ÿWPC'C ìξA¦ f9ùø¾Pƒ+$RÂp;'¥éÄiäºAŒýbÐýÜÚCì4„(¾õ¥a§ª#óÏÄaÖµäç¿tðŠÚ6l¯“@F4¾)2ÝYœáÌ]rÏjš^>TwµŠ2ZãŽõú]¹€ñê`KÍûø$¡DÞؽ…¸ULåã>+é?¸ë‡>÷(Œ¬Â#>EP#¯u’9ß¡ÜUÞ¾!‡Ž ¶¤VŸF8âÕ(š!|~¯êéöŠ¶r~Û–´GÞ=…1õ ›ºÇnN/¨Râçÿ2£¿:Ê '(î!¡ê¥Üûä|ÃX,_(·ßÍÝØ^ìY²vxéó™†_´w® “®Å €Ä––vãï.cÛ•çü:µpª7ZÅ$E× xÒ€y ôͼ°u£óï#Eˆê¥t^ƒò^õ?€W €ÜÜw…E# ÆU :Ñ %  0ˆwš™43 G 0V U:] — 0D¨ Lì AQ8Ò‰&[U:T»LU:[Ò•U:gT¡U:õ/&7U:]L—U:ãêU:#TA# B•$U:²$&ì$U:&LL&U:˜'ÒÒ'U:¤+TÞ+U:2-&l-U:’.Ì.U:Ý/L0U:c1Ò1U:o5T©5U:ý6G77U:~8L¸8U::Ò>:U:>TJ>U:ž?ÆØ? 0Dž@ 0Dâ@ 0D&A D/jA B™A¶A D3ºBU:íB˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ, øð AZ‹"Arial RegularX(`zZ$¡¡ÑTRY,3Ø'ÿ Letter3Ø'3Ø'ÿ Letterÿ3Ø'TÑÔ  ÔDEtÆE D  E  !Å ÆD•TÅY• ÆD•Ó€ìu[%ÔüÔô3|x$(·(2Fm$¤¤Ý ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø'*Avery 5165 Full Sheetÿ3Ø'TÑÔ  ÔÝ  ÝÒ4°ÒÒ„°ÒÔ€ô‚ôXXÔà Œ àòòÚ  Ú0Ú  Úóó, øð AZ"Arial Regular Ý ƒFm$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô‚ôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€to€provide€the€patient's€lungsÐ  Ðwith€oxygen.(#Ã$òòÚ  Ú0Ú  Úóó BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ôãôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€<=>?@Cþÿ<< Cÿÿ ÈÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ôãôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€ÏòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð ð è Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee. Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€and€leading€to€his€lung€areaÐ  Ðto€provide€the€patient€with€oxygen., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ôãôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1). BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€, øð AZ‹"Arial Regular ÈÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€ÏòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð ž – Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)., øð AZ‹"Arial Regular Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€and€leading€to€his€lung€areaÐ  Ðto€provide€the€patient€with€oxygen., øð AZ‹"Arial Regular BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€, øð AZ‹"Arial Regular àÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ô†òôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€Ð (  R ÐòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð  Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€!ô†òôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1). d, øð AZ‹"Arial Regular Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€#ô†òôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€and€leading€to€his€lung€areaÐ  Ðto€provide€the€patient€with€oxygen., øð AZ‹"Arial Regular BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€%ô†òôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€, øð AZ‹"Arial Regular ÈÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€'ô†òôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€ÏòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð ð è Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€)ô†òôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)., øð AZ‹"Arial Regular Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€+ô†òôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€and€leading€to€his€lung€areaÐ  Ðto€provide€the€patient€with€oxygen., øð AZ‹"Arial Regular Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€-ô†òôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€to€provide€the€patient's€lungsÐ  Ðwith€oxygen., øð AZ‹"Arial Regular BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€/ô†òôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€, øð AZ‹"Arial Regular ÈÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€1ô†òôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€ÏòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð ð è Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€3ô†òôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)., øð AZ‹"Arial Regular =Ý ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€5ôãôXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝAn€endotracheal€tube€is€a€tube€placed€in€the€patient's€throat€ò òand€leading€to€his€lung€areaÐ  Ðó óto€provide€the€ò òpatientó óò òpatient's€lungsó ó€with€oxygen., øð AZ‹"Arial Regular BÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€7ôãôXXÔà Œ àòòÚ  Ú2Ú  ÚóóÝ  ÝThe€captioned€plaintiff,€Freda€Moon,€was€substituted€for€the€original€plaintiff,€RuthÐ  ÐGarrett,€who€was€Ray€Garrett's€wife.€€Ruth€Garrett€died€after€suit€was€filed.