€action€of€the€trialÐ (x Ðcourt.Ð d ÐÓâÓÌò òTenn.€R.€App.€P.€3€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Affirmed€ó óÐ ì< ÐÌòòÓ  ÓÔ#†¼L »àXYž#ÔÔ‡XYX.¼L ÔWilliam€B.€Cain,óó€J.,€delivered€the€opinion€of€the€court,€in€which€òòóóPòòATRICIA€óóJ.€CòòOTTRELLóó,€J.,€andÐ Ä ÐòòóóEòòLLENóó€Ô_ÔHòòOBBSÔ_Ôóó€LòòYLEóó,€SòòPóó.€J.,€joined.Ð ° ÐÌÔ_ÔE.CovingtonÔ_Ô€Ô_ÔJohnston,JrÔ_Ô.,€Franklin,€Tennessee,€for€the€appellants,€Laura€C.€and€Alvin€Ô_ÔMitchelÔ_Ô€Ô_ÔTottyÔ_Ô.Ð ˆØ ÐÌMichael€A.€Ô_ÔGeraciotiÔ_Ô€and€Dale€A.€Ô_ÔTippsÔ_Ô,€Nashville,€Tennessee,€for€the€appellees,€John€Thompson,Ð `° ÐM.D.,€and€Ô_ÔNolensvilleÔ_Ô€Family€Care€Center.Ð L œ ÐÓíÓÌÌò òOPINIONó óÔ#†¼L »XXY#ÔÔ‡XYX»¼L ÔÐ #`" ÐÌòòóóÔ#†¼L »XXY‡ #ÔÓ  ÓÔ€XYX»¼L Ôà  àPlaintiffs,€Alvin€Ô_ÔMitchelÔ_Ô€Ô_ÔTottyÔ_Ô€and€Laura€C.€Ô_ÔTottyÔ_Ô,€are€husband€and€wife.€€On€April€5,€1999,Ð è$8 $ ÐLaura€Ô_ÔTottyÔ_Ô,€complaining€of€pain€above€her€left€scapula,€sought€treatment€for€this€condition€byÐ Ô%$!% ÐDefendant,€Dr.€John€Thompson,€at€his€office€in€Ô_ÔNolensvilleÔ_Ô,€Williamson€County,€Tennessee.€€WhileÐ À&"& Ðinjecting€steroid€and€pain€medication€into€the€area€of€pain€the€left€upper€back€of€Plaintiff,€DefendantÐ ¬'ü"' Ðinadvertently€pierced€the€lung€of€Plaintiff€with€a€needle€causing€a€Ô_ÔpneumothoraxÔ_Ô€(partially€collapsedÐ ˜(è#( Ðlung).€€Defendant€informed€Plaintiffs€immediately€of€the€inadvertent€lung€puncture€and€x„rayed€theÐ „)Ô$) Ðaffected€area€to€reveal€the€Ô_ÔpneumothoraxÔ_Ô€involving€about€ten€percent€of€total€lung€volume.€€Ms.Ð p*À%* ÐÔ_ÔTottyÔ_Ô€was€anxious€about€the€puncture€and€Defendant€admitted€her€directly€to€Williamson€CountyÐ \+¬&+ ÐMedical€Center€for€observation€and€further€x„rays.€€Hospital€x„rays€indicated€a€slight€enlargementÐ H,˜', Ðof€the€left€Ô_ÔpneumothoraxÔ_Ô€and€Defendant,€along€with€Dr.€Doug€York,€a€general€surgeon,€and€Dr.Ð 4-„(-ý ÐÔ_ ÔElliot€Himmelfarb,€an€interventional€radiologist,€determined€that€Dr.€Himmelfarb€should€performÐ ° Ða€catheter€re„expansion€of€the€pneumothorax.€€€Following€the€procedure,€Ms.€Totty€was€dischargedÐ œì Ðfrom€the€hospital€on€April€7,€1999,€and€two€days€later,€in€a€follow„up€visit€to€the€office€of€Dr.Ð ˆØ ÐThompson,€it€appeared€that€the€pneumothorax€had€resolved.€€She€was€released€to€return€to€work€onÐ tÄ ÐApril€12,€1999€and€never€returned€to€the€office€of€Dr.€Thompson€for€follow„up€treatment.Ð `° ÐÌà  àSuit€was€filed€against€Dr.€Thompson€and€his€employer,€Nolensville€Family€Care€Center,€onÐ 8 ˆ ÐApril€4,€2000,€alleging:Ð $ t ÐÌà8  à7.