ÿWPCž ³ÊqE} ºxsGD ôxªey=˜LÆÿ…Ã3mI5ÓˤKGÖ§$ˆ}kÖ=ömd0·óÞ˜Á09©ÿf…æ·°uU3¿Ìä¡êåâ?Á}ÍPáª±Ïøv°&FšdÏw¯ÞÚ,èôõÁdSª1SW`CÇ…”­ð\9Wuâ?û¦ekC*ò€áCy=Ïp¤è„ ÎJX¢ŸXš…ÝoÕ˜•'Ýèq{Pù£jpãêß—¿±Zy"ת cKm·(~Φq¤L" á+®äªßAl]ÖŒ;þµ)ÏüŠ@W{?0ði~QÌ(nkRx4K§EoÞEî…‹2°uG%Ûù b¢¹ž>%Œ8§ÇŽHJ.¬¤?½ÜÁñO»Ü|ÖÇn’ÆËB/kÈ d*SEVÊ©¤|Þ«áQuÁwø}2¶¬©¬?žQù ÎËeŒ,ù{\TCÙ/ó¬¶MœdóçŠÃ)„ûPž¶Ÿ%ÃYëçH3bW&u‚wáÎx}z·»Îo[Ê9º{òë‚®u±Ø \ñYyÈ…Uxz6r~¯ÚÙ•Àõ{÷š3‡ÄV9¨å4ý•$U‚³R•×]µk†öXi™›«þäÏ¡{X•Â3<ªÆúH÷Øb %\UNb 0ˆ° 1‡8U#N¿ 72 1u? z´ Ò. 72 S2 `… 0Då Æ)ÆïƵÆ{ 0cAN¤-¦U<ÓE 0w 0Šˆl^ ~wŠ4Ž¢± m³#ÁÊÊ‹‹‹‹‹‹‹‹‹‹‹‹b““““““““““““““““““““““““““““““““““““ 0ë›››› B†† 0¤£ D3G D-z 0K§§ ASòÆE 0¤  0D¯ A«ó»(ÖÃ9 Z‹6Times New Roman Regular(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó0µiCEKQW]cioAutoList11.1.I.1.1.1.1.1.(í€"  Z6Times New Roman Regular1.3#37=CIQYag­­1.a.i.(1)(a)(i)1)a) ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpti) IÝ ƒRäá$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ôÅ|ò»»ÔÝ  ÝÔ_Ôà ` àThe€complaint€also€included€as€a€defendant€Patterson€Gynecology€and€Obstetrics,€a€partnership.€€OnÐ ° Ðmotion,€the€trial€court€dismissed€the€complaint€against€the€partnership. VÝ ƒRäá$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ôÅ|ò»»ÔÝ  ÝÔ_Ôà ` àA€trocar€is€a€sharp„pointed€instrument€used€for€piercing€a€cavity€wall€in€paracentesis.€òòDorlandððsÐ °  Ðillustrated€Medical€Dictionary€1470€(óó23òòrdòòóó€óóed.òò€1957).€€óó€(#Ã$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 5(;3£$´´Ô2#ÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à #Ñ#€Cÿÿd#Ñ-šBu Z‹$Arrus BT Roman(Oé;$µµà0  àÔ2#ÔÚ  ÚaÚ  Ú.Ô3  Ôà0` (#(#à(b·¤$¶¶à0  àà0` (#(#àÔ2#ÔÚ  ÚÚ  Ú.Ô3  Ôà0¸ ` (#` (#à bÝ ƒRäá$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ôÅ|ò»»ÔÝ  ÝÔ_Ôà ` àDr.€McDaniel€is€a€general€surgeon€who€assisted€Dr.€Patterson€in€the€laparotomy€at€€€Dr.€PattersonððsÐ ° Ðrequest€when€he€discovered€that€blood€was€accumulating€in€Ms.€Wiechertððs€abdominal€cavity.8… +L ˜L-(èã§k2po¦3|x ÿU‹ÿÀÀÀ˜HP LaserJet 4,ü,,,,,ü0 - ù-(|G2äá$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€¾t»»dd8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ôÅ|ò»»Ô d(|3A$££Ý ƒ£ª!ÝÑ€.ÑÑ8€¾t»»dd8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3A$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€¾t»»dd8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€¾t»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼¾t»»»ÔÑ8€¼ƒXXdð»»d8ÑÑ  Ñà@ü ü ìàÔ‡îè‡î»¼¾tÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@õõ%ìàAT€JACKSONÔ#†¼¾t»îîè‡ #ԈРÜ, ÐÓ  ÓJune€21,€2001€SessionÐ X ÐÔ‡X¼ƒX»¼¾tÔÌò òÔ#†¼¾t»XX¼ƒð#ÔSUSAN€RENEE€WIECHERT€WILSON,€òòet€al.óó€v.€RUSHTON€E.Ð  ` ÐPATTERSON,€JR.,€M.D.òòóóÔ‡X¼ƒX»¼¾tÔó óÐ ( x ÐÌà@@½½ìàò òA€Direct€Appeal€from€the€Circuit€Court€for€Shelby€CountyÐ 0 € Ðà@@øøìàNo.€70075„2€€€€€€The€Honorable€James€F.€Russell,€JudgeÐ  p ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<ï` AßÐ ð@  ÐÌà@@TTìàNo.€W2000„02771„Ô_ÔCOAÔ_Ô„R3„CV€„€August€10,€Ô_Ô2001Ô_ÔÐ ï?  ÐÌßA€V) °°` dE<Î` AßÐ Ï Ðó óÌÓ  ÓÔ‡XâXXX¼ƒÔà  àThis€is€a€medical€malpractice€case.€€Plaintiffs,€husband€and€wife,€sued€defendant€physicianÐ Î Ðfor€injuries€allegedly€caused€to€Wife€by€the€physicianððs€negligence.€€Physician€moved€for€summaryÐ º  Ðjudgment€supported€by€his€affidavit€that€he€conformed€to€the€required€standard€of€care.€€Plaintiffs,Ð ¦ö Ðin€opposition€to€the€summary€judgment,€filed€a€deposition€and€affidavit€of€a€physician€practicing€inÐ ’â ÐKentucky€that€expressed€his€knowledge€of€the€standard€of€care€in€Memphis€and€similar€communities.€Ð ~Î ÐPhysician€moved€to€strike€the€affidavit€primarily€on€the€ground€that€plaintiffsðð€physician€expert€didÐ jº Ðnot€show€a€familiarity€with€the€standard€of€care€in€Memphis,€Tennessee.€€The€court€granted€theÐ V¦ Ðmotion€to€strike€the€affidavit€and€also€granted€summary€judgment€to€defendant€physician.€€PlaintiffsÐ B’ Ðappeal.€€We€reverse€and€remand.Ð .~ ÐÔ#†X¼ƒXXXâ÷#ÔÔ#†¼¾t»XX¼ƒœ#ÔÔ‡X¼ƒX»¼¾tÔÌÓëÓÌò òTenn.R.App.P.€3;€Appeal€as€of€Right;€Judgment€of€the€Circuit€Court€Reversed€andÐ úJ ÐRemandedó óÐ ê: ÐÌòòÓ  ÓÔ#†¼¾t»àX¼ƒW #ÔÔ‡X¼ƒX.¼¾tÔW.€Frank€Crawford,€P.J.,€W.S.óó,€delivered€the€opinion€of€the€court,€in€which€òòAlan€E.€Highers,Ð Ê  ÐJ.óó€and€òòDavid€R.€Farmer,€J.óó,€joined.Ð º!   ÐÌLanier€Fogg,€Memphis,€For€Appellants,€Susan€Renee€Wiechert€Wilson€and€James€Kelly€WiechertÐ š#ê" ÐÌDavid€M.€Cook,€Karen€S.€Koplon,€Greg€A.€Ziskind,€Memphis,€For€Appellee,€Ô_ÔRushtonÔ_Ô€E.€Patterson,Ð z%Ê $ ÐJr.,€M.D.Ð j&º!% ÐÓ ÓÌò òÌÌÌÌÌÌÐ ê-:)-ý ÐOPINIONó óÔ#†¼¾t»XX¼ƒB #ÔÔ‡X¼ƒX»¼¾tÔÐ ° ÐÌòòóóÔ#†¼¾t»XX¼ƒš #ÔÔ‡X¼ƒX»¼¾tÔÓ  ÓÑ€êÝÑà  àOn€May€24,€1995,€plaintiffs,€Susan€Renee€Wiechert€and€James€Kelly€Wiechert,€filed€aÐ à Ðcomplaint€against€defendant,€Rushton€E.€Patterson,€Jr.€M.D.׃ ×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€The€complaint€alleges€that€SusanÐ €Ð ÐRenee€Wiechert€was€a€patient€of€the€defendant,€Dr.