€, øð AZ‹"Arial Regular ÈÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€9ôãôXXÔà Œ àòòÚ  Ú3Ú  ÚóóÝ  ÝAlthough€the€appellate€court€addressed€an€issue€concerning€the€failure€of€the€plaintiff'sÐ  Ðexperts€to€explicitly€reference€in€their€affidavits€the€standard€of€care€in€Nashville€or€in€a€similarÏcommunity,€the€defendant€neither€filed€a€motion€to€strike€the€affidavits€in€the€trial€court€nor€raisedÏthe€issue€in€its€motion€for€summary€judgment.€€The€trial€court's€order€did€not€address€the€contentÏof€the€affidavits.€€This€issue,€therefore,€should€not€have€been€raised€for€the€first€time€on€appeal.€ÏòòHarrison€v.€Schraderóó,€569€S.W.2d€822€(Tenn.€1978);€òòMoran€v.€City€of€Knoxvilleóó,€600€S.W.2d€725Ð ð è Ð(Tenn.€Ct.€App.€1979).€€We€would€note,€however,€that€both€parties'€affidavits€were€comparable€inÏthat€neither€explicitly€referenced€the€standard€of€care€applicable€in€Nashville,€Tennessee., øð AZ‹"Arial Regular JÝ ƒyÕ$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€;ôãôXXÔà Œ àòòÚ  Ú4Ú  ÚóóÝ  Ý"The€recognized€standard€of€acceptable€professional€practice€.€.€.€in€the€community€inÐ  Ðwhich€he€practices€or€in€a€similar€community."€€Tenn.€Code€Ann.€ðð€29„26„115(a)(1)., øð AZ‹"Arial RegularƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý(3¯$££Ý ƒ!ÝÝ  Ý($$””ò òÚ  Ú1Ú  Úó óAA'÷ÿ dxdüÿP Pd úÝ ƒ=¯"ÝÝ  ÝÔ€DX¿©XXXÔÔ€DÜ XDX¿©ÔÓ  Óò òÔ Ad ÔFILEDÔ€DX¿©X DÜÔÐ  ÐÌDecember€21,€1998ÌÌCecil€W.€CrowsonÌAppellate€Court€ClerkÔdAhÔó ó 'ÿÿdxd,c½¬AZ‹"Arial RegularÝ ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø'*Avery 5165 Full Sheetÿ3Ø'TÑÔ  ÔÝ  ݚѰÑÒ4°ÒÒ„°ÒññÑTR[° AØ' LegalYX3Ø'ÿ Letter AØ' Legal3Ø'ÿ LetterTÑññññññÑTR[° AØ' LegalYX3Ø'ÿ Letter AØ' Legal3Ø'ÿ LetterTÑññññññÑTR[¤ AØ'ÿLegal RedXà3Ø'ÿ Letter AØ'ÿ Legal3Ø'*Avery 5165 Full SheetTÑññññññÑTR[ä AØ'ÿLegal RedYX3Ø'ÿ Letter AØ'ÿLegal Red3Ø'ÿ LetterTÑññññÑ  ÑÑ7€¿©XXdædÈ7ÑÑ  ÑÑ  ÑññÓ=€©GX°XdÐd=ÓññññÔ‡ôãôXXÔÔ#†X9Xôôã‚#Ôññò òññ›ññññßr€ BC<,(j 8` `€€@Eô ` 8ttxP,ð  rß›ññà@PPDàœñññ ñò òš›ˆÌœó óñ ñññIN›€THE€SUPREME€COURT€OF€TENNESSEEˆÐ  Ðà@rr)DàAT€NASHVILLEˆÌœññà@ÃÃ&Dàññññññò òññññññ›ññññ(Heard€at€Jackson)ññññ›ññó óññññ›ˆÌÌÌÌà Œ àà ä àà < àà ” àà ì àà D àà œ àFOR€PUBLICATIONÌœññ#98„89ññññ›ñ ñò ò#98„89›ñ ññ ñó óñ ñ›ññÌó óà Œ àà ä àà < àà ” àà ì àà D àà œ àò òFiled:ó ó€òò€€€€€ñññññ ñò òñ ñññDecemberñññ ñó óò òñ ñññ€ñññ ñó óò òñ ñññ21ñññ ñó óò òñ ñññ,ñññ ñó óò òñ ñññ€ñññ ñó óò òñ ñññ1998ññññ›ñ ñó óñ ñññ›à€T$T$MT$àóóˆÐ h` ÐÌÌœÌÌ›ÌÌFREDA€G.€MOON,€EXECUTOR€OFà@##/Dà)ˆÐ ¸°  ÐTHE€ESTATE€OF€RUTH€GARRETT,à@##/Dà)ˆÐ ž– Ðà@##/Dà)ˆÌà Œ àPLAINTIFF/APPELLANT,à@##/Dà)ˆà œ àDAVIDSON€CIRCUITÐ jb Ðà@##/Dà)ˆÌv.à@##/Dà)ˆà œ àHon.€Barbara€N.€HaynesÐ 6. Ðà@##/Dà)ˆÌST.€THOMAS€HOSPITAL,à@##/Dà)ˆà œ àNo.€01S01„9710„CV„00218Ð ú Ðà@##/Dà)ˆÌà Œ àDEFENDANT/APPELLEE.à@##/Dà)ˆÐ ÎÆ ÐÌÌÌÌÌòòFOR€APPELLANTóó:à < àà ” àà ì àà D àà œ àòòFOR€APPELLEEóó:Ð 2"* ÐÌHarlan€Dodson€IIIà < àà ” àà ì àà D àà œ àMary€Martin€SchaffnerÐ þ#ö  ÐAnne€C.€Martinà < àà ” àà ì àà D àà œ àNashvilleÐ ä$Ü! ÐJulie€K.€SandineÌNashvilleÌà Œ àà ä àà < àà ” àà ì àà D àà œ àòòFOR€AMICUS€CURIAEóó:Ð –'Ž $ ÐÌà Œ àà ä àà < àà ” àà ì àà D àà œ àRichard€L.€DuncanÌà Œ àà ä àà < àà ” àà ì àà D àà œ àKnoxvilleÌÌÌÌÌ̛̜ÌÌÌà@ss)Dàò òÔ‡èèXXÔO€P€I€N€I€O€Nó óÔ#†X¿©XèèÑ#ԈРD3<,1 ÐÌÌÌÌÌœREVERSED€AND€REMANDED›à€  CT$àHOLDER,€J.ˆÐ  F9>27 ÐññœññÓÓà Œ àÔ‡ X2XXX¿©Ôà@,Dàò òOPINIONó óˆÐ  ÐÌà Œ àÔ#†X¿©XX X2´#ÔWe€granted€this€appeal€to€address€whether€a€hospital's€general€duty€toÐ È À Ðexercise€reasonable€and€ordinary€care€to€maintain€an€open€airway€in€anÏintubated€patient€is€negated€merely€because€the€transection€of€an€endotrachealÏtube€is€an€uncommon€occurrence.€€We€œhold:€€(1)€€ñññóñò òñóñññthat€under€the€circumstances,Ïa€factual€question€exists€concerning€whether€the€standard€of€care€requiredÏplacement€of€an€oral€airway€or€bite€block€when€the€patient€exhibited€agitation€andÏbegan€biting€on€the€endotracheal€tubeñññóñó óñóñññ;ññò òthat€a›€hospital's€general€duty€to€maintainÏan€unobstructed€air€passage€through€an€endotracheal€tube€is€not€negated€merelyÏby€allegations€that€the€patient's€actions€of€transecting€the€tube€wereÏœunforeseeableó óññññ;›ñññññññ ñò òò òthat€a›€hospital's€general€duty€to€maintainÐ  Ðan€unobstructed€air€passage€through€an€endotracheal€tube€is€not€negated€merelyÏby€allegations€that€the€patient's€actions€of€transecting€the€tube€wereÏœunforeseeableó ó;ó óò òñ ñññ›€œñññ ñó óñ ñññññ›€€(2)€€that€the€foreseeability€of€theÏintubated€and€restrained€patient's€actions€are€relevant€when€assessing€theÏœappropriate›€standard€of€care€and€deviation€from€that€standard€of€care;€and€€(3)€Ïthat€the€œaffidavits€of€the€plaintiff's›€œexperts›€created€genuine€issues€of€material€factÏconcerning€œthe€standard›€of€care€and€breach€of€œthat›€standard.