ÿWPCE" ÎÍݬàh#r¨)´ÚUÔ| ®,¶y´›“A¨D%P?"6T•D{ÇNqÿîëDª_ÅI«Š‚$þª|à_¯ ”§„4{d˜|[‘k« ­GIª«-À¬ù‡Àó[O¢Ñ»[¨ºo8¦`#¦Æš@ ‡³9n­ÿ‡ L’œý|4ÂwïiòÃu ãg Å>f@ÿÓvŸÜŽ?Üй^ÆÄaWŒ„Öý€õÊùøàZãz$½—Võ-rÄ îuš4-d‚Iv7/ûq ¾”nWqÒôi*äèÏ"{¥Á0ðÊãrV½mLŸ¶õMƒsÏ ;~H€óÛèÝJ4\c™ÄômjOüͤ}LÖœ“¬”ùo¼moçKB£í 4w0 Ðïì ‘Äo}_ôÖîßȆÚõE[œÓW>„q뎯? ß'gSfyÕnœÑÐÌÀ*Sœ©QVd,ƒÄ/±'Žv(,Fàþü2¨Zv%‡Ðӹݭ§ãУëÊ †©Çàz šni¢ñÓäà't²YŠD¨÷2 ÙG×ÞeùcÁò„¨ÌÝ,†rÈ!—’@/§Æ34ç ¤kº¤.!=¡îàðLjl…³°UZ, 1À©b#Á\ % ^ # 0ˆ/ UN· w 4 z Ò— i x mz ‘ Æ™ Æ_ Æ% Æë s±N$ 0D& 1‡jEñ 72ó 1u% 72š 0cÌ 0w/ 1‡¦ 72- 1‡_ 72æ 1‡ 72Ÿ 1‡Ñ 72X°ŠŠŠŠŠŠŠŠŠŠb:::::::::::::::::::::::::::::::::::: 0ëBBBB B-- 0¤J D3î D-! 0KNN AS™Æì 0¤² 0DV! A«š!˜HP LaserJet 4050 Series PCL 5eÈÈ,,,,ÈÈ0» oY+s (`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regularj5+bk1Ü`£ ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt3|x ÿU‹ÿÀÀÀ Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5 iÝ ƒR¨ã$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ôç%ò»»ÔÝ  ÝÔ_Ô€€Mr.€Tinsley€was€aware€that€not€everything€that€could€be€done€for€Mr.€Wilson€was€done.€€He€attributes€theÐ ° Ðdereliction€to€Cline€because€of€his€advanced€training.€€His€Ô_ÔawarenessÔ_Ô€was€so€acute€that€he€wrote€the€appended€documentÐ tÄ Ðshortly€after€leaving€the€hospital.€€Tinsley€admitted€that€he€knew€theÔ_Ô€defibrillatorÔ_Ô€should€have€been€taken€into€the€house.€Ð 8ˆ ÐHe€blames€Cline€for€this€failure.€€It€seems€to€us€that€Tinsley€had€a€like€duty€with€respect€to€the€Ô_ÔÔ_ÔÔ_Ôdefibrillator,€which€tendsÐ üL Ðto€detract€from€the€somewhat€lavish€praise€heaped€upon€him€for€his€recitation.(#Ã$òòÚ  Ú0Ú  Úóó0нCEKQW]cioAutoList1A.A.A.A.A.A.A.A.A.3#37=CIQYag­­1.a.i.(1)(a)(i)1)a)i)(;3£$´´Ô2#ÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à(Oé;$µµà0  àÔ2#ÔÚ  ÚaÚ  Ú.Ô3  Ôà0` (#(#à(š½CEKQW]cioAutoList2A.A.A.A.A.A.A.A.A.0ª½CEKQW]cioAutoList3A.A.A.A.A.A.A.A.A.(º½CEKQW]cioAutoList4A.A.A.A.A.A.A.A. A.0ʽCEKQW]cioAutoList5A.A.A.A.A.A.A.A."A. ¦Ý ƒR¨ã$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ôç%ò»»ÔÝ  ÝÔ_Ô€€We€think€the€trial€judge€inadvertently€used€the€term€ð ðpecuniary€valueðð€when€ð ðeconomic€lossðð€was€intended,Ð ° Ðbecause€the€award€of€$385,000€is€derived€from€the€opinion€of€the€economist,€Dr.€John€Moore,€that€the€value€of€theÐ tÄ Ðdecedentððs€earning€capacity€was€$375,000€to€which€was€added€funeral€expenses.€€If€the€court€intended€the€award€toÐ 8ˆ Ðcompensate€the€plaintiffs€for€the€òòpecuniary€valueóó€of€their€decedentððs€life,€as€distinguished€from€òòeconomic€lossóó,€theÐ üL Ðadditional€award€of€$500,000€for€ð ðconsortium€type€damagesðð€would€amount€to€a€double€recovery,€since€damages€for€lossÐ À Ðof€consortium€are€encompassed€in€an€award€for€pecuniary€damages.€€òòò òHill€v.€City€of€Germantownó óóó,€31€S.W.3d€234€(Tenn.Ð „Ô Ð2000)€(ð ð[Ô_ÔL]ossÔ_Ô€of€consortium€damages€in€a€wrongful€death€claim€are€wholly€contained€within€the€award€for€wrongfulÐ J š Ðdeath.ðð);€òòò òJordan€v.€Baptist€Three€Rivers€Ô_ÔHospitaló óóó,€984€S.W.2d€593€(Tenn.€1999)€(ð ð[Ô_ÔL]ossÔ_Ô€of€consortium€damages€areÐ  ^ Ðrecoverable€by€a€decedentððs€family€as€part€of€the€pecuniary€value€of€a€decedentððs€lifeðð).- ù-(|G2¨ã$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€IÅ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ôç%ò»»Ô d(|3Id$££Ý ƒ£ª!ÝÑ€.ÑÑ8€IÅ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3Id$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€IÅ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€IÅ»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼IÅ»»»ÔÑ8€ XXdì»»d8ÑÑ  ÑÔ‡îG4IÅÔÓ  ÓIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÐ ° ÐÓÓà@kk$ìàAT€NASHVILLEÔ#†¼IÅ»îîG4ú#ԈРÖ& ÐÓ  ÓAugust€9,€2001€SessionÐ üL ÐÔ‡X X»¼IÅÔÌò òÔ#†¼IÅ»XX ü#ÔKATY€WILSON,€òòet€al.óó€v.€Ô_ÔDICKSONÔ_Ô€COUNTY,€TENNESSEE,€òòet€alóó.Ô‡X X»¼IÅÔó óÐ úJ ÐÌÌò òAppeal€from€the€Circuit€Court€for€Ô_ÔDicksonÔ_Ô€CountyÐ æ 6 Ðà@@øøìàNo.€CV1090€€€€€€Allen€Wallace,€JudgeÐ Ò " ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<•` AßÐ –æ  ÐÌà@@TTìàNo.€M2000„02680„Ô_ÔCOAÔ_Ô„R3„CV€„€Filed€October€25,€Ô_Ô2001Ô_ÔÐ ‘á  ÐÌßA€V) °°` dE<h` AßÐ i¹  Ðó óÌÓ  ÓThis€is€a€Ô_ÔGTLAÔ_Ô€action€for€damages€for€wrongful€death€caused€by€the€admitted€negligence€of€aÐ d´ Ðparamedic,€(who€enjoyed€no€immunity)€employed€by€the€county,€which€enjoyed€immunity.€Ð P  ÐPecuniary€damages€of€$385,000€for€the€value€of€the€decedentððs€life€were€awarded,€together€with€aÐ <Œ Ðseparate€award€of€$500,000€for€ð ðconsortium„type€damages.ðð€€As€against€the€County€and€itsÐ (x Ðambulance€service,€the€total€award€cannot€exceed€$130,000.€€As€against€the€paramedic€the€award€isÐ d Ðlimited€only€by€the€standard€of€reasonableness.€€The€total€award€is€reduced€to€$500,000.