à0` Ð Ð àThe€Defendant,€John€Thompson,€M.D.,€was€negligent€in€the€following€way:Ðü L ` Ð ` Ð  Ðà  àà8 ` àa.à0¸ ` x` xàHe€failed€to€properly€monitor€the€Plaintiffððs€condition€whileÐ è 8  Ðinserting€the€trigger€point€needle€into€the€patientððs€back.ÐÔ$ ¸ x¸ x Ðà  àà8 ` àb.à0¸ ` x` xàHe€failed€to€properly€calculate€the€depth€to€which€he€couldÐ À  Ðinsert€the€trigger€point€needle€into€the€Plaintiffððs€back.Ьü ¸ x¸ x Ðà  àà8 ` àc.à0¸ ` x` xàHe€carelessly€inserted€the€trigger€point€needle€into€theÐ ˜è  Ðpatientððs€back€to€such€a€depth€that€he€punctured€the€PlaintiffððsÐ „Ô  Ðlung.ÐpÀ¸ x¸ x Ðà  àà8 ` àd.à0¸ ` x` xàEven€after€the€Defendant€discovered€that€he€had€punctured€theÐ \¬ ÐPlaintiffððs€lung,€he€injected€the€steroid€and€pain€medicationÐ H˜ Ðinto€the€Plaintiff.Ð4„¸ x¸ x Ðà8  à8.à0` Ð Ð àThe€Plaintiff€believes€that€the€Defendant,€Nolensville€Family€Care€Center,€isÐ  p Ðthe€employer€of€the€Defendant,€John€Thompson,€M.D.,€and€at€all€timesÐ  \ Ðmaterial€to€this€Complaint,€believes€that€John€Thompson€was€acting€in€theÐ øH Ðcourse€and€scope€of€his€employment€with€the€Defendant,€Nolensville€FamilyÐ ä4 ÐCare€Center.€€The€Plaintiff€also€believes€that€the€Defendant,€John€Thompson,Ð Ð  ÐM.D.,€is€the€owner€of€the€Defendant€Nolensville€Family€Care€Center,€and€theÐ ¼  ÐDefendant€Nolensville€Family€Care€Center€is€liable€to€the€Plaintiff€for€theÐ ¨ø Ðactions€of€its€employee€and/or€owner,€John€Thompson,€M.D.Дä` Ð ` Ð  ÐÌà  àDefendants€answered€on€May€30,€2000,€denying€any€acts€of€negligence.€€On€February€6,Ð l¼ Ð2001,€Defendants€filed€a€Motion€for€Summary€Judgment€accompanied€by€the€Affidavit€of€Dr.Ð X ¨ ÐThompson€asserting€that€he€was€familiar€with€the€recognized€standard€for€acceptable€professionalÐ D!” Ðpractice€of€family€medicine€in€Williamson€County€and€that€his€treatment€of€Mrs.€Totty€compliedÐ 0"€  Ðwith€such€standard.€€He€further€asserted€that€the€complication€experienced€by€Mrs.€Totty€was€anÐ #l! Ðaccepted€and€recognized€risk€of€the€particular€procedure.Ð $X" ÐÌà  àPlaintiffs€countered€with€the€Affidavit€of€Dr.€Joseph€Bussey,€Jr.€of€Georgia€asserting€anÐ à%0!$ Ðopinion€that€the€treatment€by€Dr.€Thompson€fell€below€the€applicable€standard€of€care€in€severalÐ Ì&"% Ðrespects.€€The€trial€court,€however,€never€reached€the€merits€of€the€Bussey€affidavit,€finding€that€theÐ ¸'#& Ðaffidavit€failed€to€establish€familiarity€with€the€standard€of€professional€care€in€the€community€inÐ ¤(ô#' Ðwhich€Dr.€Thompson€practices€or€in€a€similar€community€as€is€required€by€the€ð ðLocality€RuleððÐ )à$( Ðmandated€under€Tennessee€Code€Annotated€section€29„26„115(a)(1).