€€The€appellateÏcourt's€decision€affirming€the€trial€court's€dismissal€is€reversed.€€The€case€isÏremanded€to€the€trial€court€for€proceedings€consistent€with€this€opinion.ÌÌÔ  Ôò òÓ  ÓBACKGROUNDó óÐ ð#è  ÐÓœÓÌà Œ àOn€February€6,€1986,€Ray€Garrett€was€admitted€to€St.€Thomas€Hospital,Ïthe€defendant.€€Mr.€Garrett€underwent€successful€coronary€bypass€surgery€onÏFebruary€7.€€During€surgery,€Mr.€Garrett€was€œintubated›€with€an€endotracheal€tubeÏto€provide€ventilation.ñññ ñññññœññññ׃ ×ññññ׃4×ññññññ׃,×ññññññ׃*×ññññññ׃"×ñññ ññ ñ׃×ñ ñññññ׃×ññÝ ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×›€€After€surgery,€Mr.€Garrett€was€taken€to€the€recovery€roomÐ ø,ð%* Ðwhere€his€condition€was€considered€stable.ÌÌà Œ àNurse€Patricia€Hoeflein€was€assigned€to€Mr.€Garrett€in€the€recovery€room.€ÏNurse€Hoeflein's€notes€indicated€Mr.€Garrett€"nods€yes€&€no,€but€[was]€veryÏagitated€and€restless€when€awake."€€The€notes€further€indicated€that€Mr.€GarrettÐ ô5ì.4 Ðdenied€pain€but€was€"œfigiting›€[sic]€at€pacer€wires"€and€"biting"€his€endotrachealÏtube.€€Nurse€Hoeflein€placed€Mr.€œGarrett€in€soft›€arm€œrestraints.›ÌÌà Œ àAt€approximately€1:05€a.m.,€Ronald€McKay,€a€respiratory€technician,Ïchanged€Mr.€Garrett's€ventilator.€€Around€1:40€a.m.,€McKay€decreased€theÏpercentage€of€oxygen€that€Mr.€Garrett€was€receiving.€€McKay€checked€theÏcondition€of€Mr.€Garrett's€endotracheal€tube€and€saw€no€indication€of€chewing€orÏbiting.€€Approximately€ten€minutes€later,€McKay€responded€to€an€alarm€in€Mr.ÏGarrett's€room€and€discovered€that€Mr.€Garrett€had€bitten€and€nearly€severed€theÏendotracheal€tube.€€McKay€sought€assistance€from€respiratory€therapyÏsupervisor,€Gene€Emerson.€€When€they€returned€to€Mr.€Garrett's€room,€McKayÏobserved€Mr.€Garrett€completely€sever€the€œtube,›€and€a€portion€of€the€tube€wasÏlodged€in€his€throat.€€After€several€unsuccessful€attempts€to€open€Mr.€Garrett'sÏmouth,€the€two€men€forced€a€device€known€as€an€oral€airway€into€Mr.€Garrett'sÏmouth€to€open€his€clamped€jaws.€€A€physician€arrived€and€extracted€the€severedÏportion€of€the€tube€from€Mr.€Garrett's€throat.€€Although€Mr.€Garrett€wasÏsuccessfully€reintubated,€he€had€suffered€a€fatal€heart€attack€during€theÏreintubation€procedure.ÌÌà Œ àThe€plaintiffñññ ñññññññ׃ ×ññññ׃6×ññññññ׃.×ññññññ׃$×ñññ ññ ñ׃×ñ ñññññ׃×ññÝ ƒ #ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€filed€suit€against€the€defendant€alleging€that€the€hospital:€Ð ˆ,€%( Ðfailed€to€provide€adequate€supervision€and€staffing€during€Mr.€Garrett's€recoveryÏfrom€surgery;€had€prior€notice€of€the€possible€complications€with€theÏendotracheal€tube€and€failed€to€take€appropriate€action;€and€failed€to€provide€theÏâ ânecessary€and€proper€"mouth€brace"€to€protect€the€endotracheal€tube.€€TheÐ 4-0 Ðplaintiff€alleged€that€the€hospital's€failure€to€properly€supervise€and€care€for€Mr.ÏGarrett€was€the€proximate€cause€of€his€death.Ìâ âÌà Œ àThe€defendant€hospital€filed€a€motion€for€summary€judgment.€€TheÏdefendant€argued€that:€€(1)€€the€transection€of€the€tube€was€unforeseeable;€€(2)€Ïthe€defendant€provided€appropriate€staffing€and€supervision€of€Mr.€Garrett;€and€Ï(3)€€œbecause›€the€failure€of€the€endotracheal€tube€was€unforeseeable€and€noÏmouth€brace€or€other€device€had€been€ordered€by€a€œphysician,›€the€defendantÏwas€under€no€duty€to€supply€such€a€œdevice.›€€The€defendant's€motion€relied€uponÏaffidavits€of€Patricia€Hoeflein,€R.N.,€and€Ronald€McKay,€R.R.T.€€Both€Hoeflin€andÏMcKay€testified€that€they€had€never€previously€witnessed€a€patient€bite€throughÏan€endotracheal€tube.€€McKay€further€testified€that€this€was€the€first€time€he€hadÏever€heard€of€a€patient€severing€an€endotracheal€tube.€€Hoeflein€testified€that€sheÏonly€used€bite€blocks€on€patients€who€were€continuously€having€seizures.€ÏHoeflein€testified€that€œshe›€would€attempt€to€calm€the€patient€and€œorient€ññò òññtheññó óññÏpatient›€to€the€œtube€if€a€patient€chewed€on€an€endotracheal€tube.›€€Hoeflein€statedÏthat€medication€may€be€used€to€sedate€incoherent€or€uncooperative€patientsÏbiting€or€chewing€on€their€endotracheal€tubes.€€œHoeflein›€further€stated€that€sheÏhad€commonly€used€oral€airways€"to€prevent€patients€who€continually€bite€onÏtheir€endotracheal€tube€to€the€point€they€are€preventing€the€air€line€delivering€theÏbreath€and€oxygen€they€need."