€Patterson,€and€that€on€May€25,€1994,€she€wasÐ pÀ Ðadmitted€to€the€Methodist€Hospital€in€Memphis€for€a€diagnostic€laparoscopy.€The€complaint€aversÐ ` ° Ðòòóóthat€during€the€procedure,€Ms.€Wiechert€was€caused€to€suffer€multiple€lacerations€of€her€abdomen,Ð P   Ðincluding€a€laceration€of€her€left€iliac€artery.€€The€complaint€further€avers€that€as€a€result€of€internalÐ @  Ðlacerations,€Ms.€Wiechert€sustained€massive€internal€bleeding€and€was€forced€to€undergo€anÐ 0 € Ðemergency€exploratory€laparotomy.€€Plaintiffs€alleges€that€the€injuries€sustained€by€Ms.€WiechertÐ  p  Ðwere€the€direct€and€proximate€result€of€negligence€on€the€part€of€Dr.€Patterson,€as€he€failed€toÐ `  Ðexercise€ordinary€care€and€diligence€under€the€circumstances.€€Plaintiffs€seek€damages€for€Ms.Ð P  ÐÔ_ÔWiechertÔ_Ôððs€alleged€life€threatening€injuries,€medical€expenses,€physical€pain,€mental€anguish,Ð ð@  Ðpermanent€scarring,€and€disability,€and€Mr.€Wiechertððs€loss€of€consortium.€Ð à0  ÐÌà  àDr.€Pattersonððs€answer€admits€that€Ms.€Wiechert€sustained€a€laceration€to€her€left€commonÐ À Ðiliac€artery€during€diagnostic€laparoscopy€and€that€she€sustained€internal€bleeding,€and€that€aÐ ° Ðlaparotomy€was€necessitated€to€control€the€injury,€however,€he€denies€that€he€was€guilty€of€anyÐ  ð Ðnegligent€act€or€omission€which€was€the€proximate€cause€of€any€injury€or€damages€to€Plaintiffs.€€Dr.Ð à ÐPatterson€avers€that€in€treating€Ms.€Wiechert,€he€exercised€that€degree€of€skill€and€learning€ordinarilyÐ €Ð Ðused€by€members€of€his€profession€in€good€standing€and€in€similar€practice€in€his€community,€andÐ pÀ Ðthat€at€all€times€he€used€reasonable€care€and€diligence€in€the€treatment€of€Ms.€Wiechert.€€The€answerÐ `° Ðfurther€avers€that€to€the€extent€Ms.€Wiechert€sustained€any€injury€or€that€either€of€the€plaintiffsÐ P  Ðsustained€any€damages€arising€out€of€the€course€of€medical€treatment€administered€by€him,€suchÐ @ Ðinjury€or€damage€was€in€conjunction€with€known€and€unknown€bodily€processes,€and€had€nothingÐ 0€ Ðto€do€with€and€was€not€caused€by€negligence€or€malpractice€on€his€part.€€He€also€asserts€that€allÐ  p Ðmedical€practices,€treatments€and€procedures€administered€by€him€were€acceptable€and€appropriateÐ ` Ðfor€the€physical€condition€of€Ms.€Wiechert.€€à À àÐ P ÐÌà  àDr.€Patterson€filed€a€motion€for€summary€judgment€and€an€affidavit€in€support€thereof.€€InÐ à0 Ðhis€affidavit,€€Dr.€Patterson€expresses€his€knowledge€of€the€standard€of€professional€practice€requiredÐ Ð  Ðand€states€that€Ms.€Wiechert€was€first€seen€by€him€in€his€office€on€May€12,€1994€with€a€chiefÐ À! Ðcomplaint€of€a€persistent€breast€lump.€€Ms.€Wiechert€returned€to€Dr.€Pattersonððs€office€one€week€laterÐ °"  Ðand€continued€to€complain€of€pelvic€pain€and€dyspareunia,€and€at€that€time€he€discussed€variousÐ  #ð! Ðtreatment€options.€€Ms.€Wiechert€wanted€to€proceed€with€a€laparoscopy€to€diagnose€possibleÐ $à" Ðendometriosis€and€was€admitted€to€Methodist€Hospital€on€May€25,€1994.€€The€affidavit€states€thatÐ €%Ð # Ðthe€laparoscopy€revealed€no€evidence€of€endometriosis,€but€that€the€trocar׃ ×Ý ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€used€in€the€procedureÐ p&À!$ ÐÑêÝÑâ âÑ8€âXdìXXdð8Ñâ âÑ  Ñlacerated€the€left€common€iliac€artery€which€is€a€known€complication€of€laparoscopy€and€wasÐ ° Ðexplained€fully€to€Ms.€Wiechert.€€An€emergency€laparotomy€was€performed€to€control€the€injury,Ð  ð Ðwhich€was€repaired€and€recovery€was€uneventful.€€Dr.€Patterson€stated€that€all€medical€practices,Ð à Ðtreatments,€and€procedures€administered€by€him€were€acceptable€and€appropriate€for€Ms.€Wiechert,Ð €Ð Ðand€that€at€no€time€was€he€guilty€of€any€negligence€or€malpractice.Ð pÀ ÐÌà  àIn€opposition€to€Dr.€Pattersonððs€motion€for€summary€judgment,€the€Wiecherts€filed€theÐ P   Ðaffidavit€of€Ms.€Wiechert€in€which€she€stated€as€follows:€€On€May€12,€1994,€she€had€an€appointmentÐ @  Ðwith€Dr.€Patterson€to€discuss€a€lump€in€her€breast,€some€pelvic€pain€and€a€urinary€tract€infection.€€Dr.Ð 0 € ÐPatterson€gave€her€some€medication€for€the€infection€and€scheduled€another€appointment€for€MayÐ  p  Ð19,€1994.€€On€that€date,€Dr.€Patterson€examined€Ms.€Wiechert€and€informed€her€that€it€was€necessaryÐ `  Ðthat€he€perform€a€laparoscopy€to€determine€the€cause€of€the€pelvic€pain€and€that€no€other€treatmentÐ P  Ðoptions€were€provided.€€Dr.€Patterson€described€the€laparoscopy€as€ð ðband„aid€surgery,ðð€however€didÐ ð@  Ðnot€inform€her€of€the€possible€adverse€consequences€of€the€surgery.€€As€a€result€of€having€thisÐ à0  Ðsurgery,€Ms.€Wiechert€has€a€8€3/4€inch€keloid€scar€from€1€ðð€inches€above€her€navel€to€1€inch€intoÐ Ð  Ðthe€pubis.€Ð À ÐÌà  àPlaintiffs€filed€the€affidavit€of€David€S.€Swan,€M.D.€on€November€16,€1995.€€Dr.€Swan€isÐ  ð Ðlicensed€to€practice€medicine€in€Kentucky€and€is€board€certified€in€obstetrics€and€gynecology.€€Dr.