ÿWPCk  4# èU:ó %- 0ˆ3wš»4Ui 0&x 0Dž 0Jâ 0T, 0^€ U:Þ  0h 0rˆ 0|ú 0†v 0ü 1uŒ 0d AQe B¶ ÆÓ 0D™ 0@Ý 0D D/a B D3­U *àB) DC3 AMvŽÃ~QKÏv~vÓ˜˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ, øð AZ‹"Arial RegularX(`zZ$¡¡ÑTRY,3Ø'ÿ Letter3Ø'3Ø'ÿ Letterÿ3Ø'TÑÔ  ÔlmEnEopDqDrDst+ueewtxLyD|ƒD„…E†‡ˆÆ‰DŠ•‹Ó€—WX$ÔüÔô3|x—(Ö(2/H$¤¤Ý ƒzZ!ÝÑTRY3Ø'ÿ Letter3Ø' 3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  ÝÔ€XåXXXÔÒ4°ÒÒ„°ÒÔ€ô“‘ôXXåÔà Œ àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô, øð AZ‹"Arial Regular26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô  ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ!"#$%Cþÿ<< Cÿÿ dƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó'''÷ÿ dxdüÿP Pd 'ÿÿdxd< Œ 9p`(Arial% Line 7 d,,,,7Border 1dd!#-Cþÿ << Gÿÿ „Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€+ÔÑ\R3Ø'\ÑÔ  ÔÔ  ÔÝ  ÝÝ ƒ""ÝÝ  ÝÔ€+ÔÓ  ÓÔ YYY ÔFILEDÔ€+XÔÌÌò òJuly€13,€1998ÌÌCecil€Crowson,€Jr.ÌÔ€+ôÔAppellate€Court€Clerkó ó tÝ ƒ!ÝÑ#€d#ÑÔ€+ÔÑ\R3Ø'\ÑÔ  ÔÔ  ÔÝ  ÝÝ ƒ$ÝÔ€+ÔÒ 4 ÒÒ „ ÒÔ€+ôÔà àòòÚ  ÚÚ  ÚóóÝ  Ýà8 àà8 àIn€a€malpractice€action,€the€plaintiff€shall€prove€byÏevidence€as€required€by€29„26„115(b)€that€theÏdefendant€did€not€supply€appropriateÏinformation€to€the€patient€in€obtaining€hisÏinformed€consent€in€accordance€with€theÏrecognized€standard€of€acceptable€professionalÏpractice€in€the€profession€and€in€the€specialty,€ifÏany,€that€the€defendant€practices€in€theÏcommunity€in€which€he€practices€and€in€similarÏcommunities.ÌÌTenn.€Code€Ann.€ðð€29„26„118.€€Pursuant€to€Tenn.€Code€Ann.€ðð29„26„115(b),€a€plaintiff€bearsÏthe€burden€of€proving€the€recognized€standard€of€acceptable€professional€practice,€that€theÏdefendant€acted€with€less€than€ordinary€and€reasonable€care€in€accordance€with€that€standard,€andÏthat€the€plaintiff€suffered€injuries€as€a€proximate€cause€of€the€defendantððs€act.Ì AÝ ƒ!ÝÑ#€d#ÑÔ€+ÔÑ\R3Ø'\ÑÔ  ÔÔ  ÔÝ  ÝÝ ƒ$ÝÔ€+ÔÒ 4 ÒÒ „ ÒÔ€+ôÔà àòòÚ  ÚÚ  ÚóóÝ  ÝWe€question€whether€a€patient€who€is€under€the€influence€of€an€anesthetic€and€is€in€theÏprocess€of€undergoing€an€extensive€dental€procedure€can€either€authorize€a€procedure€orÏformulate€an€intelligent€and€informed€decision€during€the€procedure€itself.ÌPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'hStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  h HD: Geneva ÒÒ  h HD: Geneva ÒÝ ƒ!ÝÔ . ÔÔ€+ÔÑ\R3Ø'\ÑÔ  ÔÔ  ÔÝ  ÝÒ 4 ÒÒ „ ÒÑ  ÑÑ  ÑÑ\R AØ'\Ñ›šœ›Ñ7€åXXdædÈ7ÑÑ  ÑÑ  Ñœò ò›Þ ÞÌà@ àIN€THE€SUPREME€COURT€OF€TENNESSEEÌà@ àAT€JACKSONÌÌÌÌÌà àà àà àà àà àà àà àFOR€PUBLICATIONÌÌÙ€!Ùó óœßR€./-A1-j||Õ` Å `€€@ÿRß›à àà àà àà àà àà àà àò òFiled:ó ó€òò€€€€€€€€€July€13,€1998à€ àóóÌÌÌÌÌÌFRANCES€BLANCHARD,à@ à)Ìà@ à)Ìà àPLAINTIFF/APPELLANT,à@ à)à àSHELBY€CIRCUITÌà@ à)Ìv.