ÌÌà Œ àThe€defendant€offered€the€testimony€of€a€respiratory€therapy€supervisor,ÏGene€Emerson,€in€support€of€its€motion€for€summary€judgment.€€EmersonÏtestified€that€he€had€neither€seen€nor€heard€of€a€patient€causing€a€defect€in€anÏendotracheal€tube€by€chewing€or€biting€on€the€tube.€€He€stated€that€it€wasÏcommon€for€patients€to€gnaw€or€chew€on€tubes€while€their€lungs€were€beingÏsuctioned.€€He€opined€that€no€precautions€were€necessary€to€prevent€a€patientÐ ¨9 26 Ðfrom€biting€on€an€endotracheal€tube€provided€the€biting€stopped€upon€cessationÏof€the€suctioning.ÌÌà Œ àThe€defendant€also€relied€on€the€affidavit€of€Clifton€Emerson,€M.D.,€inÏsupport€of€its€motion€for€summary€judgment.€€Dr.€Emerson€was€theÏanesthesiologist€responsible€for€Mr.€Garrett's€care€during€and€after€surgery.€€Dr.ÏEmerson€stated€that€he€was€aware€that€patients€can€intermittently€bite€on€theÏendotracheal€tube€and€interrupt€the€ventilatory€flow.ÌÌÓÓà8 Œ àSuch€biting,€which€frequently€occurs€when€the€patient€is€beingÏsuctioned,€is€not€considered€problematic€unless€theÏanesthesiologist€anticipates€the€patient€might€experienceÏseizures....€€If€the€anesthesiologist€anticipates€the€patient€mayÏbite€down€on€the€tube€sufficient€(sic)€to€interrupt€air€flow,€he/she€willÏorder€a€bite€block€or€oral€airway€to€be€used€in€order€to€enable€theÏendotracheal€tube€to€deliver€appropriate€ventilatory€support€to€theÏpatient.€€The€decision€to€order€a€bite€block€or€oral€airway€is€aÏmedical€decision.Ð Œ ü!Œ ü! ÐÌÓZ-ÓÌà Œ àDr.€Emerson€testified€that€œhe›€"had€never€known€nor€ever€heard€of€aÏpatient€completely€transecting€an€endotracheal€tube€as€did€Mr.€œGarrett"›€œalthoughÏhe€has€been€involved€in€over€20,000€open€heart€procedures.€›€Based€upon€Dr.ÏEmerson's€experience€and€training,€"it€was€not€reasonably€foreseeable€that€Mr.ÏGarrett€would€bite€his€endotracheal€tube€in€two."€€Dr.€Emerson€felt€that€theÏincident€was€"such€a€freak€accident€that,€even€today,€[he€does]€not€routinely€useÏbite€blocks€for€post„anesthesia€patients."€€He€added€that€"biting€on€a€tube€duringÏsuctioning€is€an€ordinary,€every€day€event€and€in€no€way€represents"€the€type€ofÏemergency€that€would€make€a€bite€block€or€oral€airway€œappropriate.€€Finally,›€theÏpresident€of€the€company€that€manufactured€the€endotracheal€tube€that€Mr.ÏGarrett€transected€testified€that€œalthough›€he€believed€that€endotracheal€tubesÏcan€be€both€bitten€"into"€and€"in€two,"€œhe›€was€unaware€of€any€other€instanceÏwhere€a€patient€had€transected€an€endotracheal€œtube.Ð ¨9 26 Їà Œ àIn€opposition€to€the€defendant's€motion€for€summary€judgment,€the€plaintiffÏrelied€upon€the€affidavits€of€a€cardiovascular€surgical€specialist,€Joseph€WilliamÏRubin,€M.D.,€and€two€critical€care€nurses,€Nell€S.€George€and€Veronica€Varallo.€ÏAll€three€of€the€plaintiff's€experts€stated€that€"[w]hen€the€bedside€nurse€observedÏMr.€Garrett€biting€his€endotracheal€tube€.€.€.€she€should€have€either€used€a€biteÏblock€or€repositioned€the€tube€to€keep€him€from€further€biting€or€contacted€theÏtreating€physician€so€that€he€could€make€that€decision."€€Dr.€Rubin€opined€thatÏ"[t]he€medical€records€in€this€case€indicate€that€the€bedside€nurse€knew€Mrñññññ ñò òñ ñññ.ñññ ñó óñ ñññÏññññGññññÏGññarrett€was€biting€his€endotracheal€tube€during€his€recovery€from€surgery€[andÏthat]€based€on€the€records,€it€was€foreseeable€that€the€endotracheal€tube€couldÏbecome€occluded€or€impaired."ÌÌà Œ àDr.€Rubin€premised€his€opinion€on›€Mr.€Garrett's€medical€records€"whichÏindicate€that€the€bedside€nurse€knew€Mr.€Garrett€was€agitated€and€biting€hisÏendotracheal€tube€during€recovery€from€surgery."€€Dr.€Rubin€stated€that€attendingÏmedical€personnel€have€a€duty€to€ensure€that€a€patient's€endotracheal€tube€is€notÏblocked€or€damaged€when€the€intubated€patient€displays€an€agitated€behavior€œorÏbegins€ññò òññbitingññó óññ€down›€on€the€tube.€€"One€such€preventive€measure€is€repositioningÏof€the€endotracheal€tube,€which€decreases€the€extent€of€damage€to€one€specificÏpart€of€the€tube€by€teeth€biting,€thereby€decreasing€the€likelihood€of€the€tubeÏbeing€severed€in€two.€€Another€preventive€measure€is€the€use€of€a€bite€block."ÌÌà Œ àThe€defendant€was€permitted€to€offer€a€supplementary€affidavit€of€Dr.ÏClifton€Emerson.€€In€this€affidavit,€Dr.€Emerson€took€issue€with€the€alternativeÏactions€plaintiff's€experts€stated€should€have€been€taken.€€In€addition,€he€statedÏthat€had€he€been€contacted€by€the€nurse,€as€plaintiff's€experts€suggested,€Dr.ÏœEmerson›€"would€not€have€ordered€a€biteblock,€oral€airway,€or€any€otherÏmeasures€in€order€to€prevent€Mr.