Ð à ÐSwan€stated€in€his€affidavit€that€he€is€familiar€with€the€recognized€standards€of€acceptableÐ €Ð Ðprofessional€medical€practice€in€the€field€of€obstetrics€and€gynecology€and€more€specifically,€the€careÐ pÀ Ðof€someone€in€the€position€of€Ms.€Wiechert€in€an€area€such€as€Memphis,€Tennessee€in€1994.€€InÐ `° Ðaddition,€Dr.€Swan€stated€that€the€standard€of€care€in€Memphis€would€be€similar€to€that€of€theÐ P  ÐLexington,€Kentucky€area€where€he€practices,€and€that€he€was€practicing€gynecology€in€Berea,Ð @ ÐKentucky€during€the€year€immediately€preceding€the€date€which€Dr.€Patterson€performed€theÐ 0€ Ðlaparoscopy€on€Ms.€Wiechert.€€The€affidavit€further€stated€that€Dr.€Patterson€breached€the€recognizedÐ  p Ðstandard€of€acceptable€professional€practice€in€Memphis€by€failing€to€carry€out€a€proper€evaluationÐ ` Ðof€Ms.€Wiechert€which€resulted€in€the€performance€of€a€laparoscopy€which€was€unnecessary€at€thatÐ P Ðtime,€and€that€the€injury€to€Ms.€Wiechertððs€left€iliac€artery€was€a€direct€result€of€this€unnecessaryÐ ð@ Ðsurgery.€€Additionally,€Dr.€Swan€states€that€Dr.€Patterson€breached€the€recognized€standard€ofÐ à0 Ðacceptable€professional€practice€in€Memphis€by€inserting€the€trocar€at€an€angle€and€depth€wherebyÐ Ð  Ðhe€struck€the€left€iliac€artery,€and€that€as€a€direct€result€of€Dr.€Pattersonððs€breach€of€the€standard€ofÐ À! Ðcare,€Ms.€Wiechert€sustained€a€laceration€to€her€left€iliac€artery.€€Dr.€Swan€stated€that€in€his€opinionÐ °"  Ðto€a€reasonable€degree€of€medical€certainty,€€Ms.€Wiechert€would€not€have€suffered€the€injury€hadÐ  #ð! ÐDr.€Patterson€adhered€to€the€recognized€standard€of€acceptable€medical€practice.Ð $à" ÐÌà  àSubsequently,€Dr.€Swanððs€deposition€was€taken€and€filed€as€part€of€the€record.€€Dr.€SwanÐ p&À!$ Ðtestified€that€in€the€evaluation€of€pelvic€pain€and€the€indications€of€performing€a€laparoscopy€thereÐ `'°"% Ðis€a€nationwide€standard.€€As€to€the€procedure€itself,€Dr.€Swan€agreed€that€nicking€the€left€iliac€arteryÐ P( #& Ðis€a€recognized€risk€of€performing€a€laparoscopy,€however€stated€that€when€that€artery€is€nickedÐ ° Ðduring€the€procedure,€it€is€the€result€of€a€deviation€from€the€standard€of€care.€Ð  ð ÐÌà  àOn€March€6,€2000,€Dr.€Patterson€filed€a€second€motion€for€summary€judgment€andÐ €Ð Ðmemorandum€in€support€thereof€asserting€that€Plaintiffs€had€failed€to€satisfy€their€burden€pursuantÐ pÀ Ðto€T.C.A.€ðð€29„26„115€which€requires€that€plaintiffs€prove€by€expert€testimony€the€standard€of€careÐ ` ° Ðin€the€defendantððs€speciality€of€obstetrics€and€gynecology,€a€deviation€from€the€standard,€and€anÐ P   Ðinjury€caused€by€the€deviation.€€Dr.€Patterson€avers€in€his€motion€that€Plaintiffs€disclosed€as€theirÐ @  Ðonly€non„treating€expert€witness€Dr.€David€Swan,€a€doctor€from€Berea,€Kentucky.€€€€The€motionÐ 0 € Ðasserts€that€Dr.€Swan€had€made€no€inquiry€into€the€Memphis€medical€community,€had€never€beenÐ  p  Ðto€Memphis,€other€than€to€testify€in€medical€malpractice€trials,€and€that€€Plaintiffs€had€not€shown,Ð `  Ðbeyond€a€conclusory€assertion€of€a€national€standard€of€care,€€that€Dr.€Swan€is€familiar€with€theÐ P  ÐMemphis€medical€community.€€Ð ð@  ÐÌà  àPlaintiffs€then€filed€another€affidavit€from€Dr.€Swan€in€opposition€to€Dr.€Pattersonððs€motionÐ Ð  Ðfor€summary€judgment€which€states:Ð À ÐÌà8  àà8` Ð Ð à1.€€I€am€familiar€with€the€recognized€standard€of€acceptableÐ  ð Ðprofessional€medical€practice€in€the€field€of€obstetrics€and€gynecologyÐ à Ðfor€Lexington,€Kentucky.ЀÐ` x` x ÐÌÓ€ (µi03Óà8  àØ! !Øà8` Ð Ð à2.€€In€my€opinion,€the€Lexington,€Kentucky€area€is€a€similar€area€toà8@Z` x` xàà @Z àÐ `° ÐMemphis,€Tennessee€with€regard€to€the€standard€of€care€of€acceptableÐ P  Ðprofessional€medical€practice€in€the€field€of€obstetrics€and€gynecologyÐ @ Ðand€in€regard€to€the€medical€services€provided€in€this€area.€€BothÐ 0€ ÐLexington,€Kentucky€and€Memphis,€Tennessee€are€regional€medicalÐ  p Ðcenters€and€are€the€locations€of€their€state€medical€schools.Ð`` x` x ÐÌà8  àà8` Ð Ð à3.€€I€am€familiar€with€the€recognized€standard€of€care€of€acceptableÐ ð@ Ðprofessional€medical€practice€in€the€field€of€obstetrics€and€gynecologyÐ à0 Ðin€Lexington,€Kentucky€because€I€was€an€assistant€professor€in€theÐ Ð  ÐDepartment€of€Obstetrics€and€Gynecology€at€the€University€ofÐ À! ÐKentucky€which€is€located€in€Lexington,€Kentucky€for€two€yearsÐ °"  Ðfrom€1970€to€1972.€€At€the€time€of€Ms.€Wiechertððs€subject€injury,€IÐ  #ð! Ðwas€an€assistant€clinical€professor€in€the€Department€of€ObstetricsÐ $à" Ðand€Gynecology€at€the€University€of€Kentucky€located€in€Lexington,Ð €%Ð # ÐKentucky.€€I€also€had€courtesy€privileges€at€three€hospitals€inÐ p&À!$ ÐLexington,€Kentucky€which€I€utilized€from€time€to€time.Ð`'°"%` x` x ÐÌà8  àà8` Ð Ð à4.€€Further,€I€have€testified€in€at€least€ten€medical€malpractice€casesÐ @)$' Ðin€Memphis,€Tennessee.