Ð |*Ì%) ÐÐ h+¸&* Ðà  àIn€this€respect,€the€Affidavit€of€Dr.€Bussey€stated:Ð ° ÐÌà8  à1.à0` Ð Ð àI€am€Joseph€G.€Bussey,€Jr.,€and€I€am€citizen€and€resident€of€the€State€ofÐ ˆØ ÐGeorgia.€€I€am€over€the€age€of€18€years.€€ÐtÄ` Ð ` Ð  Ðà8  à2.à0` Ð Ð àI€am€a€medical€doctor.€€I€limit€my€medical€practice€and€speciality€to€generalÐ `° Ðfamily€practice€and€surgery.€€Despite€my€speciality,€based€upon€my€medicalÐ L œ Ðschool€of€training,€internship,€and€residency,€I€am€familiar€with€generalÐ 8 ˆ Ðmedical€practice€which€constitutes€common€knowledge€of€all€medicalÐ $ t Ðdoctors.€€This€common€knowledge€does€not€vary€from€state€to€state€or€fromÐ  ` Ðmedical€speciality€to€medical€specialty.Ðü L ` Ð ` Ð  Ðà8  à3.à0` Ð Ð àI€practice€my€speciality€in€the€State€of€Georgia.€€I€am€licensed€to€practiceÐ è 8  Ðmedicine€in€the€State€of€Georgia€and€was€licensed€to€practice€medicineÐ Ô$  Ðcontinually€for€more€than€two€years€prior€to€April€5,€1999.€€I€was€licensed€toÐ À  Ðpractice€medicine€in€the€State€of€Georgia€in€my€specialty€in€April,€1999,Ð ¬ü  Ðwhich€is€the€time€of€the€events€complained€of€in€this€action.€€In€April,€1999,Ð ˜è  Ðas€well€as€the€date€of€the€preparation€of€this€Affidavit,€the€standard€of€care€forÐ „Ô  Ðfamily€general€practice€in€the€State€of€Tennessee,€including€Nolensville,Ð pÀ ÐTennessee,€as€it€relates€to€the€diagnosis€and€treatment€of€medical€problemsÐ \¬ Ðsuch€as€those€experienced€by€Laura€Totty€in€April€1999,€was€the€sameÐ H˜ Ðstandard€of€care€required€by€a€physician€in€the€State€of€Georgia.€€The€standardÐ 4„ Ðof€care€under€which€a€general€diagnosis€and€treatment€of€the€conditionÐ  p Ðexperienced€by€Laura€Totty€is€identical€in€the€State€of€Georgia€as€in€the€StateÐ  \ Ðof€Tennessee.€€The€diagnostic€tests€available€to€a€physician€in€the€State€ofÐ øH ÐGeorgia€and€in€the€State€of€Tennessee€to€investigate€the€symptomsÐ ä4 Ðexperienced€by€Laura€Totty€are€identical.€€The€standard€of€care€under€whichÐ Ð  Ða€family€general€practitioner€makes€his€or€her€decision€as€to€the€treatmentÐ ¼  Ðperformed€on€Laura€Totty€is€identical€in€the€State€of€Georgia€as€in€the€StateÐ ¨ø Ðof€Tennessee.€€Therefore,€I€am€familiar€with€the€standard€of€care€of€a€generalÐ ”ä Ðfamily€practitioner€treating€Laura€Totty€in€April,€1999€in€Nolensville,Ð €Ð ÐTennessee.€€I€am€qualified€to€render€the€opinion€set€forth€in€my€Affidavit.Ðl¼` Ð ` Ð  ÐÌà  àThe€Affidavit€does€not€meet€the€threshold€requirements€of€Tennesseeððs€Locality€Rule.€Ð D!” ÐTennessee€Code€Annotated€section€29„26„115(a)(1)€(Supp.