à@ à)à àHon.€George€H.€Brown,€Jr.Ìà@ à)ÌARLENE€KELLUM,€D.D.S.,à@ à)à àNo.€02S01„9709„CV„00083Ìà@ à)Ìà àDEFENDANT/APPELLEE.à@ à)ÌÌÌÌÌÌÌÌÌòòFOR€APPELLANTóó:à àà àà àà àòòFOR€APPELLEEóó:ÌÌTIMOTHY€A.€RYAN€IIIà àà àà àGEORGE€P.€BAILEYÌMEMPHISà àà àà àà àà àMEMPHISÌÌÌÌÌÌÌÌÌÌÌÌÌÌÌà@ àò òÔ€+èÔO€P€I€N€I€O€Nó óÔ€+XÔÌÌÌÌÌÌREVERSED€AND€REMANDEDà€ àHOLDER,€J.ÇÓÓà àà@ àò òOPINIONó óÌÌà àThe€issues€with€which€we€are€confronted€are:€€(1)€€whether€expertÏtestimony€is€required€in€a€medical€battery€case€when€a€doctor€performs€anÏunauthorized€procedure;€and€(2)€€whether€the€defendant's€affidavit€in€the€caseÏnow€before€us€triggered€the€non„movant's€burden€pursuant€to€òòMcCarley€v.€WestÏQuality€Food€Serv.óó,€960€S.W.2d€585€(Tenn.€1998),€and€òòByrd€v.€Hallóó,€847€S.W.2dÏ208€(Tenn.€1993).€€We€hold€that€expert€testimony€is€not€required€in€a€medicalÏbattery€case,€that€the€plaintiff's€cause€of€action€was€properly€premised€on€aÏmedical€battery€theory,€and€that€the€defendant's€conclusory€affidavit€did€notÏtrigger€the€plaintiff's€burden€in€this€motion€for€summary€judgment.€€The€Court€ofÏAppeals'€decision€is€reversed,€and€the€case€is€remanded€to€the€trial€court.ÌÌÓ  Óò òFACTSó óÌÓ  ÓÌà àThe€plaintiff,€Frances€Blanchard,€sought€treatment€for€a€gum„relatedÏproblem€and€was€advised€by€a€periodontal€specialist€to€have€her€teethÏextracted.€€The€plaintiff€then€sought€the€services€of€the€defendant,€ArleneÏKellum,€D.D.S.€€During€an€appointment€with€Dr.€Kellum,€Dr.€Kellum€anesthetizedÏthe€plaintiff's€entire€oral€cavity€and€began€a€full€extraction€of€all€thirty„two€of€theÏplaintiff's€teeth.ÌÌà àThe€plaintiff€alleges€that€Dr.€Kellum€never€informed€her€that€all€thirty„twoÏteeth€would€be€simultaneously€extracted€during€a€single€office€visit.€€The€plaintiffÏasserted€in€her€complaint€that€the€pain€became€unbearable€and€that€sheÏrefused€to€allow€Dr.€Kellum€to€proceed€with€further€extractions.€€The€recordÏindicates€that€Dr.€Kellum€had€extracted€sixteen€teeth€when€instructed€by€theÏplaintiff€to€cease€further€extractions.€€The€plaintiff€became€disoriented€andÏallegedly€lost€consciousness€while€in€Dr.€Kellum's€office.€€She€was€transportedÏto€St.€Francis€Hospital€where€she€was€admitted€and€treated€by€physicians.ÌÌà àThe€plaintiff€filed€suit€against€Dr.€Kellum€alleging€both€battery/lack€ofÏconsent€and€that€Dr.€Kellum's€services€"fell€below€the€standards€of€reasonableÏcare€and€practice€in€this€community."€€She€asserted€in€answers€to€theÏdefendant's€interrogatories€that€Dr.€Kellum€did€not€inform€her€that€all€thirty„twoÏteeth€were€to€be€extracted€during€a€single€procedure.€€The€plaintiff€maintainedÏthat€she€would€not€have€consented€to€having€a€full€extraction€during€a€singleÏoffice€visit.