€€As€a€consequence,€I€have€had€theÐ 0*€%( Ðopportunity€to€review€the€depositions€of€and€hear€the€testimony€ofÐ  +p&) Ðnumerous€Memphis,€Tennessee€physicians€on€the€recognizedÐ ,`'* Ðstandard€of€care€of€acceptable€professional€medical€practice€in€theÐ ° Ðfield€of€gynecology€and€obstetrics.€€This€has€confirmed€my€opinionÐ  ð Ðthat€the€recognized€standard€of€care€of€acceptable€professionalÐ à Ðmedical€practice€in€the€field€of€obstetrics€and€gynecology€inÐ €Ð ÐMemphis,€Tennessee€is€the€same€as€that€of€Lexington,€Kentucky€inÐ pÀ Ðregard€to€the€way€that€patients€are€evaluated€for€diagnosticÐ ` ° Ðlaparoscopys€and€the€manner€in€which€the€laparoscopic€procedure€isÐ P   Ðexecuted.€€Ð@ ` x` x ÐÌà  àDr.€Patterson€filed€a€motion€to€strike€the€affidavit€of€Dr.€Swan,€arguing€that€statements€madeÐ  p  Ðin€his€affidavit€regarding€his€familiarity€with€the€standard€of€care€in€Memphis€are€in€contradictionÐ `  Ðwith€his€deposition€testimony€that€the€applicable€standard€of€care€is€a€national€standard€of€care.€€Dr.Ð P  ÐPatterson€asserts€that€because€Dr.€Swan€directly€contradicts€himself€in€sworn€affidavits€andÐ ð@  Ðdepositions€on€the€issue€of€his€familiarity€with€the€local€standard€of€care,€his€affidavit€must€beÐ à0  Ðstricken€as€inherently€untrustworthy€and€therefore,€inadmissable.€€On€October5,€2000,€after€aÐ Ð  Ðhearing,€the€trial€court€entered€an€order€granting€defendantððs€motion€to€strike€Dr.€Swanððs€lastÐ À Ðaffidavit€and€granting€summary€judgment€to€defendant.€€The€order€states€in€pertinent€part:€€Ð ° ÐÌà8  àà8` Ð Ð à[T]he€plaintiff€is€not€able€to€establish€the€requirements€of€TennesseeÐ à ÐCode€Annotated€ðð€29„26„115(a)(1)€insofar€as€the€locality€rule€isÐ €Ð Ðconcerned€as€has€been€interpreted€in€the€case€of€ò òòòMabon€v.€Jackson„Ð pÀ ÐMadison€County€General€Hospital,óóó ó€968€S.W.€2d€826€(Tenn.€Ct.€App.Ð `° Ð1997).€€The€Court€specifically€rejects€plaintiffððs€argument€that€theÐ P  Ðstandard€of€care€is€a€national€standard€or€that€the€standard€of€care€inÐ @ ÐMemphis,€Tennessee€is€the€same€as€in€Lexington,€Kentucky€becauseÐ 0€ Ðall€gynecologist€read€the€same€journals€and€articles€and€because€theyÐ  p Ðhave€to€pass€the€same€examination€to€be€board€certified.€€The€CourtÐ ` Ðrelies€upon€the€case€of€ò òòòBeaty€v.€Irwin,€óóó ó2000€WL€66028€(Tenn.€Ct.Ð P ÐApp.€2000),€in€which€the€Court€of€Appeals€for€the€Eastern€SectionÐ ð@ Ðrejected€the€identical€argument.€€The€Court€further€finds€Dr.€SwanððsÐ à0 Ðconclusion€that€Dr.€Patterson€deviated€from€the€standard€of€careÐ Ð  Ðbecause€he€cut€the€iliac€artery,€without€having€any€basis€for€theÐ À! Ðopinion,€amounts€to€a€presumption€of€negligence.€€T.C.A.€ðð€24„26„Ð °"  Ð115(c)€strictly€disallows€any€presumption€of€negligence.€€For€all€theÐ  #ð! Ðforegoing€reasons,€the€Court€is€of€the€considered€opinion€that€theÐ $à" Ðmotion€to€strike€the€affidavit€should€be€granted€and€the€motion€forÐ €%Ð # Ðsummary€judgment€should€likewise€be€granted.Ðp&À!$` x` x ÐÌà  àPlaintiffs€appeal€the€judgment€of€the€trial€court€and€present€three€issues€for€review€which,€asÐ P( #& Ðstated€in€their€brief,€are:Ð @)$' ÐÌâ âà  àà ` àI.€€Did€Plaintiffs€make€a€òòprima€facieóó€showing€that€Dr.€David€Swan€hadÐ  +p&) Ðà  àà8 ` àknowledge€of€the€recognized€standard€of€acceptable€professionalÐ ° Ðâ âpractice€in€Memphis,€Tennessee€or€in€a€similar€community€as€to€theÐ  ð Ðtreatment€of€pelvic€pain€and€of€the€performance€of€a€diagnosticÐ à Ðlaparoscopy.ЀÐ` x` x ÐÌà8  àà8` Ð Ð àII.€€Did€the€Plaintiffs,€in€response€to€the€Motion€For€SummaryÐ ` ° ÐJudgment€filed€by€Defendant€on€October€11,€1995,€make€a€òòprimaÐ P   Ðfacie€óóshowing€that€the€Defendant€deviated€from€the€appropriateÐ @  Ðstandard€of€acceptable€medical€practice€in€his€performance€of€aÐ 0 € Ðdiagnostic€laparoscopy€upon€Plaintiff.Ð p ` x` x ÐÌà8  àà8` Ð Ð àIII.€€Did€the€trial€court€err€in€striking€the€affidavit€of€Dr.€David€SwanÐ P  Ðdated€September€28,€2000€which€was€submitted€by€Plaintiffs€inÐ ð@  Ðopposition€to€the€Defendantððs€Motion€For€Summary€Judgment€AndÐ à0  ÐSupporting€Memorandum€filed€on€April€6,€2000.ÐÐ ` x` x ÐÌÔ‡X¼ƒXXX¼ƒÔà  àA€motion€for€summary€judgment€should€be€granted€when€the€movant€demonstrates€that€thereÐ ° Ðare€no€genuine€issues€of€material€fact€and€that€the€moving€party€is€entitled€to€a€judgment€as€a€matterÐ  ð Ðof€law.€€Tenn.€R.€Civ.€P.€56.04.€€The€party€moving€for€summary€judgment€bears€the€burden€ofÐ à Ðdemonstrating€that€no€genuine€issue€of€material€fact€exists.€€ò òòòBain€v.€Wellsó óóó,€936€S.W.2d€618,€622Ð €Ð Ð(Tenn.€1997).€€On€a€motion€for€summary€judgment,€the€court€must€take€the€strongest€legitimate€viewÐ pÀ Ðof€the€evidence€in€favor€of€the€nonmoving€party,€allow€all€reasonable€inferences€in€favor€of€thatÐ `° Ðparty,€and€discard€all€countervailing€evidence.€€òòò òId.ó óóó€€In€ò òòòByrd€v.€Halló óóó,€847€S.W.2d€208€(Tenn.€1993),Ð P  Ðour€Supreme€Court€stated:Ð @ ÐÌà8  àà8` Ð Ð àOnce€it€is€shown€by€the€moving€party€that€there€is€no€genuine€issueÐ  p Ðof€material€fact,€the€nonmoving€party€must€then€demonstrate,€byÐ ` Ðaffidavits€or€discovery€materials,€that€there€is€a€genuine,€material€factÐ P Ðdispute€to€warrant€a€trial.