€2000)€requires€the€plaintiff€to€prove:Ð 0"€  ÐÌà8  àà ` à(1)€€The€recognized€standard€of€acceptable€professional€practice€in€theÐ $X" Ðprofession€and€the€specialty€thereof,€if€any,€that€the€defendant€practices€in€theÐ ô$D # Ðcommunity€in€which€the€defendant€practices€or€in€a€similar€community€at€the€timeÐ à%0!$ Ðthe€alleged€injury€or€wrongful€action€occurred;ÐÌ&"%Ð Ð  Ðâ âÐ ¸'#& Ðà  àThe€State€of€Georgia€hardly€qualifies€as€a€ð ðcommunityðð€within€the€meaning€of€the€statutoryÐ ° Ðlocality€rule.€€Neither€does€the€State€of€Tennessee.׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€No€factual€basis€is€asserted€in€the€Affidavit€ofÐ œì Ðâ âDr.€Bussey€to€establish€his€familiarity€with€the€standard€of€care€in€Williamson€County,€TennesseeÐ ˆØ Ðnor,€if€indeed€it€be€the€involved€ð ðcommunityðð€within€the€meaning€of€the€statute,€does€the€AffidavitÐ tÄ Ðassert€a€factual€basis€relative€to€knowledge€of€the€standard€of€practice€in€Nolensville,€Tennessee.€Ð `° ÐIn€a€similar€context€this€Court€has€held:Ð L œ ÐÌà8  àHe€presented€no€other€factual€basis€for€his€belief€that€he€was€familiar€with€the€localÐ $ t Ðstandard€of€care,€and€there€is€no€proof€whatsoever€in€the€record€that€would€explainÐ  ` Ðhow€the€witness,€a€physician€from€Washington,€D.C.,€would€be€familiar€with€theÐ ü L  Ðstandard€of€care€in€Knoxville.€€It€is€clear€the€Trial€Court€has€broad€discretion€inÐ è 8  Ðdetermining€the€qualifications€for€admissibility€of€testimony€of€expert€witnesses.€€WeÐ Ô$  Ðfind€no€abuse€of€that€discretion€in€this€case.€€òòMabon€v.€Jackson„Madison€CountyÐ À  ÐGeneral€Hosp.óó,€968€S.W.2d€826€(Tenn.Ct.App.€1997).€€òòSee€also€Osler€v.€Burnettóó,Ð ¬ü  Ð1993€WL€90381€(Tenn.Ct.App.€March€30,€1993);€òòBryant€v.€Baugussóó,€1996€WLÐ ˜è  Ð465539€(Tenn.Ct.App.€August€16,€1996);€òòSwift€v.€Schoettleóó,€1996€WL€730286Ð „Ô  Ð(Tenn.Ct.App.€December€20,€1996);€òòHopper€v.€Taboróó,€1998€WL€498211Ð pÀ Ð(Tenn.Ct.App.€August€19,€1998).Ð\¬Ð Ð  ÐÌòòSpangler€v.€East€Tenn.€Baptist€Hosp.óó€No.€E1999„01501„COA„R3„CV,€2000€WL€22543,€at€*2€(Tenn.Ð 4„ ÐCt.€App.€Feb.€28,€2000).Ð  p ÐÌà  àFew€areas€of€American€Jurisprudence€have€been€more€challenging€through€the€years€than€theÐ øH Ðdevelopment€of€the€standard€of€care€applicable€in€medical€malpractice€cases.€€Historically,€TennesseeÐ ä4 Ðfollowed€the€ð ðstrict€locality€ruleðð€until€it€was€legislatively€supplanted€in€1975€by€Tennesseeððs€versionÐ Ð  Ðof€the€ð ðsimilar€locality€rule.ðð€€òòSutphin€v.€Plattóó,€720€S.W.2d€455€(Tenn.€1986);€òòHaskins€v.€Howardóó,Ð ¼  Ð16€S.W.2d€20€(Tenn.