€Garrett€from€biting€the€tube."€€The€affidavit€wentÐ ¨9 26 Ðon€to€state,€"Thus,€even€had€the€nurse€caring€for€Mr.€Garrett€contacted€me€in€theÏearly€morning€hours€of€February€8,€1986,€the€outcome€of€this€case€would€haveÏbeen€no€different."€€By€so€opining,€the€defendant€argues€that€Dr.€œEmerson›€hasÏinterjected€"causation"€into€the€summary€judgment€motion€as€an€additional€basisÏfor€the€motion€for€summary€judgment.€€ÌÌà Œ àThe€trial€court€granted€the€defendant's€motion€for€summary€judgment.€ÏThe€judge€opined€that€no€showing€had€been€made€from€which€it€could€be€saidÏthat€the€defendant€reasonably€knew€or€should€have€known€of€the€probability€ofÏan€occurrence€such€as€the€one€that€caused€Mr.€Garrett's€death.€€The€trial€court,Ïtherefore,€held€that€Mr.€Garrett's€death€was€unforeseeable€and€that€theÏdefendant€had€no€duty€to€take€precautions€against€such€an€unforeseeable€injury.€ÏThe€trial€court€did€not€rule€on€the€"causation"€issue,€preferring€to€rest€its€decisionÏon€the€determination€that€no€duty€was€owed€to€Mr.€œGarrett.Ì›Ìà Œ àThe€plaintiff€appealed€to€the€appellate€court€arguing€that€her€affidavitsÏcreated€genuine€issues€of€material€fact.€€The€appellate€court€affirmed€the€trialÏcourt's€dismissal€and€held€that€the€œdefendant›€œdid›€not€have€a€duty€to€prevent€theÏtransection€"because€the€transection€of€the€tube€was€completely€unforeseeable."€ÏThe€court€also€opined€that€the€plaintiff's€experts€failed€to€describe€the€applicableÏstandard€of€professional€care€in€Nashville€or€œin€a›€similar€community€as€requiredÏby€Tenn.€Code€œAnn.€ðð€29„26„115(a)(1).ñññ ñññññññ׃×ññññ׃8×ññññññ׃0×ññññññ׃&×ñññ ññ ñ׃×ñ ñññññ׃×ññÝ ƒ #ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×›€€Finally,€the€court€faulted€the€expertÐ h.`'* Ðâ âproof€of€the€œplaintiff›€because€the€opinions€of€those€experts€were€based€on€anÐ H0@), Ðinaccurate€factual€predicate,€i.e.,€that€Mr.€Garrett€was€in€an€agitated€stateÏfollowing€surgery.Ìâ âÌÔ  Ôò òÓ  ÓANALYSISó óÐ ¨   ÐÓlDÓÌà Œ àÔ‡ X9XXX9ÔSummary€judgment€is€appropriate€if€the€movant€can€demonstrate€theÐ h`  Ðabsence€of€any€genuine€issues€of€material€fact€and€that€the€movant€is€entitled€toÏa€judgment€as€a€matter€of€law.€€Tenn.€R.€Civ.€P.€56.03.€€The€non„movant€isÏentitled€to€the€strongest€legitimate€view€of€the€evidence€and€is€entitled€to€allÏreasonable€inferences€which€may€be€drawn€from€the€evidence,€discarding€allÏcountervailing€evidence.€€òòShadrick€v.€Cokeróó,€963€S.W.2d€726,€731€(Tenn.€1998)Ð ÈÀ Ð(citing€òòByrd€v.€Hallóó,€847€S.W.2d€208,€210„11€(Tenn.€1993)).Ô#†X9XX X9µD#ÔÐ ¨  ÐÌà Œ àThe€deceased€was€intubated,€restrained,€and€in€critical€care.€€WhileÏphysicians€cannot€œensure›€œeither›€recovery€from€surgery€or€success€of€medicalÏtreatment,€hospitals€owe€a€general€duty€to€prevent€patients€from€injuringÏthemselves€following€surgical€procedures.€€òòKeeton€v.€Maury€County€œHosp.óó,›€713Ð %  ÐS.W.2d€314€(Tenn.€Ct.€App.€1986)€(stating€œhospital's›€"prime€responsibility"Ïincludes€reasonable€attendance€to€prevent€patients€from€injuring€themselves);Ïòòseeóó€òòalsoóó€W.€Page€Keeton€et€al.,€òòProsser€and€Keeton€on€Tortsóó,€ðð€53,€at€357€(5thÐ ¨* #& Ðed.€1984)€(stating€duty€may€be€analyzed€as€to€"whether€the€plaintiff's€interestsÏare€entitled€to€legal€protection€against€the€defendant's€conduct.").€€Clearly,€a€dutyÏis€owed€to€an€intubated€and€restrained€patient€to€maintain€a€clear€andÏunobstructed€breathing€passage€through€an€endotracheal€tube.€€òòSeeóó€òògenerallyóóÐ (2 +. ÐòòHughes€v.€Hastingsóó,€469€S.W.2d€378,€381€(Tenn.€1971)€(noting€use€of€plasticÐ 4-0 Ðairway€to€prevent€tongue€from€obstructing€air€passage€and€"to€prevent€plaintiffÏfrom€biting€.€.€.€the€endotracheal€tube.").Ô‡ X9XXX9ÔÐ È7À04 ÐÐ ¨9 26 Ðà Œ àThe€defendant€argues€that€the€deceased's€act€was€so€unusual€andÏextraordinary€that€the€act€was€œunforeseeable;›€œtherefore,›€the€defendant€wasÏunder€no€duty€to€guard€against€such€an€act.€€Accidents,€however,€"almostÏinvariably€are€surprises,€in€the€sense€that€the€precise€manner€of€their€occurrenceÏœcannot›€be€foreseen."€€òòSpivey€v.€St.€Thomas€Hospitalóó,€211€S.W.2d€450,€455Ð ˆ€ Ð(Tenn.€Ct.€App.€1947).€€Accordingly,€the€particular€harm€need€not€have€beenÏforeseeable€if€another€"harm€of€a€like€general€character€was€reasonablyÏforeseeable."€€òòIdóó.€at€457.Ô#†X9XX X9èK#ÔÐ (  ÐœÌñññìñò òñìñññà Œ àThe€defendant€stresses€that€the€accident€was€not€foreseeable,€since€thereÏis€no€indication€that€another€patient€had€ever€severed€an€endotracheal€tube.