€€In€this€regard,€Rule€56.05€[now€Rule€56.06]Ð ð@ Ðprovides€that€the€nonmoving€party€cannot€simply€rely€upon€hisÐ à0 Ðpleadings€but€must€set€forth€òòspecific€factsóó€showing€that€there€is€aÐ Ð  Ðgenuine€issue€of€material€fact€for€trial.ÐÀ!` x` x ÐÔ#†X¼ƒXXX¼ƒ!O#ÔÔ‡X¼ƒXXX¼ƒÔà8  àÐ Ð Ð  Ðò òòòÓÓId.ó óóó€at€211€(citations€omitted)€(emphasis€in€original).Ð  #ð! ÐÓÓà  àSummary€judgment€is€only€appropriate€when€the€facts€and€the€legal€conclusions€drawn€fromÐ €%Ð # Ðthe€facts€reasonably€permit€only€one€conclusion.€€ò òòòCarvell€v.€Bottomsó óóó,€900€S.W.2d€23,€26€(Tenn.Ð p&À!$ Ð1995).€€Since€only€questions€of€law€are€involved,€there€is€no€presumption€of€correctness€regardingÐ `'°"% Ða€trial€court's€grant€of€summary€judgment.€€ò òòòBainó óóó,€936€S.W.2d€at€622.€€Therefore,€our€review€of€theÐ P( #& Ðtrial€courtððs€grant€of€summary€judgment€is€ò òòòde€novoó óóó€on€the€record€before€this€Court.€€ò òòòWarren€v.Ð @)$' ÐEstate€of€Kirkó óóó,€954€S.W.2d€722,€723€(Tenn.€1997).Ô#†X¼ƒXXX¼ƒrU#ÔÔ‡X¼ƒXXX¼ƒÔÐ 0*€%( Ðâ âÐ  +p&) Ðà  àIn€determining€whether€summary€judgment€was€proper,€we€first€address€the€correctness€ofÐ ° Ðâ âthe€trial€courtððs€decision€to€strike€Dr.€Swanððs€affidavit,€as€the€dispositive€issue€on€appeal€is€whetherÐ  ð Ðthe€opinion€of€Plaintiffsðð€expert,€that€defendantððs€treatment€of€Ms.€Wiechert€did€not€meet€theÐ à Ðstandard€of€professional€care€in€the€community,€or€a€similar€community,€is€admissible€in€evidence.€Ð €Ð ÐÔ#†X¼ƒXXX¼ƒY#ÔÔ‡X¼ƒXXX¼ƒÔ€A€plaintiffððs€burden€in€a€medical€malpractice€case€is€defined€in€T.C.A.€ðð€29„26„115:Ð pÀ ÐÌò òó óà8  àà8` Ð Ð àà ¸ à(a)€In€a€malpractice€action,€the€claimant€shall€have€the€burdenÐ P   Ðof€proving€by€evidence€as€provided€by€subsection€(b):Ð@ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à(1)€The€recognized€standard€of€acceptable€professionalÐ  p  Ðpractice€in€the€profession€and€the€specialty€thereof,€if€any,€that€theÐ `  Ðdefendant€practices€in€the€community€in€which€the€claimant€practicesÐ P  Ðor€in€a€similar€community€at€the€time€the€alleged€injury€or€wrongfulÐ ð@  Ðaction€occurred;Ðà0 ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à(2)€That€the€defendant€acted€with€less€than€or€failed€to€actÐ À Ðwith€ordinary€and€reasonable€care€in€accordance€with€such€standard;€Ð ° ÐandРð` x` x ÐÌà8  àà8` Ð Ð àà ¸ à(3)€As€a€proximate€result€of€the€defendant's€negligent€act€orÐ €Ð Ðomission,€the€plaintiff€suffered€injuries€which€would€not€otherwiseÐ pÀ Ðhave€occurred.Ð`°` x` x ÐÌà8  àà8` Ð Ð àà ¸ à(b)€No€person€in€a€health€care€profession€requiring€licensureÐ @ Ðunder€the€laws€of€this€state€shall€be€competent€to€testify€in€any€courtÐ 0€ Ðof€law€to€establish€the€facts€required€to€be€established€by€subsectionÐ  p Ð(a),€unless€the€person€was€licensed€to€practice€in€the€state€or€aÐ ` Ðcontiguous€bordering€state€a€profession€or€specialty€which€wouldÐ P Ðmake€the€person's€expert€testimony€relevant€to€the€issues€in€the€caseÐ ð@ Ðand€had€practiced€this€profession€or€specialty€in€one€(1)€of€these€statesÐ à0 Ðduring€the€year€preceding€the€date€that€the€alleged€injury€or€wrongfulÐ Ð  Ðact€occurred.€€This€rule€shall€apply€to€expert€witnesses€testifying€forÐ À! Ðthe€defendant€as€rebuttal€witnesses.€€The€court€may€waive€thisÐ °"  Ðsubsection€when€it€determines€that€the€appropriate€witnessesÐ  #ð! Ðotherwise€would€not€be€available.Ð$à"` x` x ÐÌà8  àà8` Ð Ð àà ¸ à(c)€In€a€malpractice€action€as€described€in€subsection€(a),€thereÐ p&À!$ Ðshall€be€no€presumption€of€negligence€on€the€part€of€the€defendant;€Ð `'°"% Ðprovided,€there€shall€be€a€rebuttable€presumption€that€the€defendantÐ P( #& Ðwas€negligent€where€it€is€shown€by€the€proof€that€the€instrumentalityÐ @)$' Ðcausing€injury€was€in€the€defendant's€(or€defendants')€exclusiveÐ 0*€%( Ðcontrol€and€that€the€accident€or€injury€was€one€which€ordinarilyÐ  +p&) Ðdoesn't€occur€in€the€absence€of€negligence.Ð,`'*` x` x ЇT.C.A.€ðð€29„26„115€(a)€„€(c)€(2000).€€Ô#†X¼ƒXXX¼ƒo[#ÔÔ‡XâXXX¼ƒÔ€In€order€tòòò òó óóóo€qualify€as€an€expert€in€a€medical€malpractice€action,Ð ° Ða€physician€is€not€required€to€be€familiar€with€all€the€medical€statistics€of€a€particular€community.€Ð ° Ðò òòòLedford€v.€Moskowitz,€ó óóó742€S.W.2d€645€(Tenn.€Ct.€App.€1987).€€An€expert€tendered€to€demonstrateÐ œì Ða€breach€of€duty€must€be€familiar€with€the€standard€of€care€in€the€community€in€which€the€defendantÐ ˆØ Ðpractices€or€in€a€similar€community€in€order€to€meet€the€threshold€requirement€regarding€the€standard€Ð tÄ Ðstandard€of€care€in€the€locality.€€Although€the€trial€court€has€broad€discretion€in€determining€theÐ ` ° Ðqualifications€of€expert€witnesses€and€the€admissibility€of€their€testimony,€ò òòòShelby€County€v.€Barden,óóó óÐ L œ Ð527€S.W.2d€124€(Tenn.