Ð P ÐÓñÓÌò òTenn.€R.€App.€P.€3€Appeal€as€of€Right;€Judgment€of€the€Circuit€CourtÐ Ø( ÐAffirmed€in€Part€and€Modified€in€Partó óÐ Ä ÐÌòòÓ  ÓÔ#†¼IÅ»àX ¦#ÔÔ‡X X.¼IÅÔWilliam€H.€Ô_ÔInmanÔ_Ô,€Sr.€J.óó,€delivered€the€opinion€of€the€court,€in€which€òòWilliam€B.€Cainóó€andÐ œì ÐòòPatricia€J.€Cottrell,€Ô_ÔJ.J.Ô_Ôóó,€joined.Ð ˆØ ÐÌWilliam€C.€Moody,€Nashville,€Tennessee,€for€the€appellants,€Ô_ÔDicksonÔ_Ô€County,€Tennessee;€Ô_ÔDicksonÔ_ÔÐ `° ÐCounty€Ambulance€Service;€and€David€Cline.Ð L œ ÐÌWalter€W.€Ô_ÔBussartÔ_Ô,€Ô_ÔLewisburgÔ_Ô,€Tennessee,€for€the€appellee,€Katy€Wilson.Ð $"t! ÐÌPaul€G.€Summers,€Attorney€General€and€Reporter;€Michael€E.€Moore,€Solicitor€General;€and€HeatherÐ ü#L# ÐC.€Ross,€Senior€Counsel,€for€the€Ô_ÔintervenorÔ_Ô,€State€of€Tennessee.Ð è$8 $ ÐÓsÓÌò òOPINIONó óÔ#†¼IÅ»XX ¢#ÔÔ‡X X»¼IÅÔÐ À&"& ÐÌòòóóÔ#†¼IÅ»XX s #ÔÓ  ÓÔ€X X»¼IÅÔà  àThis€is€an€action€for€damages€for€the€alleged€wrongful€death€of€Clayton€Wilson€who€sufferedÐ ˜(è#( Ða€heart€attack€at€his€home€in€the€early€morning€hours€of€November€20,€1997€and€died€in€theÐ „)Ô$) Ðemergency€room€of€a€hospital.€€He€was€51€years€old,€and€was€survived€by€his€widow,€Katy€Wilson,Ð p*À%* Ðand€two€children.Ð \+¬&+ Ðâ âÐ H,˜',ýÿ ÐÔ_Ôà  àResponding€to€a€911€call,€Donald€Tinsley,€an€EMT,€and€David€Cline,€a€paramedic,€both€ofÐ ° Ðâ âwhom€were€employed€by€the€Dickson€County€Ambulance€Service,€arrived€at€the€residence.€€ClaytonÐ œì ÐWilson€was€breathing,€and€oxygen€was€administered.€€He€was€carried€by€stretcher€to€the€ambulanceÐ ˆØ Ðand€transported€to€a€hospital.Ð tÄ ÐÌà  àThe€ambulance€was€equipped€with€a€cardiac€defibrillator€which€admittedly€was€not€used.€Ð L œ ÐThe€failure€of€the€paramedic,€David€Cline,€to€use€the€defibrillator€is€the€basis€of€this€litigation.Ð 8 ˆ ÐÌà  àThe€complaint€alleged€that€the€defendant€David€Cline€was€negligent€and€deviated€from€theÐ  ` Ðrecognized€standard€of€care€in€Dickson€County€in€the€care€and€treatment€of€Clayton€Wilson€in€thatÐ ü L  Ðhe€failed€to€use€the€defibrillator,€failed€to€intubate€Mr.€Wilson,€failed€to€call€the€emergency€room€andÐ è 8  Ðin€other€particulars.Ð Ô$  ÐÌà  àThe€factual€pattern€need€not€be€labored€in€light€of€the€admission€of€David€Cline€that€he€wasÐ ¬ü  Ðnegligent€in€failing€to€take€a€monitor/defibrillator€into€the€Wilson€residence.€€His€counsel€concedesÐ ˜è  Ðthat€Cline€was€negligent,€but€not€proximately€so,€and€does€not€question€the€applicability€of€theÐ „Ô  Ðdoctrine€of€òòrespondent€superioróó€with€respect€to€the€Ambulance€Service€and€Dickson€County.Ð pÀ ÐÌà  àBecause€the€Governmental€Tort€Liability€Act€was€implicated,€T.C.A.€ðð€29„20„205€òòet€seq.,Ð H˜ Ðóóthe€case€was€tried€without€a€jury.€€The€trial€judge€found€that€the€admitted€negligence€of€David€Cline,Ð 4„ Ðcontrary€to€the€insistence€of€the€defendants,€was€the€proximate€cause€of€the€death€of€Mr.€Wilson.Ð  p ÐÌà  àJudgment€for€$385,000,€described€as€representing€the€pecuniary€value€of€the€life€of€Mr.Ð øH ÐWilson,€and€$500,000€representing€damages€for€the€loss€of€consortium,€was€awarded€the€plaintiffs.€Ð ä4 ÐThe€defendants€appeal,€presenting€for€review€the€issues€discussed€òòin€seriatimóó.€€Our€review€isòò€de€novoóóÐ Ð  Ðon€the€record€accompanied€with€a€presumption€that€the€judgment€is€correct€unless€the€evidenceÐ ¼  Ðotherwise€preponderates.€€Rule€13(d),€T.R.A.P.€€The€presumptive€correctness€principle€does€notÐ ¨ø Ðapply€to€questions€of€law.Ð ”ä ÐÌò òòòÓ  ÓIssue€Oneóóó óÐ l¼ ÐÓ¿ÓÌà  àDoes€the€preponderance€of€the€evidence€support€the€trial€judgeððs€finding€that€the€negligenceÐ D!” Ðof€the€defendants€proximately€caused€the€death€of€Clayton€Wilson?Ð 0"€  ÐÌà  àThe€testimony€of€Donald€Tinsley€is€likely€pivotal.€€He€manuscripted€an€account€of€the€eventÐ $X" Ðsoon€after€leaving€the€hospital,€and€his€testimony€tracks€the€recorded€account.€€We€have€reproducedÐ ô$D # Ðhis€account€as€an€Appendix€to€this€opinion.€€Suffice€to€say€that€the€opinion€of€Dr.€Smith€to€anÐ à%0!$ Ðâ âimportant€extent€assumed€as€true€the€statements€of€Mr.€Tinsley,€while€the€other€experts€tendedÐ Ì&"% Ðotherwise.׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€Dr.€Smith€believed€that€Mr.€Wilson€had€a€60„70€percent€chance€of€survival€had€theÐ ° Ðdefibrillator€been€used.Ð œì Ðâ âÌà  àTo€recount€somewhat,€this€is€a€medical€malpractice€case€governed€by€the€provisions€ofÐ tÄ ÐT.C.A.€ððÔ‡ôç%òXX Ô€Ô#†X Xòôç%:#Ô29„26„115€òòet€seq.óó€€The€plaintiff€has€the€burden€of€proving€that€as€a€proximate€result€ofÐ `° ÐClineððs€negligence€the€decedent€suffered€injuries€which€would€not€otherwise€have€occurred.€€T.C.A.Ð L œ Ððð€29„26„115(a)(3).