€1929);€òòFloyd€v.€Wallsóó,€1941€Tenn.€App.€Lexis€142€(Tenn.€Ct.€App.€Dec.€13,Ð ¨ø Ð1941);€òòóó1975€Tenn.€Pub.€Acts€229,€ðð€14€(codified€as€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)).Ð ”ä ÐÌà  àIn€òòShilkret€v.€Annapolis€Emergency€Hosital.,€Assððnóó,€the€Supreme€Court€of€Maryland€tracedÐ l¼ Ðthe€history€of€these€two€locality€rules€in€a€manner€worthy€of€notice.Ð X ¨ ÐÌà8  àà ` àThe€earliest€traces€of€the€strict€locality€rule€appeared€a€century€ago.€€òòSmothersÐ 0"€  Ðv.€Hanksóó,€34€Iowa€286€(1872);€òòTefft€v.€Wilcoxóó,€6€Kan.€46€(1870);€òòHathorn€v.Ð #l! ÐRichmondóó,€48€Vt.€557,€559€(1876)€(ð ðsuch€skill€as€doctors€in€the€same€generalÐ $X" Ðneighborhood,€in€the€same€general€lines€of€practice,€ordinarily€have€and€exercise€inÐ ô$D # Ðlike€casesðð).€€It€is€an€exclusive€product€of€the€United€States;€possibly€because€of€theÐ à%0!$ Ðdifference€in€the€size€of€the€two€countries,€the€English€courts€have€never€developedÐ Ì&"% Ðsuch€a€principle.€€Waltz,€òòThe€Rise€And€Gradual€Fall€Of€The€Locality€Rule€In€MedicalÐ ¸'#& ÐMalpractice€Litigationóó,€18€DePaul€L.Rev.€408€(1969).€€The€rule€was€unquestionablyÐ ¤(ô#' Ðdeveloped€to€protect€the€rural€and€small€town€practitioner,€who€was€presumed€to€beÐ ° Ðless€adequately€informed€and€equipped€than€his€big€city€brother.€€òòId.óó€€The€courtÐ œì Ðreasoned€with€what€was€then€unassailable€logic€in€òòTefft€v.€Wilcox,€supraóó,€6€Kan.€atÐ ˆØ Ð63„64:ÐtÄÐ Ð  ÐÌà8  àà8` Ð Ð àð ð€.€.€.€€In€the€smaller€towns€and€country,€those€who€practice€medicineÐ L œ Ðand€surgery,€though€often€possessing€a€thorough€theoreticalÐ 8 ˆ Ðknowledge€of€the€highest€elements€of€the€profession€do€not€enjoy€soÐ $ t Ðgreat€opportunities€of€daily€observation€and€practical€operations,Ð  ` Ðwhere€the€elementary€studies€are€brought€into€every€day€use,€as€thoseÐ ü L  Ðhave€who€reside€in€the€metropolitan€towns,€and€though€just€as€wellÐ è 8  Ðinformed€in€the€elements€and€literature€of€their€profession,€theyÐ Ô$  Ðshould€not€be€expected€to€exercise€that€high€degree€of€skill€andÐ À  Ðpractical€knowledge€possessed€by€those€having€greater€facilities€forÐ ¬ü  Ðperforming€and€witnessing€operations,€and€who€are,€or€may€beÐ ˜è  Ðconstantly€observing€the€various€accidents€and€forms€of€disease.€.€.€.ðð€Ð „Ô  ÐÐ ` x` x Ðà8  àà ` àIn€short,€the€rationale€underlying€the€development€of€the€strict€locality€ruleÐ \¬ Ða€century€ago€was€grounded€in€the€manifest€inequality€existing€in€that€day€betweenÐ H˜ Ðphysicians€practicing€in€large€urban€centers€and€those€practicing€in€remote€rural€areas.