€1975),€reversal€of€the€trial€courtððs€discretion€is€appropriate€where€the€trialÐ 8 ˆ Ðcourtððs€action€is€clearly€erroneous€or€where€there€has€been€an€abuse€of€discretion.€€ò òòòThomas€v.Ð $ t ÐHarper,€óóó ó53€Tenn.€App.€549,€385€S.W.2d€130€(1964).€€€à p àÐ  `  ÐÌà  àThe€trial€court€found€that€Plaintiffs€were€not€able€to€establish€the€requirements€of€T.C.A.€ððÐ è8  Ð29„26„115(a)(1)€insofar€as€the€locality€rule€is€concerned€as€interpreted€in€òòò òMabon€v.€Jackson„Ð Ô$  ÐMadison€County€General€Hospital,óóó ó€968€S.W.€2d€826.€€However,€the€facts€in€ò òòòMabonó óóó€appear€to€beÐ À  Ðdistinguishable€from€the€instant€case.€€In€€òòò òMabonóóó ó,€this€Court€found€that€the€plaintiffððs€expert€was€notÐ ¬ü  Ðqualified€to€give€an€opinion€as€to€whether€the€plaintiffððs€wifeððs€death€was€caused€by€a€doctorððs€breachÐ ˜è  Ðof€the€standard€of€care€in€treating€her€bowel€obstruction€because€the€expert€was€not€familiar€with€theÐ „Ô Ðstandard€of€care€in€the€area€of€Jackson,€Tennessee,€where€the€treatment€took€place.€€In€that€case,Ð pÀ Ðplaintiffððs€expert,€Dr.€Shane,€stated€in€his€affidavit€that€he€was€familiar€with€the€recognized€standardÐ \¬ Ðof€acceptable€medical€practice€in€areas€such€as€Jackson,€Tennessee€and€at€a€hospital€the€size€of€theÐ H˜ Ðfacility€at€which€the€plaintiffððs€wife€received€treatment.€€The€ò òòòMabon€óóó óCourt€noted€that€Dr.€ShaneÐ 4„ Ðstated€that€the€standard€of€care€in€Jackson€would€be€comparable€to€cities€and€facilities€in€which€heÐ  p Ðpracticed€medicine,€and€is€the€same€standard€used€for€New€York€and€other€large€cities,€which,€inÐ  \ Ðeffect,€is€a€national€standard.€€ò òòòId.€€ó óóóAt€830.€€The€Court€found€significant€Dr.€Shaneððs€€statement€thatÐ øH Ðthe€defendant€failed€to€meet€the€standard€of€care€that€ð ðshould€have€been€availableðð€in€a€city€the€sizeÐ ä4 Ðof€Jackson,€Tennessee,€finding€that€the€statement€ð ðillustrates€that€his€statement€in€his€affidavitÐ Ð  Ðregarding€the€standard€of€care€is€premised€on€the€national€standard€of€care€and€not€on€the€standardÐ ¼  Ðof€care€for€Jackson€or€similar€communities.ðð€€ò òòòId.€€óóó óIn€addition,€the€Court€noted€that€in€his€deposition,Ð ¨ø ÐDr.€Shane€ð ðreadily€admits€his€complete€lack€of€knowledge€of€Jacksonððs€medical€community...ðð€€òòò òId.ó óóóÐ ”ä ÐThe€ò òòòMabonóóó ó€Court€found€a€complete€lack€of€knowledge€concerning€a€communityððs€medical€resourcesÐ €Ð Ðwould€be€contrary€to€knowledge€of€the€required€standard€of€care.€€ò òòòId.€€óóó óÐ l ¼ ÐÌà  àThe€trial€court€also€relied€on€the€case€of€ò òòòBeaty€v.óóó ó€òòò òIrwin,€ó óóóNo.€E1999„00014„COA„R3„CV,Ð D"”  Ð2000€WL€66028€(Jan.€27,€2000),€stating€that€in€òòò òBeatyóóó ó,€the€Eastern€Section€of€the€Tennessee€CourtÐ 0#€! Ðof€Appeals€rejected€the€same€argument€as€presented€in€the€instant€case.€€The€trial€court€presents€theÐ $l" Ðargument€as:€ð ðthat€the€standard€of€care€is€a€national€standard€or€that€the€standard€of€care€in€Memphis,Ð %X # ÐTennessee€is€the€same€as€in€Lexington,€Kentucky€because€all€gynecologist€read€the€same€journalsÐ ô%D!$ Ðand€articles€and€because€they€have€to€pass€the€same€examination€to€be€board€certified.ðð€€€However,Ð à&0"% Ðwe€distinguish€the€facts€in€òòò òBeaty€ó óóófrom€the€facts€before€us.€€In€ò òòòBeaty€ó óóóthe€plaintiffððs€expert€stated€thatÐ Ì'#& Ðhe€had€not€done€anything€to€determine€the€standard€of€care€in€Knox€County,€the€community€whereÐ ¸($' Ðthe€defendant€practiced€as€a€dentist.€€In€addition,€although€plaintiffððs€expert€claimed€that€he€believedÐ ¤)ô$( Ðthat€Knox€County€and€Augusta,€Georgia,€where€he€lived,€were€similar€communities,€he€had€not€doneÐ *à%) Ðany€research€to€determine€if€that€was€true.€€ò òòòId.€ó óóóat€*1.€€€In€€ò òòòBeaty€óóó óthe€plaintiff€made€efforts€to€buttressÐ |+Ì&* Ðtheir€expertððs€opinion€by€filing€a€supplementary€affidavit€containing€claims€of€having€written€anÐ ° Ðarticle€for€the€Tennessee€Dental€Association,€having€taken€a€course€in€Tennessee,€though€not€inÐ œì ÐKnox€county,€€contact€with€individuals€in€Knox€County,€and€a€familiarity€with€the€number€of€dentistÐ ˆØ Ðin€that€area.€€The€expert€claimed€to€be€familiar€with€the€standard€of€care€in€Knoxville€based€on€hisÐ tÄ Ðbelief€that€the€standard€of€care€was€the€same€throughout€the€Southeast€region€and€possibly€theÐ `° Ðcountry.€On€appeal,€the€Court€found€no€abuse€of€€discretion€in€not€allowing€the€testimony€ofÐ L œ Ðplaintiffððs€expert€ò òòòóóó óstating€that€although€plaintiffððs€expert€testified€that€he€thought€Knoxville€andÐ 8 ˆ ÐAugusta€were€similar€communities,€he€had€not€produced€facts€to€support€that€this€was€true.€€€Ð $ t Ðà  àò òòòóóó óDr.€Swan,€in€his€deposition,€indicates€that€there€is€a€national€standard€of€care€for€physiciansÐ  ` Ðin€this€particular€specialty€and€that€therefore€he€is€familiar€with€the€standard€of€care€in€Memphis,Ð ü L  ÐTennessee.