€€Reduced€to€simple€terms,€the€plaintiff€says€her€husband€suffered€a€cardiac€arrest,Ð 8 ˆ Ðwhich€would€not€have€been€fatal€had€the€paramedic€acted€appropriately.€€The€defendants€say€thatÐ $ t Ðeven€had€Mr.€Wilson€been€defibrillated,€he€would€have€died€anyway.€€The€opinion€of€the€SupremeÐ  ` ÐCourt€in€òòò òKilpatrick€v.€Bryantóóó ó,€868€S.W.2d€594€(Tenn.€1993)€settles€the€legal€issue.€€The€Court€heldÐ ü L  Ðð ð.€.€.€the€rule€requiring€causation€be€proved€by€a€preponderance€of€the€evidence€dictates€that€plaintiffsÐ è 8  Ðdemonstrate€that€the€negligence€òòmore€likely€than€not€caused€the€injury.óóðð€[Emphasis€in€original].Ð Ô$  Ðà  àà ` àà ¸ àà  àà h àÌà  àDr.€Smith€testified€orally,€as€contrasted€with€Drs.€McMurray€and€Fesmire€who€testified€byÐ ¬ü  Ðvideo€depositions.€€With€respect€to€the€depositional€testimony€we€are€as€well€situated€as€the€trialÐ ˜è  Ðjudge€to€judge€of€their€worth€and€weight,€but€with€respect€to€the€testimony€of€Dr.€Smith€the€rule€isÐ „Ô  Ðdifferent€because€the€trial€judge€observed€his€manner,€mien,€attitude€and€credibility.Ð pÀ ÐÌà  àSuffice€to€say€that€the€trial€judge€extolled€Dr.€Smith€and€his€testimony€while€findingÐ H˜ Ðconsiderable€fault€with€Drs.€McMurray€and€Fesmire.Ð 4„ ÐÌà  àDr.€Smith€is€a€board„certified,€peripatetic€practitioner€and€professor€of€emergency€medicineÐ  \ Ðlicensed€in€four€states€including€Tennessee.€€He€testified€that€he€had€an€appointment€as€a€professorÐ øH Ðof€emergency€medicine€at€the€University€of€Tennessee€at€Chattanooga,€and€served€as€Chairman€ofÐ ä4 Ðthe€Emergency€Department€at€Erlanger€Hospital€in€Chattanooga.€€His€qualifications€as€an€expert€inÐ Ð  Ðemergency€medicine€were€not€questioned.€Ð ¼  ÐÌà  àDr.€Smith€reviewed€the€historicity€of€the€apparent€heart€attack€suffered€by€Mr.€Wilson.€€WhenÐ ”ä Ðasked€to€ð ðtell€the€court€what€you€understand€to€be€the€circumstances€involved€in€Mr.€Wilsonððs€deathÐ €Ð Ðon€November€20,€1997,ðð€he€responded,€without€objection,€at€great€length:Ð l¼ ÐÌÓ€ (н83ÓÝ"‚3£"ÝÝ  Ýà8  àÝ‚3£ (ÝÔ2нÔÚ  ÚAÚ  Ú.Ô3  Ôà0` Ð Ð àÝ  ÝWell€at€approximately€1:00€a.m.,€he€awakened€his€wife€saying€that€he€didnððtÐ D!” Ðfeel€well.€€He€was€not€very€specific€apparently€in€what€he€related,€just€that€heÐ 0"€  Ðdidnððt€feel€good.€€He€got€up,€got€out€of€bed€and€walked€around€a€little€bit,€saidÐ #l! Ðhe€felt€ð!ð€I€think€he€went€to€the€bathroom,€said€he€felt€better.€€Came€back,€gotÐ $X" Ðback€in€bed€again€denying€any€specific€complaints€because€his€wife€sort€ofÐ ô$D # Ðqueried€him€being€a€nurse.€€And€he€laid€in€bed€for€a€few€minutes€and€then€gotÐ à%0!$ Ðup€again€saying€he€didnððt€feel€well.€€Got€up,€walked€around€a€little€bit€more.€Ð Ì&"% ÐLaid€back€down€still€saying€he€didnððt€feel€well,€told€her€that€he€loved€her.€Ð ° ÐAnd€apparently€she€turned€to€call€the€ambulance€and€became€aware€ofÐ œì Ðsomething€going€on€in€the€bed€behind€her.€€She€turned€back€over€and€he€wasÐ ˆØ Ðhaving€what€she€described€as€a€grand€mal€seizure.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð tÄ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð `° ÐAt€that€point€he€became€unresponsive,€unconscious€and€remained€that€wayÐ L œ Ðfrom€that€point€on.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð 8 ˆ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð $ t ÐShe€then€called€EMS€to€summons€an€ambulance€and€then€started€to€performÐ  ` ÐCPR€on€him€while€he€was€in€bed€because€she€couldnððt€feel€a€pulse.€€SheððsÐ ü L  Ðmaintained€that€he€continued€to€breathe,€but€she€could€not€feel€a€pulse.€€€€€€€€Ð è 8  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð Ô$  ÐShe€then€summoned€her€daughter€down€from€upstairs,€had€her€call€their€ð!ð€orÐ À  ÐI€guess€it€was€his€son€who€lived€approximately€a€third€of€a€mile€away,Ð ¬ü  Ðsomething€like€that,€to€come€help€her€do€CPR€because€he€was€such€a€big€manÐ ˜è  Ðshe€couldnððt€get€him€out€of€bed.€€And€she€knew€to€maximize€the€efficiencyÐ „Ô  Ðof€CPR€she€needed€him€on€a€hard€surface.€€She€continued€to€do€CPRÐ pÀ Ðcompressions€apparently€while€he€was€in€the€bed.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð \¬ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð H˜ ÐThe€son€arrived,€they€put€him€on€the€floor€and€then€started€doing€two€personÐ 4„ ÐCPR.€€Although,€they€said€that€he€continued€to€breathe€spontaneously€duringÐ  p Ðthis€period€of€time.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð  \ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð øH ÐThen€a€second€call€was€placed€to€EMS,€I€think€by€the€daughter,€just€basicallyÐ ä4 Ðwondering€where€the€ambulance€was.