Ð4„Ð Ð  ÐÌà  àà ` à.€.€.€.Ð  \ ÐÌà8  àà ` àWhatever€may€have€justified€the€strict€locality€rule€fifty€or€a€hundred€yearsÐ ä4 Ðago,€it€cannot€be€reconciled€with€the€realities€of€medical€practice€today.€€ð ðNewÐ Ð  Ðtechniques€and€discoveries€are€available€to€all€doctors€within€a€short€period€of€timeÐ ¼  Ðthrough€medical€journals,€closed€circuit€television€presentations,€special€radioÐ ¨ø Ðnetworks€for€doctors,€tape€recorded€digests€of€medical€literature,€and€currentÐ ”ä Ðcorrespondence€courses.ðð€€Note,€òòAn€Evaluation€Of€Changes€In€The€Medical€StandardÐ €Ð ÐOf€Careóó,€23€Vand.L.Rev.€729,€732€(1970).€€More€importantly,€the€quality€of€medicalÐ l¼ Ðschool€training€itself€has€improved€dramatically€in€the€last€century.€€Where€earlyÐ X ¨ Ðmedical€education€consisted€of€a€course€of€lectures€over€a€period€of€six€months,Ð D!” Ðwhich€was€supplemented€by€apprenticeships€with€doctors€who€had€even€less€formalÐ 0"€  Ðeducation,€there€now€exists€a€national€accrediting€system€which€has€contributed€toÐ #l! Ðthe€standardization€of€medical€schools€throughout€the€country.€€òòId.óó€n.€16.Ð$X"Ð Ð  ÐÌà  àà ` à.€.€.€.Ð à%0!$ ÐÌà8  àà ` àWe€have€noted€that€one€of€the€earliest€applications€of€the€similar€locality€ruleÐ ¸'#& Ðoccurred€in€òòSmall€v.€Howard,€supraóó,€128€Mass.€at€136,€where,€essentially€for€theÐ ¤(ô#' Ðsame€reasons€that€have€traditionally€undergirded€the€strict€locality€rule,€the€courtÐ )à$( Ðenunciated€as€the€standard:€€ð ð€ððthat€skill€only€which€physicians€and€surgeons€ofÐ |*Ì%) Ðordinary€ability€and€skill,€practi[c]ing€in€similar€localities,€with€opportunities€for€noÐ h+¸&* Ðlarger€experience,€ordinarily€possessðð€ðð;€thus€the€defendant€ð ð€ððwas€not€bound€toÐ ° Ðpossess€that€high€degree€of€art€and€skill€possessed€by€eminent€surgeons€practi[c]ingÐ œì Ðin€large€cities,€and€making€a€specialty€of€the€practice€of€surgery.ðð€ððЈØÐ Ð  ÐÌòòà  àóóà0 ` à.€.€.€.Ð`°` (#` (# ÐÌà8  àà ` àThe€similar€locality€rule€answers€some€of€the€criticism€aimed€at€the€strictÐ 8 ˆ Ðlocality€standard€by€enabling€the€plaintiff€to€obtain€expert€witnesses€from€differentÐ $ t Ðcommunities,€thus€reducing€the€likelihood€of€their€acquaintance€with€the€defendant.€Ð  ` ÐIt€does€not,€however,€effectively€alleviate€the€other€potential€problem,€a€low€standardÐ ü L  Ðof€care€in€some€of€the€smaller€communities,€because€the€standard€in€similarÐ è 8  Ðcommunities€is€apt€to€be€the€same.€€Another€criticism€leveled€at€the€similar€localityÐ Ô$  Ðrule€is€the€difficulty€which€arises€in€defining€a€ð ðsimilarðð€locality.