€€TheÏrecord,€however,€is€clear€that€a€risk€of€some€harm€is€foreseeable€if€anÏendotracheal€tube€is€occluded€or€impaired.€€The€plaintiff's€experts,€relying€onÏNurse€Hoeflein's€notes€and€other€evidence,€create€a€genuine€issue€of€materialÏfact€concerning€whether€the€defendant€should€have€been€aware€of€this€risk€ofÏocclusion€due€to€Mr.€Garrett's€behavior.€€If€a€jury€were€to€find€that€some€harmÏresulting€from€occlusion€was€foreseeable€in€light€of€the€circumstances,€then€theÏdefendant€would€also€owe€a€duty€to€protect€Mr.€Garrett€from€completely€severingÏthe€endotracheal€tube,€even€though€this€specific€harm€was€never€foreseen.€ÏòòñýñMcClenahan€ñêñvñêñ.Ð € x ÐCooleyñýñóóñýñ,€806Ð € x ÐS.W.2d€767,€775Ð € x Ð(Tenn.Ð € x Ð1991);Ð € x ÐñýñòòSpiveyóó,€211€S.W.2d€at€457.ñññìñó óñìñññÐ ¨* #& Л̜ññò ò›à Œ àThe€hospital's€general€duty€to€maintain€an€unobstructed€air€passage€is€notÏnegated€in€this€case€merely€by€allegations€concerning€the€foreseeability€of€aÏpatient's€transecting€an€endotracheal€tube.€€Whether€or€not€restrained€andÏintubated€patients€commonly€masticate€on€endotracheal€tubes€causing€eitherÏtransection€or€obstruction€of€the€air€passage€is€not€relevant€to€the€defendants'Ïòògeneralóó€duty€to€maintain€the€unobstructed€air€passage.€€Were€we€to€hold€thatÐ È7À04 Ðforeseeability€of€a€specific€harm€establishes€whether€a€general€duty€existed€inÐ ¨9 26 Ðthis€case,€a€hospital€could€generally€avoid€liability€merely€because€the€specificÏharm€had€yet€to€occur.€€While€such€a€holding€would€be€akin€to€the€"one€free€biteÏrule"€in€dog€bite€cases,€we€believe€that€such€a€rule€has€no€place€in€medicalÏmalpractice€œactions.ó ó›ñññ ñÌÌÔ‡ X©GXXX©GÔñ ñññò òà Œ àThe€defendant€urges€that€this€Court's€decisions€in€òòDoe€v.€Linderóó,€845Ð (2 +. ÐS.W.2d€173€(Tenn.€1992),€and€òòPittman€v.€Upjohnóó,€890€S.W.2d€425€(Tenn.€1994),Ð 4-0 Ðare€authority€for€the€conclusion€that€no€duty€existed€in€the€case€now€before€us.€ÏIn€òòPittmanóó,€this€Court€was€required€to€determine€whether€a€physician€owed€aÐ È7À04 Ðgeneral€duty€to€a€non„patient€who€sustained€injuries€after€taking€medicationÐ ¨9 26 Ðprescribed€to€his€grandmother€by€the€defendant€physician.€€Accordingly,€thisÏCourt's€analysis€in€òòPittmanóó€addressed€whether€the€plaintiff€was€a€member€of€thatÐ èà Ðclass€of€persons€to€whom€a€physician€owed€a€general€duty€of€care.€€òòIdóó.€at€435.Ð È À ÐÌà Œ àIn€òòDoe€v.€Linderóó,€845€S.W.2d€173€(Tenn.€1992),€two€individuals€illegallyÐ ˆ€ Ðentered€the€defendant's€office€and€stole€a€key€to€the€plaintiff's€residence.€€TheÏindividuals€then€used€the€key€to€gain€access€to€the€plaintiff's€residence€and€rapeÏher.€€The€plaintiff€filed€suit€against€the€defendant€alleging€that€the€defendantsÏnegligently€allowed€a€key€to€the€plaintiff's€residence€to€be€stolen€by€other€partiesÏwho€thereby€gained€access€to€her€residence€and€raped€her.ÌÌà Œ àIn€òòDoeóó,€we€held€that€if€the€intentional€criminal€act€of€a€third€party€would€notÐ ¨  Ðbe€"reasonably€foreseeable,€then€the€criminal€act€of€the€third€party€would€be€aÏsuperseding,€intervening€cause€of€the€harm,€relieving€the"€defendants›€fromÏliability€for€the€intentional€criminal€act€which€emanated€from€the€defendants'Ïnegligence.€€òòDoeóó,€œ845›€S.W.2d€178€(quoting€òòTedder€v.€Raskinóó,€728€S.W.2d€343,Ð (#  Ð349€(Tenn.€Ct.€App.€1987));€òòseeóó€œòòalsoóó€›W.€Page€Keeton€òòetóó€òòalóó.,€òòProsser€and€KeetonÐ %  Ðon€Tortsóó,€ðð€44,€at€311€(5th€ed.€1984)€(stating€liability€must€be€limited€to€cover€onlyÐ è&à" Ðthose€intervening€causes€that€lie€within€the€scope€of€the€foreseeable€risk).€€TheÏduties€owed€by€the€defendants€in€òòDoeóó€were€as€follows:Ð ¨* #& ÐÌà8 Œ à1.à ä àThe€general€duty€to€exercise€reasonable€care€inÐ h.`'* Ðsafeguarding€the€plaintiff's€key;€andÐ Œ ü!Œ ü! Ðà8 Œ à2.à ä àThe€duty€to€prevent€a€third€party€from€injuring€the€plaintiff:Ð(2 +.Œ ü!Œ ü! Ðà8 Œ àà8ä Œ ü!Œ ü!à(a)à < àif€the€injury€were€foreseeable;€andÐ4-0ä ¤ä ¤ Ðà8 Œ àà8ä Œ ü!Œ ü!à(b)à < àif€the€injury€were€made€possible€by€theÐ è5à.2 Ðdefendant's€failure€to€exercise€reasonable€care€overÏthe€plaintiff's€key.Ш9 26ä ¤ä ¤ ЇThis€Court€held€that€the€third€parties'€acts€of€raping€the€victim€were€anÏunforeseeable€consequence€of€the€defendant's€failure€to€safeguard€the€œvictim'sÏkey.€€òòIdóó.€at€179.€€Accordingly,€the€third€parties'€intentional€criminal€acts€wereÐ È À Ðintervening,€superseding€causes€of€the€plaintiff's€harm€that€the€defendant€wasÏnot€under€a€duty€to€prevent.