€€It€seemed€like€it€had€been€anÐ Ð  Ðextraordinarily€long€period€of€time€for€the€ambulance,€most€everybody€feels,Ð ¼  Ðand€at€that€time€informed€EMS€that€now€CPR€was€in€progress€as€opposed€toÐ ¨ø Ðð!ð€apparently€it€had€been€initially€logged€in€as€respiratory€distress€and€nowÐ ”ä Ðthey€were€told€it€was€a€full€code,€CPR€in€progress.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð €Ð Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð l¼ ÐApproximately€two€to€three€minutes€later€EMS€arrived€and€thereððs€someÐ X ¨ Ðdebate€exactly€when€the€CPR€was€stopped€by€Ms.€Wilson€and€her€son,€butÐ D!” Ðsomewhere€around€the€time€the€EMS€unit€arrived€they€stopped€and€theÐ 0"€  Ðparamedic€and€EMT€came€in,€and€again€thereððs€seemingly€a€little€bit€ofÐ #l! Ðdebate€here€of€exactly€what€happened.€€One€version€is€the€paramedic€went€onÐ $X" Ðin€with€Mr.€Wilson€and€the€EMT€stopped€to€talk€briefly€with,€Iððm€assumingÐ ô$D # Ðit€was€the€son,€and€then€came€into€the€room,€was€told€to€go€back€out€to€the€rigÐ à%0!$ Ðand€get€the€stretcher€and€a€backboard,€a€full€length€backboard.€€€€€€€€€€€€€€€€€€€€€Ð Ì&"% Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¸'#& ÐAnd€during€that€period€of€time€the€paramedic€was€primarily€focusing€on€theÐ ¤(ô#' Ðairway€apparently,€bagging€the€patient€with€what€we€call€a€bag€valve€maskÐ )à$( Ðapparatus€hooked€to€oxygen.€€And€came€back€in,€they€continued€CPR€briefly,Ð |*Ì%) Ðthen€put€him€on€the€backboard,€put€him€on€the€stretcher€and€took€him€backÐ h+¸&* Ðout€to€the€back€of€the€rig,€the€ambulance€truck,€whatever€you€want€to€call€it,Ð ° Ðand€then€apparently€intermittently€performed€CPR€while€attempting€to€startÐ œì Ðan€IV.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ˆØ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð tÄ ÐThe€EMT€tried€twice€to€start€an€IV,€was€unsuccessful,€and€the€paramedicÐ `° Ðintubated€the€patient.€€Thereððs€some€debate€on€whether€or€not€that€wasÐ L œ Ðsuccessful,€but€anyway,€was€managing€the€airway.€€They€were€intermittentlyÐ 8 ˆ Ðdoing€compressions€during€this.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð $ t Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð  ` ÐThey€hooked€him€up€to€a€monitor€which€supposedly€showed€asystole€on€twoÐ ü L  Ðdifferent€leads,€but€we€have€no€strip€that€Iððm€aware€of€that€would€substantiateÐ è 8  Ðone€way€or€the€other€that,€and€then€they€transported€him€to€the€hospital.€€€€€€€Ð Ô$  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð À  ЀAnd€apparently€in€the€interim€there€are€a€couple€of€notes€that€upon€arrival€atÐ ¬ü  Ðthe€scene€when€the€ambulance€got€to€the€house,€Mr.€Wilson€was€still€pink€andÐ ˜è  Ðwarm.€€And€then€when€he€got€to€the€emergency€department,€the€notes€thereÐ „Ô  Ðclearly€indicate€he€was€deeply€cyanotic,€blue,€so€there€had€been€a€significantÐ pÀ Ðchange,€deterioration€in€his€coloring€during€that€period€of€time.€€€€€€€€€€€€€€€€€€€€Ð \¬ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð H˜ ÐThey€briefly€worked€on€him€in€the€emergency€department,€but€it€was€felt€dueÐ 4„ Ðto€the€length€of€him€being€down€and€the€condition€upon€which€he€presented,Ð  p Ðbeing€deeply€cyanotic,€et€cetera,€that€he€was€probably€not€resuscitatible€andÐ  \ Ðthey€I€think€quit€after€approximately€eleven€minutes.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð øH Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ä4 ÐThey€had€given€a€couple€of€rounds€of€medications€but€felt€like€it€was€prettyÐ Ð  Ðfutile€at€that€time.€€The€monitor€at€that€time€did€show€that€he€was€in€asystole.€Ð ¼  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¨ø ÐThe€first€rhythm€strip€that€I€saw€looks€like€he€might€have€had€actually€whatÐ ”ä Ðwe€call€an€anneal€ventricular€rhythm€with€very€slow€sporadic€spontaneousÐ €Ð Ðheartbeats,€but€were€not€perfusing,€not€doing€anything€to€maintain€life.݃3£ (Y(ÝŒÐl¼` Ð ` Ð  ÐŒÝ  ÝÌØ! !ØÓ€ (ª½88Óà8  àQ.€€à0` Ð Ð àDr.€Smith,€based€upon€your€education,€training€and€experience€as€anÐ D!” Ðemergency€room€physician,€based€upon€your€review€of€the€records€and€theÐ 0"€  Ðfact€that€you€just€stated,€do€you€have€an€opinion€based€upon€a€reasonableÐ #l! Ðdegree€of€medical€certainty€as€to€what€happened€to€Clay€Wilson€that€evening?Ð$X"` Ð ` Ð  ÐÌà8  àÝ"‚3£"ÝÝ  ÝÝ‚3£iLÝÔ2ª½ÔÚ  ÚAÚ  Ú.Ô3  Ôà0` Ð Ð àÝ  ÝWell€when€I€was€first€ð!ð€let€me€make€that€addition.€€I€want€to€add€somethingÐ à%0!$ Ðto€the€clinical€scene€and€this€hit€me€last€night€while€I€was€reviewingÐ Ì&"% Ðdocuments.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¸'#& Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¤(ô#' ÐIn€both€Mr.€Clineððs€deposition€and€in€Ms.€Wilsonððs€deposition,€they€bothÐ )à$( Ðclearly€state€that€Mr.€Wilsonððs€pupils€were€constricted.