€€For€these€reasons,Ð À  Ðthe€similar€locality€rule€is€regarded€as€no€more€than€a€slight€improvement€over€theÐ ¬ü  Ðstricter€standard.Иè Ð Ð  ÐÌòòShilkret€v.€Annapolis€Emergency€Hosp.€Assððnóó,€349€A.2d€245,€248„250,€(Md.€1975).€€Ð pÀ ÐÌà  àThe€locality€rule€in€Maryland€was€of€common€law€origin,€and€Maryland€was,€thus,€free€toÐ H˜ Ðfollow€the€emerging€trend€in€other€jurisdictions€to€adopt€what€was€essentially€a€national€standard.Ð 4„ ÐIn€Tennessee,€the€1975€Act€liberalized€what€was€then€the€ð ðstrict€locality€ruleðð€by€legislativelyÐ  p Ðmandating€a€ð ðsimilar€locality€rule.ðð׃×Ý ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€€Whatever€may€be€the€desirability€„€„€or€undesirability€„€„€ofÐ  \ Ðfollowing€the€trend€in€sister€jurisdictions€toward€a€national€standard,€this€avenue€in€Tennessee€isÐ øH Ðforeclosed€to€judicial€action.€€The€ink€is€barely€dry€on€the€decision€of€the€Supreme€Court€ofÐ ä4 ÐTennessee€in€òòRobinson€v.€Lecorpsóó,€83€S.W.3d€718€(Tenn.€2002),€issued€September€5,€2002,€whereinÐ Ð  Ðthe€court€addressed€this€very€question.€€Said€the€court:Ð ¼  ÐÌà8  àà ` àDespite€the€clear€statutory€language€and€evidence€of€legislative€intent,Ð ”ä ÐRobinson€asserts€that€the€locality€rule€in€Tenn.Code€Ann.€ðð€29„26„115(a)(1)€shouldÐ €Ð Ðbe€enlarged€or€broadened€by€adopting€a€national€standard€of€professional€care€for€allÐ l¼ Ðmalpractice€actions,€malpractice€actions€involving€physicians€who€are€board„certifiedÐ X ¨ Ðin€a€particular€area,€or€malpractice€actions€involving€a€specific€treatment€issue€or€areaÐ D!” Ðof€medicine.€€There€is€no€statutory€language€or€other€evidence€of€legislative€intent,Ð 0"€  Ðhowever,€that€would€support€such€an€interpretation.Ð#l!Ð Ð  ÐÌà8  àà ` àThe€legislature,€which€is€presumed€to€know€of€its€enactments€and€the€state€ofÐ ô$D # Ðthe€law,€has€not€amended€or€supplemented€the€statutory€language€in€any€way€thatÐ à%0!$ Ðwould€broaden€the€locality€rule€or€support€such€a€sweeping€change€in€the€standard€ofÐ Ì&"% Ðcare€in€malpractice€actions.€€Moreover,€in€the€absence€of€applicable€statutoryÐ ° Ðlanguage,€we€decline€to€adopt€the€plaintiffððs€interpretation€based€either€on€policyÐ œì Ðarguments€or€alleged€evidence€of€the€existence€of€a€national€standard€of€care€in€theÐ ˆØ Ðmedical€community€that€are€better€addressed€to€the€legislature.ÐtÄÐ Ð  ÐÌà8  àà ` àThis€Court€is€mindful,€however,€that€in€many€instances€the€national€standardÐ L œ Ðwould€indeed€be€representative€of€the€local€standard,€especially€for€board€certifiedÐ 8 ˆ Ðspecialists.