€€Following€the€plaintiff's€release€from€the€hospital,€Dr.€KellumÏcompleted€the€extractions€in€a€series€of€separate€appointments.ÌÌà àDr.€Kellum€filed€a€motion€for€summary€judgment€supported€by€what€canÏbest€be€described€as€a€conclusory€affidavit.€€A€memorandum€in€support€of€theÏmotion€argued€that€the€plaintiff€had€"failed€to€state€specifically€what€theÏapplicable€standard€of€care€in€this€case€was."€€The€memorandum€also€allegedÍthat€the€plaintiff€had€failed€to€allege€specifically€what€actions€by€Dr.€KellumÏdeviated€from€the€applicable€standard€of€care.€€The€motion€was€supported€byÏDr.€Kellum's€affidavit€that€merely€stated:€€(1)€€that€her€treatment€wasÏ"administered€in€a€recognized€and€approved€form€accepted€and€followed€byÏ[sic]€significant€segment€of€the€profession"€of€which€she€practices;€(2)€€if€theÏplaintiff€"sustained€any€injury€or€damage,€it€was€not€related€.€.€.€or€caused€by€.€.€.Ïany€negligence"€on€Dr.€Kellum's€part;€and€(3)€€that€her€treatment€of€the€plaintiffÏdid€not€fail€to€meet€the€appropriate€standard€of€care.€€Dr.€Kellum's€affidavitÏneither€set€forth€a€standard€of€care€nor€alleged€that€the€plaintiff€authorized€a€fullÏextraction.ÌÌà àThe€trial€court€granted€the€defendant's€motion€for€summary€judgmentÏfinding€that€there€were€no€"genuine€issues€of€material€fact."€€The€plaintiffÏapparently€abandoned€the€medical€malpractice€issue€on€appeal€but€did€assertÏthat€the€trial€court€erred€in€dismissing€the€battery/consent€issue.€€The€Court€ofÏAppeals€found€that€the€plaintiff€failed€"to€come€forward€with€evidence,€in€the€formÏof€an€expert€opinion,"€and€affirmed€the€trial€court's€dismissal.ÌÌÓ  Óò òANALYSISó óÓ  ÓÌà àThe€plaintiff€has€alleged€that€she€did€not€give€Dr.€Kellum€permisson€toÏpull€thirty„two€teeth€during€the€office€visit€giving€rise€to€this€litigation.€€The€plaintiffÏcontends€that€her€claim€on€appeal€is€predicated€upon€a€theory€of€"a€violation€ofÍplaintiff's€person"€or€"an€actionable€battery"€and€is€not€"related€to€medical€orÏprofessional€negligence."€€She€argues€that€expert€testimony€should€not€beÏrequired€merely€to€show€whether€Dr.€Kellum€procured€permission€to€perform€theÏextractions.ÌÌà àWe€believe€that€there€is€a€distinction€between:€€(1)€€cases€in€which€aÏdoctor€performs€an€unauthorized€procedure;€and€(2)€cases€in€which€theÏprocedure€is€authorized€but€the€patient€claims€that€the€doctor€failed€to€inform€theÏpatient€of€any€or€all€the€risks€inherent€in€the€procedure.€€Performance€of€anÏunauthorized€procedure€constitutes€a€medical€battery.