€€And€to€me€thatððs€veryÐ |*Ì%) Ðsignificant€and€I€canððt€believe€I€hadnððt€picked€up€on€this€earlier,€but€it€just€hitÐ h+¸&* Ðme€like€a€bolt€of€lightening€last€night.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ° Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð œì ÐPupils€are€very€sensitive€to€oxygen€supplied€to€the€brain,€and€when€you€cutÐ ˆØ Ðthat€oxygen€supply€off,€in€approximately€45€seconds€the€pupils€will€dilate,Ð tÄ Ðyouððll€have€the€classic€fixed€dilated€pupils,€and€nowhere€is€that€mentioned.€Ð `° Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð L œ ÐIn€fact,€specifically€the€opposite€is€mentioned€from€the€standpoint€of€what€hisÐ 8 ˆ Ðpupil€condition€was€at€the€house.€€And€to€me€that€is€very€consistent€with€theÐ $ t ÐEMT€saying€that€he€was€pink€and€warm€at€the€scene,€because€to€me€his€brainÐ  ` Ðwas€being€perfused€at€the€time€they€got€to€the€house€because€thatððs€the€onlyÐ ü L  Ðwas€these€pupils€stay€constricted.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð è 8  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð Ô$  ÐAnd€I€almost€forgot€it€again,€but€thatððs€something€I€wanted€to€make€sure€I€putÐ À  Ðin€there,€because€that€to€me€is€crucial€here€from€the€standpoint€ofÐ ¬ü  Ðsurvivability€of€the€brain.€€So€now€that€said,€I€forgot€your€question,€Iððm€sorry.€Ýƒ3£iL–L݌Иè ` Ð ` Ð  ÐŒÝ  ÝÌÓ€ "(ʽ88Óà8  àQ.à0` Ð Ð àWhat€do€you€think€happened€to€Clay€Wilson€that€night?ÐpÀ` Ð ` Ð  ÐÌà8  àA.à0` Ð Ð àWell€when€I€first€read€the€chart,€really€two€things€went€through€my€mind.€Ð H˜ ÐThe€first€one€which€I€really€rather€rapidly€dismissed€was€the€thought€that€heÐ 4„ Ðmight€have€had€an€acute€bleed€into€his€brain.€€Certainly€that€can€happen.€€€€€Ð  p Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð  \ ÐWe€have€these€little€weaknesses€in€our€blood€vessels€called€aneurysm.€€AndÐ øH Ðthere€are€about€20€people€in€here,€so€approximately€four€people€in€here€haveÐ ä4 Ðthem€already.€€About€20€percent€of€the€population€have€them;€fortunately€theyÐ Ð  Ðdonððt€all€burst.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¼  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¨ø ÐBut€in€my€experience,€several€things€donððt€fit€with€that€having€happened.€Ð ”ä ÐOne,€Iððve€never€had€a€patient€or€their€family€relay€to€me€that€somebody€hadÐ €Ð Ðthis€feeling€ð!ð€and€Iððll€bet€he€was€having€a€feeling€of€impending€doomÐ l¼ Ðalthough€that€was€never€said€ð!ð€but€Iððve€never€had€anybody€present€with€aÐ X ¨ Ðhistory€of€just€where€they€didnððt€feel€good,€got€up,€walked€around€a€little€bit,Ð D!” Ðfelt€better,€laid€back€down€and€didnððt€feel€food,€got€up€walked€and€then€hadÐ 0"€  Ða€seizure€and€went€out.€€Just€never€had€that€history€in€30€years€of€practice.€€€Ð #l! Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð $X" ÐAnd€Iððve€had€folks€who€ð!ð€we€are€always€told€if€somebody€presents€with€aÐ ô$D # Ðseizure€and€unconscious,€you€worry€about€a€stroke,€and€Iððve€evaluatedÐ à%0!$ Ðprobably€a€couple€of€thousand€people€in€that€scenario,€and€rarely€do€we€evenÐ Ì&"% Ðfind€a€stroke€in€that€setting.€€So€that,€number€one,€it€just€didnððt€fit€theÐ ¸'#& Ðscenario.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¤(ô#' Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð )à$( ÐAnd€two,€this€thing€with€the€pupils€and€usually€youððll€get€one€pupil€dilatedÐ |*Ì%) Ðif€you€have€a€massive€stroke.€€One€at€least,€sometimes€two,€but€usually€atÐ h+¸&* Ðleast€one€because€most€of€the€pressure€will€be€on€one€side€of€the€brain€and€itÐ ° Ðwill€effect€the€third€optic€nerve€and€dilate€it.€€So€that€just€didnððt€fit€to€me.€€€€Ð œì Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ˆØ ÐSo€then€I€went€to€the€other€most€likely€cause€of€sudden€death€in€a€relativelyÐ tÄ Ðyoung€man,€and€51€is€younger€all€the€time,€and€thatððs,€of€course,€acute€cardiacÐ `° Ðcollapse,€and€I€would€say€that€this€scenario€is€much€more€compatible€withÐ L œ Ðthat.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð 8 ˆ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð $ t ÐJust€because€ð!ð€lots€of€patients€both€have€told€me€themselves€and€familiesÐ  ` Ðhave€related€later€that,€you€know,€well€they€werenððt€feeling€good,€they€got€up,Ð ü L  Ðthey€walked€around,€they€felt€better,€came€back,€laid€back€down,€may€haveÐ è 8  Ðdone€that€once,€maybe€done€it€three€or€four€times€during€the€course€of€a€shortÐ Ô$  Ðperiod€of€time€and€then€they€went€out€type€thing.€€And€so€thatððs€much€moreÐ À  Ðcompatible€with€my€experience€as€far€as€how€patients€frequently€present.