€€In€his€second€affidavit,€which€was€stricken€by€the€trial€court,€he€establishes€that€he€isÐ è 8  Ðfamiliar€with€the€recognized€standard€of€care€in€the€field€of€obstetrics€and€gynecology€in€Lexington,Ð Ô$  ÐKentucky,€by€virtue€of€his€experience€set€out€in€his€affidavit.€€He€also€opines€that€Lexington,Ð À  ÐKentucky€and€Memphis,€Tennessee€are€similar€areas€with€regard€to€the€standard€of€care€of€acceptableÐ ¬ü  Ðprofessional€medical€services,€stating:€ð ðBoth€Lexington,€Kentucky€and€Memphis,€Tennessee€areÐ ˜è  Ðregional€medical€centers€and€are€the€locations€of€their€state€medical€schools.ðð€€The€affidavit€goesÐ „Ô  Ðsomewhat€further€stating€that€because€of€Dr.€Swanððs€involvement€in€medical€malpractice€cases€inÐ pÀ ÐMemphis,€Tennessee,€he€has€the€opinion€that€the€recognized€standard€of€care€of€acceptableÐ \¬ Ðprofessional€medical€services€of€obstetrics€and€gynecology€in€Memphis€is€the€same€as€that€inÐ H˜ ÐLexington.€€à ` àÐ 4„ ÐÌà  àDr.€Patterson€additionally€argues€that€according€to€Tennessee€law,€Dr.€Swanððs€statementsÐ  \ Ðcancel€each€other€out€as€they€are€in€direct€conflict€with€one€another.€Ð øH ÐÌà8  àà8` Ð Ð àà ¸ àTennessee€follows€the€rule€that€contradictory€statements€byÐ Ð  Ðthe€same€witness€regarding€a€single€fact€cancel€each€other€out.€ò òòòSeeóóó óÐ ¼  Ðòòò òState€v.€Matthews,ó óóó€888€S.W.2d€446,€449€(Tenn.Crim.App.1993);Ð ¨ø Ðòòò òGambill€v.€Middle€Tenn.€Med.€Ctr.,ó óóó€751€S.W.2d€at€149-50.€€TheÐ ”ä ÐTennessee€Supreme€Court€has€characterized€mutually€contradictoryÐ €Ð Ðstatements€by€the€same€witness€as€"no€evidence"€of€the€fact€sought€toÐ l¼ Ðbe€proved.€€òòò òSee€€Johnston€v.€Cincinnati€N.O.€&€T.P.€Ry.,ó óóó€146€Tenn.Ð X ¨ Ð135,€160,€240€S.W.€429,€436€(1922).€€However,€in€order€to€beÐ D!” Ðdisregarded€under€the€so-called€cancellation€rule,€the€allegedlyÐ 0"€  Ðcontradictory€statements€must€be€unexplained€and€neither€statementÐ #l! Ðcan€be€corroborated€by€other€competent€evidence.€€òòò òSee€€State€v.Ð $X" ÐMatthews,ó óóó€888€S.W.2d€at€450;òòò ò€Gambill€v.€Middle€Tenn.€Med.€Ctr.,ó óóóÐ ô$D # Ð751€S.W.2d€at€151.€€When€the€cancellation€rule€is€invoked€at€theÐ à%0!$ Ðsummary€judgment€stage€to€challenge€evidence€opposing€the€motion,Ð Ì&"% Ðthe€courts€must€view€the€challenged€evidence€in€the€light€mostÐ ¸'#& Ðfavorable€to€the€opponent€of€the€motion.Ф(ô#'` x` x ÐÌò òòòChurch€v.€Ô_ÔPeralesÔ_Ô,€ó óóóNo.€M1997„00227„Ô_ÔCOAÔ_Ô„R3„CV,€2000€WL€1183074òòò ò€€óóó óat€€*17€(Ô_ÔTenn.Ct.AppÔ_Ô.Ð |*Ì%) ÐAug.€22,€2000).Ð h+¸&* Їà  à€€Upon€a€review€of€the€record€in€a€light€that€is€most€favorable€to€Plaintiffs,€€we€do€not€findÐ ° Ðstatements€made€by€Dr.€Swan€regarding€the€applicable€standard€of€care€to€be€in€conflict€with€oneÐ œì Ðanother.€€In€response€to€questions€regarding€the€standard€of€care€for€the€treatment€of€pelvic€pain,€Dr.Ð ˆØ ÐSwan€states€in€his€deposition€that€there€is€a€nationwide€standard€of€care.€€In€his€first€affidavit,€Dr.Ð tÄ ÐSwan€states€that€ð ðthe€standard€of€care€in€Memphis€would€be€similar€to€that€of€the€Lexington,Ð `° ÐKentucky€the€area€where€I€practiceðð€and€further€that€ð ðI€was€practicing€Gynecology€in€Berea,Ð L œ ÐKentucky€during€the€year€immediately€preceding€the€date€which€Dr.€Patterson€performed€theÐ 8 ˆ Ðlaparoscopy€on€Susan€Wiechert.ðð€€In€his€second€affidavit,€Dr.€Swan€enumerates€similarities€betweenÐ $ t ÐMemphis€and€Lexington€and€gives€facts€to€substantiate€his€familiarity€with€the€standard€of€care€inÐ  ` ÐMemphis€including€his€involvement€in€other€medical€malpractice€case€in€Memphis.€€We€find€noÐ ü L  Ðinherent€contradiction€in€the€statements€made€by€Dr.€Swan.€€ð ðMoreover,€when€the€cancellation€ruleÐ è 8  Ðis€invoked€at€the€summary€judgment€stage,€the€challenged€evidence€opposing€the€motion,€the€courtÐ Ô$  Ðmust€view€the€challenged€evidence€in€the€light€most€favorable€to€the€opponent€of€the€motion.ðð€Ð À  Ðò òòòChurch€,€ó óóó2000€WL€1183074€at€*17€(Aug.€22,€2000).Ð ¬ü  ÐÌà  àThe€trial€court€also€found€that€Dr.€Swan€concluded€€that€Dr.€Patterson€deviated€from€theÐ „Ô  Ðstandard€of€care€because€he€cut€the€iliac€artery€without€having€any€basis€for€the€opinion,€therebyÐ pÀ Ðmaking€a€presumption€of€negligence€which€is€strictly€disallowed€by€€T.C.A.€ðð€29„26„115(c).€€WhenÐ \¬ Ðan€expertððs€opinion€is€challenged,€the€court€is€to€determine€whether€the€opinion€is€based€on€creditableÐ H˜ Ðfacts€or€data€sufficient€to€provide€some€basis€for€the€opinion.€€òòò òMcDaniel€v.€CSX€Transp.,€Inc.,€ó óóó955Ð 4„ ÐS.W.2d€257,€265€(Tenn.€1997).€€€Our€task€is€not€to€determine€the€expertððs€credibility€or€the€weightÐ  p Ðto€be€giving€the€evidence,€but€rather€to€review€the€challenged€opinion€and€determine€if€it€has€someÐ  \ Ðlegally„acceptable€basis€from€which€the€expertððs€conclusion€could€be€rationally€drawn.€€ò òòòChurchóóó ó,Ð øH Ð2000€WL€1183074€at€*13€€(citing€ò òòòDevore€v.€Deloitte€&€Touche,€óóó óNo.€01A01„9602„CH„00073,€1998Ð ä4 ÐWL€68985,€at€*9„10€(Tenn.€Ct.€App.€Feb.€20,€1998)).