ó óñññ ñÌÌñ ñññò òà Œ àWhile€both€òòDoeóó€and€òòPittmanóó€allude€to€general€propositions€governing€aÐ è5à.2 Ðduty€analysis,€the€specific€inquiries€addressed€and€the€analyses€employed€inÏboth€cases€are€readily€distinguishable€from€the€case€now€before€us.€€UnlikeÐ ¨9 26 ÐòòPittmanóó,€the€plaintiff€in€the€case€now€before€us€was€a€patient€of€the€defendant,€soÐ  Ðwe€need€not€determine€whether€the€plaintiff€was€a€member€of€that€class€ofÏpersons€to€whom€the€defendant€owed€a€general€duty€of€care.€€In€òòDoeóó,€we€heldÐ È À Ðthat€the€defendant€did€not€owe€a€duty€to€prevent€a€third€party's€unforeseeableÏintentional€criminal€act€which€was€an€intervening€and€superseding€cause€of€theÏplaintiff's€injuries.€€In€the€case€now€before€us,€we€are€neither€confronted€with€theÏforeseeability€of€a€third€party's€intentional€criminal€act€nor€with€the€determinationÏof€whether€a€third€party's€intentional€act€was€an€interveningñññ ñÔ#†X©GXX X©GýO#ÔÔ‡ X©GXXX©GÔñ ñññ,€superseding€€causeÐ (  Ðof€the€plaintiff's€death.ó óñññ ñÌÌñ ñà Œ àñññ ñò òThe€hospital's€general€dutyó óò òñ ñññPerhaps€more€importantñññ ñó óñ ñññ€to€ñññ ñò òmaintain€an€unobstructed€air€passage€is€notÏnegated€in€thisó óò òñ ñññour€decision,€however,€is€that€theñññ ñó óñ ñññ€case€ñññ ñò òmerelyó óò òñ ñññnowÏbefore€ñ ñus€ñ ñis€specifically€controlledñññ ñó óñ ñññ€by€ñññ ñò òallegations€concerning€the€foreseeability€ofÏa€patient's€transecting€an€endotracheal€tubeó óò òñ ñññthe€medical€malpractice€statuteñññ ñó óñ ñññ.ñ ñÔ#†X©GXX X©Gc`#Ôñ ññññ ñò ò€€WhetherÏor€not€restrained€and€intubated€patients€commonly€masticate€on€endotrachealÏtubes€causing€either€transection€or€obstruction€of€the€air€passage€is€not€relevantÏto€the€defendants'€òògeneralóó€duty€to€maintain€the€unobstructed€air€passage.€€WereÐ è5à.2 Ðwe€to€hold€that€foreseeability€of€a€specific€harm€establishes€whether€a€generalÏduty€existed€in€this€case,€a€hospital€could€generally€avoid€liability€merely€becauseÐ ¨9 26 Ðthe€specific€harm€had€yet€to€occur.€€While€such€a€holding€would€be€akin€to€theÏ"one€free€bite€rule"€in€dog€bite€cases,€we€believe€that€such€a€rule€has€no€place€inÏmedical€malpractice€actions.ÌÌò òà Œ àThe€defendant€urges€that€this€Court's€decisions€in€òòDoe€v.€Linderóó,€845Ð ˆ€ ÐS.W.2d€173€(Tenn.€1992),€and€òòPittman€v.€Upjohnóó,€890€S.W.2d€425€(Tenn.€1994),Ð h`  Ðare€authority€for€the€conclusion€that€no€duty€existed€in€the€case€now€before€us.€ÏIn€òòPittmanóó,€this€Court€was€required€to€determine€whether€a€physician€owed€aÐ (  Ðgeneral€duty€to€a€non„patient€who€sustained€injuries€after€taking€medicationÏprescribed€to€his€grandmother€by€the€defendant€physician.€€Accordingly,€thisÏCourt's€analysis€in€òòPittmanóó€addressed€whether€the€plaintiff€was€a€member€of€thatÐ ÈÀ Ðclass€of€persons€to€whom€a€physician€owed€a€general€duty€of€care.€€òòIdóó.€at€435.Ð ¨  ÐÌà Œ àIn€òòDoe€v.€Linderóó,€845€S.W.2d€173€(Tenn.€1992),€two€individuals€illegallyÐ h` Ðentered€the€defendant's€office€and€stole€a€key€to€the€plaintiff's€residence.€€TheÏindividuals€then€used€the€key€to€gain€access€to€the€plaintiff's€residence€and€rapeÏher.€€The€plaintiff€filed€suit€against€the€defendant€alleging€that€the€defendantsÏnegligently€allowed€a€key€to€the€plaintiff's€residence€to€be€stolen€by€other€partiesÏwho€thereby€gained€access€to€her€residence€and€raped€her.ÌÌà Œ àIn€òòDoeóó,€we€held€that€if€the€intentional€criminal€act€of€a€third€party€would€notÐ ˆ,€%( Ðbe€"reasonably€foreseeable,€then€the€criminal€act€of€the€third€party€would€be€aÏsuperseding,€intervening€cause€of€the€harm,€relieving€the"€defendants›€fromÏliability€for€the€intentional€criminal€act€which€emanated€from€the€defendants'Ïnegligence.€€òòDoeóó,€œ845›€S.W.2d€178€(quoting€òòTedder€v.€Raskinóó,€728€S.W.2d€343,Ð 4-0 Ð349€(Tenn.€Ct.€App.€1987));€òòseeóó€œòòalsoóó€›W.€Page€Keeton€òòetóó€òòalóó.,€òòProsser€and€KeetonÐ è5à.2 Ðon€Tortsóó,€ðð€44,€at€311€(5th€ed.€1984)€(stating€liability€must€be€limited€to€cover€onlyÐ È7À04 Ðthose€intervening€causes€that€lie€within€the€scope€of€the€foreseeable€risk).€€TheÏduties€owed€by€the€defendants€in€òòDoeóó€were€as€follows:Ð èà ÐÌà8 Œ à1.à ä àThe€general€duty€to€exercise€reasonable€care€inÐ ¨   Ðsafeguarding€the€plaintiff's€key;€andÐ Œ ü!Œ ü! Ðà8 Œ à2.à ä àThe€duty€to€prevent€a€third€party€from€injuring€the€plaintiff:Ðh` Œ ü!Œ ü! Ðà8 Œ àà8ä Œ ü!Œ ü!à(a)à < àif€the€injury€were€foreseeable;€andÐH@ ä ¤ä ¤ Ðà8 Œ àà8ä Œ ü!Œ ü!à(b)à < àif€the€injury€were€made€possible€by€theÐ (  Ðdefendant's€failure€to€exercise€reasonable€care€overÏthe€plaintiff's€key.