€€€€Ð ¬ü  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ˜è  ÐSo€looking€at€all€of€that,€I€came€to€the€conclusion€that€I€thought€it€was€muchÐ „Ô  Ðmore€likely€that€this€was€a€cardiac€event€as€opposed€to€a€neurologic€event.ÐpÀ` Ð ` Ð  ÐÌà8  àQ.à0` Ð Ð àIs€that€what€laymen€would€just€call€a€heart€attack?ÐH˜` Ð ` Ð  ÐÌà8  àA..à0` Ð Ð àWell€some€folks€will€call€it€a€stroke€and€mean€either€one€of€those€soÐ  p Ðsometimes€that€gets€kind€of€gray,€but€yes.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð  \ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð øH ÐMy€conclusion€was€it€was€cardiac€and€in€the€lay€population€that€wouldÐ ä4 Ðprimarily€mean€they€had€a€heart€attack.ÐÐ ` Ð ` Ð  Ðà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àÌà8  àQ.à0` Ð Ð àWhat€is€the€most€common€thing€that€happens€in€that€scenario€to€the€heart?€Ð ¨ø ÐWhat€happens?Дä` Ð ` Ð  ÐÌà8  àA.à0` Ð Ð àWell€when€you€acutely€block€or€either€totally€or€partially€block€the€bloodÐ l¼ Ðsupply€to€a€part€of€the€heart,€that€muscle€becomes€very€irritated,€and€the€heartÐ X ¨ Ðmuscle€has€its€own€built„in€pacing€machine,€if€you€will,€so€it€wants€to€beatÐ D!” Ðrhythmically€on€its€own.€€And€the€famous€frog€experiment€when€you€cut€theÐ 0"€  Ðheart€out€and€lay€it€on€a€table€and€it€continues€to€beat€for€a€long€period€ofÐ #l! Ðtime,€well€thatððs€what€heart€muscle€in€the€human€is€like,€itððs€made€to€beat.€Ð $X" ÐAnd€when€you€take€away€some€of€that€blood€supply,€that€muscle€becomesÐ ô$D # Ðirritated€and€sometimes€it€causes€pain,€we€call€angina;€sometimes€it€doesnððtÐ à%0!$ Ðcause€anything€that€the€patient€can€really€specifically€feel€necessarily.€€ButÐ Ì&"% Ðthen€it€reaches€a€certain€point€where€instead€of€beating€in€a€rythmatic€fashion,Ð ¸'#& Ðit€just€sort€of€starts€to€quiver€and€we€call€that€fibrillation.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð ¤(ô#' Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð )à$( ÐYou€can€have€atrial„fibrillation€which€is€usually€not€fatal,€you€reduce€theÐ |*Ì%) Ðamount€of€blood€your€heart€pumps€by€about€15€percent.€€In€some€peopleÐ h+¸&* Ðthatððs€crucial,€but€most€of€the€time€atrial„fibrillation€is€not€fatal.€€€€€€€€€€€€€€€€€€€Ð ° Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð œì ÐBut€if€you€take€that€down€to€the€ventricles,€the€larger€ventricles,€that€pumpsÐ ˆØ Ðmost€of€the€blood€in€the€human€heart,€if€they€start€to€quiver€and€are€notÐ tÄ Ðeffectively€circulating€blood,€then€you€die€if€thatððs€left€untreated.€€That€mayÐ `° Ðvery€well€have€been€what€happened€to€him.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð L œ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð 8 ˆ ÐThe€only€thing€that€makes€me€wonder€if€he€didnððt€completely€fibrillate€butÐ $ t Ðmaybe€had€an€episode€where€he€had€became€extremely€slow€in€his€heartbeat,Ð  ` Ðand€we€call€the€(sic)€bradycardia,€is€that€he€continued€to€be€pink€and€warmÐ ü L  Ðand€supposedly€to€breathe.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð è 8  Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð Ô$  ÐWell,€if€youððre€pure€fibrillation,€youððre€not€going€to€continue€to€breatheÐ À  Ðunless€the€CPR€is€superb,€and€that€is€possible.€€I€have€had€actually€had€severalÐ ¬ü  Ðpatients€who€we€had€them€on€a€heart€monitor,€they€were€fibrillating,€but€whileÐ ˜è  Ðwe€were€doing€their€CPR,€they€were€awake€and€talking€to€us.€€And€then€weÐ „Ô  Ðwould€stop€to€defibrillate€them€and€they€would€go€unconscious€again,€andÐ pÀ Ðthen€weððd€start€back€up€and€they€would€wake€right€back€up€again.€€And€thatððsÐ \¬ Ða€really€unpleasant€feeling€especially€when€you€canððt€get€them€out€of€that.€€€Ð H˜ Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð 4„ ÐSo€itððs€possible€that€he€could€have€been€fibrillating€and€with€excellent€CPRÐ  p Ðremained€pink,€continued€to€breathe,€et€cetera,€and€weððll€never€know.Ð \` Ð ` Ð  ÐÌDr.€Smith€further€testified,€without€objection,€the€ð ðonly€thingòò€theyóó€[the€paramedic€and€technician]Ð ä4 Ðabsolutely€had€to€take€in€[the€house]€was€the€monitor€defibrillator.€.€.€.€€And€for€òòthemóó€to€go€in€thereÐ Ð  Ðwith€an€airway€kit€is€just€ridiculous.ðð€[Emphasis€added].€€Further,€Ð ¼  ÐÌà8  àð ðthe€fact€that€he€never€even€got€put€on€a€monitor€until€they€actually€got€him€back€outÐ ”ä Ðto€the€truck€which€is€somewhere€around€10€to€12€minutes€after€they€arrived€.€.€.€didnððtÐ €Ð Ðget€the€potentially€definitive€care.ðð€Ðl¼Ð Ð  ÐÌà  àWhen€asked€if€the€paramedic€and€technician€had€used€a€defibrillator€on€Mr.€Wilson€what€hisÐ D!” Ðchances€were€of€surviving,€Dr.€Smith€replied€ð ðIððd€say€60€to€70€percent,ðð€and€ð ðthat€he€would€haveÐ 0"€  Ðbeen€close€to€if€not€totally€normal€neurologically.ððÐ #l! ÐÌà  àOn€cross„examination,€Dr.