€€A€simple€inquiry€can€beÏused€to€determine€whether€a€case€constitutes€a€medical€battery:€€(1)€€was€theÏpatient€aware€that€the€doctor€was€going€to€perform€the€procedure€(i.e.,€did€theÏpatient€know€that€the€dentist€was€going€to€perform€a€root€canal€on€a€specifiedÏtooth€or€that€the€doctor€was€going€to€perform€surgery€on€the€specified€knee?);Ïand,€if€so€(2)€€did€the€patient€authorize€performance€of€the€procedure?€€AÏplaintiff's€cause€of€action€may€be€classified€as€a€medical€battery€only€whenÏanswers€to€either€of€the€above€questions€are€in€the€negative.€€If,€however,Ïanswers€to€the€above€questions€are€affirmative€and€if€the€plaintiff€is€alleging€thatÏthe€doctor€failed€to€inform€of€any€or€all€risks€or€aspects€associated€with€aÏprocedure,€the€patient's€cause€of€action€rests€on€an€informed€consent€theory.ÌÌà àInformed€consent€cases€require,€by€statute,€expert€evidence€to€establishÏwhether€the€information€provided€to€the€patient€deviated€from€the€usual€andÏcustomary€information€given€to€patients€to€procure€consent€in€similar€situations.€ÏòòSeeóó€òògenerallyóó€òòGerman€v.€Nichopoulosóó,€577€S.W.2d€197€(Tenn.€Ct.€App.€1978)Ï(holding€expert€evidence€required€to€establish€informed€consent€when€patientÏknew€of€procedure€to€be€performed€but€alleged€that€no€risks€associated€withÏprocedure€were€disclosed);€òòseeóó€òòalsoóó€Tenn.€Code€Ann.€ðð€29„26„115,€„118.œ× ƒ0 ××  ×›€€TheÏinquiry€focuses€on€whether€the€doctor€provided€òòanyóó€or€òòadequateóó€information€toÏallow€a€patient€to€formulate€an€intelligent€and€informed€decision€whenÏauthorizing€or€consenting€to€a€procedure.€€òòShadrick€v.€Coker,€M.D.óó,€963€S.W.2dÏ726€(Tenn.€1998).€€To€determine€the€adequacy€of€information€provided€in€anÏinformed€consent€case,€a€court€must€consider€the€nature€of€the€medicalÏtreatment,€extent€of€the€risks€involved€and€the€applicable€standard€of€care.€€òòIdóó.;ÍTenn.€Code€Ann.€ððœ29„26„118.›€€These€determinations€require€expert€testimonyÏand€are€outside€the€common€knowledge€of€a€lay€witness.ÌÌà àLack€of€informed€consent€in€a€medical€malpractice€action€under€Tenn.ÏCode€Ann.€ðð€29„16„118€operates€to€negate€a€patient's€authorization€for€aÏprocedure€thereby€giving€rise€to€a€cause€of€action€for€battery.€€òòCardwell€v.ÏBechtolóó,€724€S.W.2d€739,€750„51€(Tenn.€1987).€€There€is,€however,€no€priorÏauthorization€or€consent€in€a€medical€battery€case€to€be€negated€by€expertÏtestimony.€€The€primary€consideration€in€a€medical€battery€case€is€simplyÏwhether€the€patient€knew€of€and€authorized€a€procedure.€€This€determinationÏdoes€not€require€the€testimony€of€an€expert€witness.ÌÌà àThe€plaintiff€argues€that€she€was€not€aware€of€Dr.€Kellum's€intention€toÏperform€a€full€extraction€and€that€she€did€not€authorize€a€full€extraction€duringÏthe€office€visit€giving€rise€to€this€litigation.