€€Although€such€issues€are€properly€left€to€the€discretion€of€the€legislature,Ð $ t Ðwe€encourage€the€General€Assembly€to€reconsider€the€current€statutory€frameworkÐ  ` Ðof€the€locality€rule.€€However,€until€such€legislative€action,€we€believe€that€theÐ ü L  Ðlegislative€intent€and€purpose€of€Tenn.Code€Ann.€ðð€29„26„115(a)(1),€as€presentlyÐ è 8  Ðderived€from€the€statutory€language,€continues€to€be€that€the€conduct€of€doctors€inÐ Ô$  Ðthis€State€is€assessed€in€accordance€with€the€standard€of€professional€care€in€theÐ À  Ðcommunity€in€which€they€practice€or€one€similar€to€it.€à È àà  à€€Ð¬ü Ð Ð  ÐÌòòRobinsonóó,€83€S.W.3d€at€723„24.Ð „Ô  ÐÌà  àBy€order€of€May€11,€2001,€the€trial€court,€relying€on€òòCardwell€v.€Bechtolóó,€724€S.W.2d€739Ð \¬ Ð(Tenn.€1987),€and€òòMabon€v.€Jackson„Madison€County€General€Hospitalóó,€968€S.W.2d€826€(Tenn.€Ct.Ð H˜ ÐApp.€1997),€granted€summary€judgment€to€Defendants€under€the€Tennessee€Locality€Rule.Ð 4„ ÐÌà  àOn€June€7,€Plaintiffs€filed€a€Motion€to€Alter€or€Amend€accompanied€by€a€SupplementalÐ  \ ÐAffidavit€of€Dr.€Bussey.€€This€Motion€to€Alter€or€Amend€was€denied€by€the€trial€court€by€OrderÐ øH Ðentered€September€25,€2001.Ð ä4 ÐÌà  àThe€trial€court€did€not€abuse€its€discretion€in€refusing€to€alter€or€amend€the€grant€of€summaryÐ ¼  Ðjudgment.€€òòMoore€v.€Walwynóó,€No.€01A01„9507„CV„00295,€1996€WL€17143€(Tenn.€Ct.€App.€Jan.Ð ¨ø Ð19,€1996).€€It€is€well€to€observe€that,€even€if€the€trial€court€had€considered€the€late€filed€SupplementalÐ ”ä ÐAffidavit€of€Dr.€Bussey,€it€could€not€have€altered€the€grant€of€summary€judgment.€€The€SupplementalÐ €Ð ÐAffidavit€added€nothing€to€the€previous€Affidavit€except€to€assert€ð ðI€am€aware€of€the€fact€thatÐ l¼ ÐNolensville,€Tennessee€is€a€small€town€with€no€hospital€located€within€its€city€limits.€€I€am€alsoÐ X ¨ Ðaware€that€the€closest€hospital€to€Nolensville,€Tennessee,€is€approximately€ten€or€fifteen€miles€to€theÐ D!” Ðnorth€in€Nashville,€Tennessee,€and€approximately€ten€or€fifteen€miles€to€the€southwest€in€Franklin,Ð 0"€  ÐTennessee.ðð€€This€assertion€in€no€way€cures€the€deficiencies€relating€to€Dr.€Busseyððs€lack€ofÐ #l! Ðfamiliarity€with€the€applicable€standard€of€care.Ð $X" ÐÌà  àThe€trial€court€had€no€alternative€but€to€grant€summary€judgment€to€Defendants€in€this€case,Ð à%0!$ Ðand€that€action€is€in€all€respects€affirmed.Ð Ì&"% ÐÌà  àThe€case€is€remanded€to€the€trial€court€with€costs€assessed€to€Appellants.€Ð ¤(ô#' ÐÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð |*Ì%) Ðà  àà ` àà ¸ àà  àà h àà À àà  àWILLIAM€B.€CAIN,€JUDGE