€Smith€testified€that€Mr.€Wilson€had€some€degree€of€underlyingÐ ô$D # Ðcoronary€heat€disease;€that€50€percent€of€first€heart€attacks€are€fatal;€that€ð ðwe€know€absolutelyÐ à%0!$ Ðnothing€about€his€heart€attackðð;€that€it€is€impossible€to€determine€Mr.€Wilsonððs€life€expectancy;€ð ðthatÐ Ì&"% Ðwithout€an€autopsy€there€is€no€way€to€really€know€for€sure€what€happened€to€him.ðð€€On€redirect,€heÐ ¸'#& Ðreiterated€his€opinion€that€Mr.€Wilson€suffered€a€cardiac€event.€€Ð ¤(ô#' Ðâ âÐ )à$( Ðà  àDr.€Brian€McMurray,€also€board„certified€in€emergency€medicine,€testified€that€the€mostÐ ° Ðlikely€explanation€for€the€death€of€Mr.€Wilson€was€ventricular€fibrillation,€and€that€even€had€he€beenÐ œì Ðdefibrillated€his€chance€of€survival€was€nonexistent.€Ð ˆØ Ðâ âÌà  àDr.€Francis€Fesmire,€also€board„certified,€testified€that€in€his€opinion€Mr.€Wilson€sufferedÐ `° Ða€subarachnoid€hemorrhage€which€the€paramedic€could€not€have€treated.€Ð L œ ÐÌà  àThe€defendants€argue€that€the€testimony€of€Dr.€Smith,€and€the€conclusions€derived€from€it,Ð $ t Ðis€speculative€and€thus€unfair,€because€the€burden€is€always€on€the€plaintiff€to€prove€her€case€by€aÐ  ` Ðpreponderance€of€all€the€evidence.€€But€a€contrary€conclusion€would€yield€the€same€argument,€fromÐ ü L  Ða€different€perspective,€thus€giving€rise€to€the€salutary€concept€that€appellate€courts€do€not€exerciseÐ è 8  Ðoriginal€jurisdiction€but€must€defer€to€findings€of€trial€judges€that€are€supported€by€preponderantÐ Ô$  Ðevidence.€€We€are€frank€to€say€that€the€evidence€on€the€issue€of€causation,€or€loss€of€chance€ofÐ À  Ðsurvival,€is€troublesomely€close,€but€we€cannot€find€that€the€evidence€preponderates€against€theÐ ¬ü  Ðfinding€of€the€trial€judge.€€Ð ˜è  ÐÌò òòòÓ  ÓIssues€Two€and€Threeó óóóÐ pÀ ÐÓ/ˆÓÌà  àThe€plaintiffs€were€awarded€$385,000€for€the€ð ðpecuniary€valueðð€of€the€decedentððs€life.׃$×Ý ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ׀РH˜ ÐDefendants€argue€that€this€award€is€excessive,€since€the€decedent,€a€farmer,€suffered€a€loss€of€incomeÐ 4„ Ðfor€eight€of€the€last€nine€years€of€his€life.€€Moreover,€the€defendants€argue€that€had€Mr.€WilsonÐ  p Ðsurvived,€his€life€expectancy€is€unknown,€and€his€ability€to€work€is€likewise€unknown.€€Thus,€theÐ  \ Ðdefendants€argue,€the€pecuniary€value€is€limited€to€funeral€expenses.€€The€trial€judge€approved€theÐ øH Ðtestimony€of€Dr.€€John€Moore,€an€economist,€that€the€value€of€Mr.€Wilsonððs€òòearning€capacityóó€wasÐ ä4 Ð$375,926.€€€òòSee,€ò òSpencer€v.€A„1€Crane€Services€Inc.óóó ó,€880€S.W.2d€938€(Tenn.€1994).€€The€evidenceÐ Ð  Ðdoes€not€preponderate€against€the€award€of€damages€for€the€economic€loss€incurred€by€the€plaintiffs.Ð ¼  ÐÌà  àThe€trial€court€then€made€a€separate€award€of€$500,000€for€ð ðconsortium„typeðð€damages,Ð ”ä Ðcitingòòò ò€Jordon€v.€Baptist€Three€Rivers€Hospitalóóó ó,€984€S.W.2d€593€(Tenn.€1999).€€As€explained€below,Ð €Ð Ðwe€do€not€believe€the€trial€judge€intended€to€award€a€double€recovery,€since€loss€of€consortium€is€aÐ l¼ Ðòòfactoróó€to€be€considered€in€a€determination€of€the€òòpecuniary€óóvalue€of€a€life.€€In€his€determination€ofÐ X ¨ Ðthe€ð ðpecuniary€valueðð€of€the€decedentððs€life€the€trial€court€òòprima€facieóó€did€not€consider€the€factor€ofÐ D!” Ðloss€of€consortium,€but,€as€stated,€considered€the€issue€separately.Ð 0"€  ÐÐ #l! Ðà  àThe€award€of€a€recovery€for€wrongful€death€is€based€on€many€factors,€including€age,€healthÐ ° Ðand€strength,€capacity€for€work,€personal€habits,€loss€of€consortium,€and€the€like.€€The€decedent€wasÐ œì Ðdescribed€as€well„educated,€happy,€jolly,€a€conservationist,€sober€and€industrious.€€The€dark€side€wasÐ ˆØ Ðthe€state€of€his€health€immediately€before€his€heart€attack,€and€what€would€have€been€the€state€of€hisÐ tÄ Ðhealth€had€he€survived,€assuming€proper€care€and€treatment.€€To€avoid€the€obvious€specter€ofÐ `° Ðspeculation,€since€a€monetary€value€cannot€be€placed€with€exactness€on€any€of€the€factors€to€beÐ L œ Ðconsidered,€it€has€consistently€been€held€in€Tennessee€that€the€amount€of€a€recovery€is€to€a€largeÐ 8 ˆ Ðextent€discretionary€with€the€trial€judge.€€òòSee,€ò òSpencer€v.€A„1€Crane€Serviceððs€Inc.ó óóó,€880€S.W.2d€938Ð $ t Ð(Tenn.€1994).Ð  ` ÐÌà  àThe€trial€judge€did€not€articulate€his€reason(s)€for€the€amount€of€the€award€for€loss€ofÐ è 8  Ðconsortium.€€We€think€it€evident€that€when€considered€as€a€òòfactoróó€in€a€determination€of€the€pecuniaryÐ Ô$  Ðvalue€of€the€decedentððs€life,€the€award€is€excessive.Ð À  ÐÌà  àThe€decedent€obviously€suffered€a€disabling€attack.€€Had€he€survived,€the€extent€of€hisÐ ˜è  Ðdisability€cannot€be€known.