€€Consequently,€the€plaintiff's€claim€isÏappropriately€classified€as€a€medical€battery.ÌÌà àOur€next€inquiry€is€whether€the€defendant's€efforts,€as€the€movant€in€aÏmotion€for€summary€judgment,€properly€negated€an€essential€element€of€theÏplaintiff's€medical€battery€case€or€established€an€affirmative€defense.€€AbsentÏthe€negation€of€an€essential€element€or€establishment€of€an€affirmative€defense,Ïthe€burden€does€not€shift€to€the€non„movant€in€a€summary€judgmentÍproceeding.€€òòSeeóó€òòMcCarley€v.€West€Quality€Foods€Serv.óó,€960€S.W.2d€at€588€("IfÏthe€movant€does€not€negate€a€claimed€basis€for€the€suit,€the€non„movant'sÏburden€to€produce€either€supporting€affidavits€or€discovery€materials€is€notÏtriggered€and€the€motion€for€summary€judgment€fails.").ÌÌà àDr.€Kellum's€affidavit€merely€contains€a€conclusory€statement€that€sheÏacted€"in€a€recognized€and€approved€form€.€.€.€and€that€such€treatment€would€notÏand€did€not€fail€to€meet€the€standard€of€care€.€.€.€."€€The€affidavit€is€non„responsive€to€the€plaintiff's€allegation€that€Dr.€Kellum€failed€to€inform€the€plaintiffÏof€her€intention€to€perform€a€full€extraction€during€the€appointment€giving€rise€toÏthis€litigation.€€Moreover,€Dr.€Kellum's€brief€relies€on€a€theory€of€implied€consent:ÌÌÓÓà8 à[When€the€p]laintiff€came€in,€sat€down€in€the€dental€chair,€allowedÏthe€Doctor€to€anesthetize€her€entire€oral€cavity,€and€willinglyÏsubmitted€to€the€extraction€of€sixteen€(16)€teeth€„€that€it€isÏreasonable€for€the€Defendant/Appellee€Doctor€to€presume€that€sheÏhas€the€Patient's€"consent"€to€extract€her€teeth.ÓÓÌÌA€theory€of€implied€consent€does€not€negate€an€essential€element€of€theÏplaintiff's€claim.× ƒ1 ××  ×€€The€defendant€must€proffer€admissible€evidence€establishingÏthat€the€plaintiff€authorized€a€full€extraction€to€trigger€the€plaintiff's€burden,€suchÍas€a€signed€consent€form€authorizing€a€full€extraction.€€Reliance€on€an€impliedÏconsent€theory€or€a€mere€allegation€that€the€plaintiff€authorized€the€procedureÏcreates€material€issues€of€fact.ÌÌà àWe€hold€that€Dr.€Kellum's€affidavit€did€not€negate€an€essential€element€ofÏthe€plaintiff's€claim€or€establish€an€affirmative€defense.€€Accordingly,€the€burdenÏdid€not€shift€to€the€plaintiff.€€òòSeeóó€òòMcCarleyóó,€960€S.W.2d€at€588;€òòByrdóó,€847€S.W.2dÏat€215€(Tenn.€1993).€€€Summary€judgment€on€the€issue€of€battery€is€reversed,Ïand€the€case€is€remanded€to€the€trial€court€for€proceedings€consistent€with€thisÏopinion.€€Costs€of€this€appeal€shall€be€taxed€to€the€defendant,€Dr.€Arlene€Kellum,ÏD.D.S.,€for€which€execution€may€issue€if€necessary.ÌÌÌÓÓà àà àà àà àà àà àòòà€ àóóÌà àà àà àà àà àà àJANICE€M.€HOLDER,€JUSTICEÌÌÌÌò òœCONCURRING:ó ó›ÌÌAnderson,€C.J.ÌDrowota€and€Birch,€J.J.