Ð ä ¤ä ¤ ÐÌThis€Court€held€that€the€third€parties'€acts€of€raping€the€victim€were€anÏunforeseeable€consequence€of€the€defendant's€failure€to€safeguard€the€œvictim'sÏkey.€€òòIdóó.€at€179.€€Accordingly,€the€third€parties'€intentional€criminal€acts€wereÐ h` Ðintervening,€superseding€causes€of€the€plaintiff's€harm€that€the€defendant€wasÏnot€under€a€duty€to€prevent.ó óÐ (#  ÐÌò òà Œ àWhile€both€òòDoeóó€and€òòPittmanóó€allude€to€general€propositions€governing€aÐ è&à" Ðduty€analysis,€the€specific€inquiries€addressed€and€the€analyses€employed€inÏboth€cases€are€readily€distinguishable€from€the€case€now€before€us.€€UnlikeÏòòPittmanóó,€the€plaintiff€in€the€case€now€before€us€was€a€patient€of€the€defendant,€soÐ ˆ,€%( Ðwe€need€not€determine€whether€the€plaintiff€was€a€member€of€that€class€ofÏpersons€to€whom€the€defendant€owed€a€general€duty€of€care.€€In€òòDoeóó,€we€heldÐ H0@), Ðthat€the€defendant€did€not€owe€a€duty€to€prevent€a€third€party's€unforeseeableÏintentional€criminal€act€which€was€an€intervening€and€superseding€cause€of€theÏplaintiff's€injuries.€€In€the€case€now€before€us,€we€are€neither€confronted€with€theÏforeseeability€of€a€third€party's€intentional€criminal€act€nor€with€the€determinationÐ È7À04 Ðof€whether€a€third€party's€intentional€act€was€an€intervening,€superseding€€causeÏof€the€plaintiff's€death.ó óÐ èà ÐÌà Œ àPerhaps€more€important€to€our€decision,€however,€is€that€the€case€nowÏbefore€is€specifically€controlled€by€the€medical€malpractice€statute.ó óñ ñññ€€TheÏstatutory€elements€of€a€medical€malpractice€action€are€codified€at€Tenn.€CodeÏAnn.€ðð29-26„115.€€The€relevant€inquiries€under€this€statute€are:€›€the€standard€ofÏcare;ñññ ñññññññ׃×ññññ׃:×ññññññ׃2×ññññññ׃(×ñññ ññ ñ׃×ñ ñññññ׃×ññÝ ƒ #ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€a€deviation€from€the€standard€of€care;€and€causation.€€Tenn.€Code€Ann.Ð è5à.2 Ððð29-25-115(a)(1)„(3).€€Expert€testimony€is€required€to€prove€each€of€theseÏelements.€€Tenn.€Code€Ann.€ðð€29„25„115(b).€€The€standard€of€care€and€theÏdeviation€from€the€standard€of€care,€therefore,€are€not€established€by€aÏreasonable€person€standard€as€in€other€areas€of€negligence€law.€€€SummaryÏjudgment,€therefore,€is€inappropriate€if€competent€expert€testimony€is€conflicting.ÌÌà Œ àThe€proper€inquiry€in€this€case€is€simply€whether€the€defendant's€failure€toÏorder€a€bite€block€or€oral€airway,€reposition€the€endotracheal€tube,€or€contact€theÏtreating€physician€deviated€from€the€recognized€standard€of€care.€€The€defendantÏhas€filed€a€motion€for€summary€judgment€with€supporting€affidavits€alleging:ÌÌà8 Œ à(1)à ä à"the€endotracheal€tube['s]€.€.€.€failure€in€this€case€wasÐ ¨  Ðunforeseeable;"Ð Œ ü!Œ ü! Ðà8 Œ à(2)à ä à"the€defendant€provided€appropriate€staffing€and€supervisionÐ h` Ðœof€Mr.›€œGarrett;"€and›Ð Œ ü!Œ ü! Ðà8 Œ à(3)à ä àbecause€the€"failure€of€the€endotracheal€tube€was€notÐ (#  Ðforeseeable€and€no€mouth€brace€or€other€device€had€been€orderedÏby€a€physician,€the€defendant€had€œno›€duty€to€supply€such€a€device."Ð Œ ü!Œ ü! ÐÌIn€response,€the€plaintiff€countered€with€affidavits€from€Nell€S.€George,€R.N.,ÏB.S.N.,€M.S.N.,€Dr.€Joseph€William€Rubin,€M.D.,€C.M.,€and€Veronica€Varallo,ÏR.N.€€The€œaffidavits€of€the€plaintiff's›€œexperts€may›€be€summarized€as€follows:ÌÌà8 Œ àthe€beside€nurse's€care€of€Mr.€Garrett€fell€below€the€recognizedÏstandard€of€care€when€failing€to€order€a€bite€block,€reposition€theÏtube,€or€contact€the€treating€physician€upon€observing€Mr.€GarrettÏbiting€his€endotracheal€tube€as€occlusion€or€impairment€of€the€tubeÏwas€foreseeable.Ш9 26Œ ü!Œ ü! ЇThe€hospital€record€and€Nurse€œHoeflein's›€testimony€indicate€that€Mr.€Garrett€wasÏbiting€on€his€tube€on€two€occasions€occurring€within€less€than€a€two„hour€periodÏof€time.€€Mr.€Garrett€became€agitated€and€had€to€be€restrained.€€The€conflictingÏexpert€testimony€as€well€as€the€inferences€to€be€drawn€from€the€record€createÏgenuine€issues€of€material€fact€as€to€the€standard€of€care€and€whether€aÏdeviation€from€the€standard€of€care€occurred.€€Resolution€of€material€issues€ofÏfact€concerning€possible€deviations€from€the€standard€of€care€is€generally€withinÏthe€purview€of€the€trier€of€fact.€€Summary€judgment,€therefore,€was€improperlyÏgranted.ÌÌà Œ àCosts€of€this€appeal€shall€be€taxed€against€the€defendant€for€whichÏexecution€may€issue€if€necessary.ÌÌÌÓÓà Œ àà ä àà < àà ” àà ì àà D àòòà€T$T$MT$àóóˆÐ H!@ Ðà Œ àà ä àà < àà ” àà ì àà D àJANICE€M.€HOLDER,€JUSTICEÌÌÌÌœò òñ ñPanelñ ññ ññññ ñò òòŒòPanelóŒóó óò òñ ñññConcurringñ ññññ ñó óñ ñññ:ó ó›Ð ø%ð! ÐÌAnderson,€C.J.ÌDrowota€and€Birch,€J.J.