€€His€life€expectancy€is€unknown;€his€capacity€for€life€is€unknown;€theÐ „Ô  Ðquality€of€his€life€is€unknown;€whether€he€would€have€continued€to€be€companionable€or€fatherly€isÐ pÀ Ðunknown;€whether€he€could€have€provided€spousal€or€paternal€attention,€guidance€or€care,€protection,Ð \¬ Ðtraining,€affection€or€love€is€unknown.€€The€defendants€correctly€argue€that€the€burden€of€provingÐ H˜ Ðloss€of€consortium€is€upon€the€plaintiffs,€and€this€case€is€perilously€close€to€a€complete€absence€ofÐ 4„ Ðproof€other€than€that€afforded€by€a€presumption€of€continued€consortium€had€the€decedent€survived.€Ð  p ÐThe€testimony€of€Dr.€Smith€offers€some€support€for€loss€of€consortium€damages€[ð ð60€percent€chanceÐ  \ Ðof€survival€with€minimal€neurological€damageðð]€while€conceding€a€lack€of€reasonable€definitiveness.€Ð øH ÐWe€think,€and€so€hold,€that€a€recovery€of€$500,000€as€damages€for€the€wrongful€death€of€Mr.€WilsonÐ ä4 Ðis€justified€by€the€evidence.Ð Ð  Ðò òòòÓ  ÓÌIssue€Fouróóó óÐ ¨ø ÐÓÀ™ÓÌà  àT.C.A.€ðð€29„20„310(b)€removes€the€immunity€of€a€governmental€employer€who€is€a€healthÐ €Ð Ðcare€practitioner,€as€is€the€defendant€Cline.€€The€defendants€argue€that€this€statute€violates€the€equalÐ l¼ Ðprotection€provisions€of€the€Tennessee€and€United€States€Constitutions.€€This€argument€has€beenÐ X ¨ Ðresolved€by€the€Western€Section€of€this€court€in€òòò òTodd€and€State€of€Tennessee€v.€Weakley€CountyÐ D!” Ðd/b/a/Weakley€County€Nursing€Home,€et€aló óóó,€No.€02A01„9708„CV„00197€(Tenn.€App.€July€16,Ð 0"€  Ð1998),€which€held€that€the€statute€was€constitutional.€€The€defendants€raise€an€issue€not€involved€inÐ #l! Ðòòò òToddóóó ó,€which€questions€the€constitutionality€of€T.C.A.€ðð€29„20„310€because€a€health€practitionerÐ $X" Ðemployed€by€the€State€is€immune€from€personal€liability€under€T.C.A.€ðð€9„8„307.€€The€defendantsÐ ô$D # Ðargue€that€since€the€health€practitioner€is€employed€by€the€County€„€rather€than€by€the€State€„€heÐ à%0!$ Ðenjoys€no€immunity€and€thus€is€denied€equal€protection.€€This€argument€overlooks€the€fact€that€Mr.Ð Ì&"% ÐCline€is€treated€no€differently€than€other€paramedics€similarly€situated.Ð ¸'#& ÐÌò òòòÓ  ÓÌÌÐ h+¸&* ÐIssue€Fiveóóó óÐ ° ÐÓŸÓÌà  àThis€issue€poses€the€question€of€whether€the€provisions€of€T.C.A.€29„20„311€were€violatedÐ ˆØ Ðby€the€entry€of€a€judgment€exceeding€the€ð ðminimum€amount€of€insurance€coverage€for€deathððÐ tÄ Ðspecified€in€T.C.A.€ðð€29„20„403.Ð `° ÐÌà  àT.C.A.€ðð€29„20„404(a)€provides€thatÐ 8 ˆ ÐÌà8  àA€governmental€entity€or€the€insurer€of€such€governmental€entity€shall€not€be€heldÐ  ` Ðliable€for€any€claim€arising€under€state€law,€for€which€the€governmental€entity€hasÐ ü L  Ðimmunity€under€the€provisions€of€this€Chapter€unless€the€governmental€entity€hasÐ è 8  Ðwaived€its€immunity.ÐÔ$ Ð Ð  ÐÌà  àT.C.A.€ðð€29„20„403(b)(2)(A)€provides€for€minimum€limits€of€not€less€than€$130,000.00€forÐ ¬ü  Ð.€.€.€death€of€any€one€person,€unless€the€governmental€entity€has€waived€its€immunity.€€DicksonÐ ˜è  ÐCounty€has€not€waived€its€immunity€by€the€purchase€of€a€policy€of€insurance€because€the€policy€didÐ „Ô  Ðnot€expressly€so€provide,€T.C.A.€ðð€29„20„404.€€òòSee,ò ò€Colburn€v.€City€of€Dyersburgóóó ó,€774€S.W.2d€610Ð pÀ Ð(Tenn.€Ct.€App.€1989),€and€hence€is€liable€only€to€the€extent€of€$130,000.€€The€total€judgment,€as€toÐ \¬ Ðthe€defendant€Cline,€is€reduced€to€$500,000.Ð H˜ ÐÌò òòòÓ  ÓIssue€Sixó óóóÐ  p ÐÓ¥ÓÌà  àDefendants€question€the€award€of€$18,662.96€for€discretionary€costs.€€Rule€54.04€T.R.C.P.Ð øH Ðcontrols.€€It€provides,€as€relevant€here,€that€discretionary€costs€allowable€are:€(1)€reasonable€andÐ ä4 Ðnecessary€court€reporter€expenses€for€depositions€and€trials;€(2)€reasonable€and€necessary€expertÐ Ð  Ðwitness€fees€for€depositions€and€trial.€€The€fees€of€Rieback€Consultants,€$3802.50,€are€not€allowable;Ð ¼  Ðthe€fee€of€Dr.€Earl€Smith,€ð ðfor€post„depo€time€spent,ðð€$1,690,€is€not€allowable;€the€travel€expensesÐ ¨ø Ðof€Dr.€Smith€and€Dr.€Moore,€$2,259.08,€are€not€allowable.€€€An€award€of€$4,000€for€the€courtÐ ”ä Ðappearance€of€€Dr.€Smith€of€less€than€two€hours€is€excessive€by€$2,000€and€is€therefore€partiallyÐ €Ð Ðdisallowed.€€The€judgment€awarding€discretionary€costs€is€accordingly€modified.Ð l¼ ÐÌà  àThe€judgment€is€affirmed€in€part€and€modified€in€part.€€The€case€is€remanded€for€allÐ D!” Ðappropriate€purposes.€€One„half€of€the€costs€are€assessed€to€the€plaintiffs;€one„half€of€the€costs€areÐ 0"€  Ðassessed€to€the€defendants,€all€jointly€and€severally.Ð #l! ÐÌà  à€€€€€Ð ô$D # Ðà  àà ` àà ¸ àà  àÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð Ì&"% Ðà  àà ` àà ¸ àà  àà h àà À àà  àWILLIAM€H.€INMAN,€SENIOR€JUDGE