€òòò òó óóó€Although€a€€lack€of€precision€by€Dr.€SwanÐ Ð  Ðmay€eventually€undermine€the€weight€of€his€testimony,€it€is€not€the€task€of€the€appellate€court€toÐ ¼  Ðweigh€the€evidence€at€the€summary€judgment€s€stage€of€the€proceedings.€€ò òòòIdóóó ó,€€at€*18.€€Ð ¨ø ÐÌà  àDr.€Swanððs€opinions€are€based€on€his€personal€review€of€Ms.€Ô_ÔWiechertÔ_Ôððs€medical€recordsÐ €Ð Ðincluding€the€office€records€of€Drs.€Patterson€and€McDaniel׃×Ý ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×,€the€hospital€records€for€MethodistÐ l¼ ÐHospital€from€May€25€through€June€1,€1994,€€the€deposition€of€Dr.€Patterson€taken€August€24,€1995,Ð X ¨ Ðand€Dr.€Pattersonððs€affidavit.€€€€Dr.€Swanððs€affidavit€states€that€he€graduated€from€medical€school€inÐ D!” Ð1962,€and€is€currently€licensed€to€practice€medicine€in€Kentucky.€€He€is€board€certified€in€obstetricsÐ 0"€  Ðand€gynecology.€€Dr.€Swan€testified€that€nicking€the€€left€iliac€artery€in€this€procedure,€even€thoughÐ #l! Ðconsidered€to€be€a€recognized€risk€and€complication,€is€a€result€of€deviation€from€the€standard€ofÐ $X" Ðcare,€stating€in€his€deposition:Ð ô$D # ÐÌà  àà8 ` àA.€à ¸ àOkay.€I€have€already€defined€the€standard€of€care,€that€theÐ Ì&"% Ðtrocar€must€be€passed€into€the€abdominal€cavity€parallel€to€theÐ ¸'#& Ðmidline€in€the€midline.€€It€should€be€passed€to€a€depth€that€permitsÐ ¤(ô#' Ðentry€into€the€peritoneal€cavity€at€the€level€of€the€anterior€abdominalÐ ° Ðwall.Мì` x` x ÐÌà8  àà8` Ð Ð àQ.€€Right.ÐtÄ` x` x ÐÌà8  àà8` Ð Ð àA.€€That€is€the€standard€of€care.ÐL œ` x` x ÐÌà8  àà8` Ð Ð àA.€Right.Ð$ t` x` x ÐÌà8  àà8` Ð Ð àA.€€As€previously€testified€to,€the€iliac€artery€is€far€deeper,€far€furtherÐ ü L  Ðfrom€that€point.€€One€person€has€the€control€of€the€€placement€of€thatÐ è 8  Ðtrocar€and€that€is€the€surgeon.€€If€that€trocar€goes€anywhere€else€butÐ Ô$  Ðdirectly€in€the€midline€and€directly€into€the€peritoneal€cavity,€thenÐ À  Ðwho€is€doing€it,€the€surgeon.€€He€is€responsible€for€that€deviation€fromÐ ¬ü  Ðstandard€of€care.Иè ` x` x ÐÌà  àMs.€Wiechert€suffered€damages€resulting€from€a€laceration€to€her€left€iliac€artery€whichÐ pÀ Ðoccurred€during€a€procedure€preformed€by€Dr.€Patterson.€€In€his€deposition,€Dr.€Patterson€testifiedÐ \¬ Ðthat€during€the€surgery€he€made€two€insertions€of€the€trocar€into€the€peritoneal€cavity€because€theÐ H˜ Ðfirst€insertion€was€too€small€to€accommodate€the€insertion€of€the€laparoscope.€€When€Dr.€PattersonÐ 4„ Ðwas€able€to€view€the€peritoneal€cavity,€he€noticed€significant€bleeding€in€the€cavity€and€requested€theÐ  p Ðassistance€of€Dr.€McDaniel.€€According€to€Dr.€Pattersonððs€deposition€the€distance€from€the€point€ofÐ  \ Ðentry€to€Ms.€Wiechertððs€left€iliac€artery€injury€was€significantly€more€than€the€entry€point€of€theÐ øH Ðtrocar€to€the€location€where€Dr.€Patterson€intended€to€place€the€trocar€to€enter€the€peritoneal€cavity.€Ð ä4 ÐDr.€Patterson€further€testified€that€the€risk€of€striking€the€left€iliac€artery€was€remote,€and€injury€toÐ Ð  Ðthe€iliac€artery€could€be€caused€by€the€angle€at€which€the€trocar€is€inserted€and/or€the€distance€thatÐ ¼  Ðthe€trocar€enters€the€cavity.€€He€states€that€there€were€no€abnormalities€in€Ms.€Wiechertððs€anatomicalÐ ¨ø Ðstructures.€€Ð ”ä ÐÌà  àAdmittedly,€when€a€plaintiff€is€relying€on€the€standard€of€care€in€a€similar€community,€thereÐ l¼ Ðmust€be€proof€that€the€community€is€similar€to€the€one€where€the€defendant€physician€practices.€€ò òòòSeeÐ X ¨ ÐMabon€v.€Jackson„Madison€County€General€Hosp.ó óóó,€968€S.W.2d€826,€831€(Tenn.€Ct.€App.€1997).€Ð D!” ÐÔ#†X¼ƒXXXâŽg#ÔÔ‡X¼ƒXXX¼ƒÔAlthough€Dr.€Swanððs€testimony€concerning€the€similarity€of€Lexington€and€Memphis€is€somewhatÐ 0"€  Ðmeager,€we€believe€this€testimony€in€conjunction€with€Dr.€Swanððs€testimony€concerning€hisÐ  #p! Ðknowledge€of€the€standard€of€care€of€Memphis€is€barely€sufficient€to€withstand€attack€at€theÐ $`" Ðsummary€judgment€stage€of€the€proceeding.€€Therefore,€the€order€striking€Dr.€Swanððs€affidavitÐ %P # Ðshould€be€reversed€and€his€testimony€in€its€entirety€considered€for€summary€judgment€purposes.Ð ð%@!$ ÐÌà  àViewing€the€record€as€a€whole€and€considering€Dr.€Swanððs€testimony€along€with€theÐ Ð' #& Ðtestimony€of€Dr.€Patterson,€there€does€appear€to€be€material€issues€of€fact€in€dispute€concerningÐ À($' Ðdeviation€from€the€standard€of€care.€Ð °)%( Ðâ âÐ  *ð%) Ðà  àAccordingly,€the€order€of€the€trial€court€granting€summary€judgment€to€defendant€is€reversed.€Ð ° Ðâ â€The€case€is€remanded€to€the€trial€court€for€further€proceedings€as€may€be€necessary.€€Costs€of€theÐ  ð Ðappeal€are€assessed€against€the€appellee,€Dr.€Rushton€E.€Patterson.Ð à Ѐ€€€€Ô#†X¼ƒXXX¼ƒ>¨#ÔÔ‡X¼ƒXXX¼ƒÔòòò òà  àóóó óÐ €Ð ÐÔ#†X¼ƒXXX¼ƒa­#Ôò òòòóóó óÔ#†¼¾t»XX¼ƒø #ÔÔ€X¼ƒX»¼¾tÔà  àà ` àà ¸ àà  àà h àà À à__________________________________________Ð pÀ Ðà  àà ` àà ¸ àà  àà h àà À àW.€FRANK€CRAWFORD,€PRESIDING€JUDGE,€W.S.