I N THE COURT OF APPEALS OF TENNESSEE
EASTERN SECTI ON FILED July 2, 1997
Cecil Crowson, Jr. Appellate C ourt Clerk
SANDRA J . SCOTT ) ANDERSON COUNTY ) 03A01- 9608- CV- 00270 Pl a i nt i f f - Appe l l a nt )
) )
v. ) HON. J AMES B. SCOTT, J R. , ) J UDGE )
DR. GERALD B. CALI A )
)
De f e nda nt - Appe l l e e ) VACATED AND REMANDED
KENNETH K. KENNEDY OF KNOXVI LLE FOR APPELLANT
MARTI N L. ELLI S a nd VONDA M LAUGHLI N OF KNOXVI LLE FOR APPELLEE .
O P I N I O N
Godda r d, P. J .
Thi s me di c a l ma l pr a c t i c e s ui t a r i s e s out of s ur ge r y
p e r f o r me d on Sa ndr a Sc ot t ’ s f e e t by Dr . Ge r a l d Ca l i a on M y 17 ,
a
1989. M . Sc ot t c ont e nds t ha t Dr . Ca l i a wa s ne gl i ge nt i n hi s
s
me di c a l c a r e of h e r . She i ns i s t s on a ppe a l t ha t t he Tr i a l Cour t
wa s i n e r r or i n d i r e c t i ng a ve r di c t a ga i ns t he r a t t he c l os e of
h e r p r o of .
M . Sc ot t r a i s e s t he f ol l owi ng t wo i s s ue s on a ppe a l :
s
I. Di d t he t r i a l c our t e r r i n e xc l udi ng t he t e s t i mony o f Dr . M r i on C. Ha r pe r on t he i s s ue s of c a us a t i on
a
u n de r t he r e qui r e me nt s of § 29- 26- 115, Te nn. Code Ann. , 1 9 96?
II. W s t he t r i a l c our t ’ s s ua s pont e gr a nt of di r e c t e d
a
v e r di c t pr ope r unde r Te nne s s e e Rul e s of Ci vi l Pr oc e dur e 5 0 . 01?
I n Apr i l 1989 M . Sc ot t s ought t r e a t me nt f r om Dr .
s
Ca l i a , a p odi a t r i s t , t o c or r e c t a va r i e t y of a i l me nt s a f f l i c t i ng
he r f e e t . M . Sc ot t a gr e e d t o ha ve Dr . Ca l i a pe r f or m s ur ge r y on
s
he r f e e t . Dr . Ca l i a pe r f or me d f i ve s e pa r a t e s ur gi c a l pr oc e dur e s
o n e a c h of M . Sc ot t ’ s f e e t .
s M . Sc ot t c ont i nue d t o vi s i t Dr .
s
Ca l i a f or pos t - ope r a t i ve e va l ua t i ons . De s pi t e f ol l owi ng Dr .
Ca l i a ’ s i ns t r uc t i ons f or t he c a r e of he r s ur gi c a l wounds t ha t
r e ma i n e d a f t e r t he s ur ge r y, t he s ur gi c a l wound on he r r i ght gr e a t
t oe f a i l e d t o h e a l .
Ei ght mont hs a f t e r he r s ur ge r y, M . Sc ot t s ought t he
s
o p i n i o n of Dr . M r i on C. Ha r pe r , a n or t hope di s t a s s oc i a t e d wi t h
a
Va n d e r b i l t Hos pi t a l i n Na s hvi l l e , Te nne s s e e . Dr . Ha r pe r
p e r f o r me d a s e c ond s ur ge r y i n Fe br ua r y 1990 t o c omba t a n
i n f e c t i on t ha t ha d i nva de d t he bone of M . Sc ot t ’ s gr e a t r i ght
s
t oe . Dr . Ha r pe r a l s o l a t e r pe r f or me d a t hi r d s ur ge r y t o c l os e
t h e wo u nd on M . Sc ot t ’ s gr e a t r i ght t oe t ha t ha d be e n ope n s i n c e
s
t h e M y 1989 s ur ge r y pe r f or me d by Dr . Ca l i a .
a
3
The r e qui r e me nt s ne c e s s a r y f or a pl a i nt i f f t o e s t a bl i s h
a pr i ma f a c i e c a s e o f me di c a l ma l pr a c t i c e i s s e t out i n T. C. A.
2 9 - 2 6 - 1 1 5. W quot e t he pe r t i ne nt pr ovi s i ons a s f ol l ows :
e
29- 26- 115. Cl ai m ant ' s bur de n i n m pr ac t i c e al
a c t i on - - Expe r t t es t i mony - - Pr e s um i on of ne gl i ge nc e pt
- - Jur y i ns t r uc t i ons . - - ( a ) I n a ma l pr a c t i c e a c t i on, t h e c l a i ma nt s ha l l ha ve t he bur de n of pr ovi ng by e v i de nc e a s pr ovi de d by s ubs e c t i on ( b) :
( 1) The r e c ogni z e d s t a nda r d of a c c e pt a bl e p r of e s s i ona l pr a c t i c e i n t he pr of e s s i on a nd t he s p e c i a l t y t he r e of , i f a ny, t ha t t he de f e nda nt pr a c t i c e s i n t he c ommuni t y i n whi c h he pr a c t i c e s or i n a s i mi l a r c o mmuni t y a t t he t i me t he a l l e ge d i nj ur y or wr ongf ul a c t i on o c c ur r e d;
( 2) Tha t t he de f e nda nt a c t e d wi t h l e s s t ha n or f a i l e d t o a c t wi t h o r di na r y a nd r e a s ona bl e c a r e i n a c c or da nc e wi t h s uc h s t a nda r d; a nd
( 3) As a pr oxi ma t e r e s ul t of t he de f e nda nt ’ s n e gl i ge nt a c t or o mi s s i on, t h e pl a i nt i f f s uf f e r e d i n j ur i e s whi c h woul d not ot he r wi s e ha ve oc c ur r e d.
To s a t i s f y t he s t a t ut or y r e qui r e me nt s , M . Sc ot t ha d
s
Dr . I v a n Coope r , a podi a t r i s t s ur ge on f r om Ea s t Te nne s s e e ,
t es t i f y at t r i al . Dr . Coope r t e s t i f i e d t ha t Dr . Ca l i a br e a c he d
t h e s t a nda r d of c a r e f or podi a t r i s t s . Fi r s t , Dr . Coope r
t e s t i f i e d t ha t he br e a c he d t he s t a nda r d of c a r e by pe r f or mi ng t o o
ma n y s u r gi c a l pr oc e dur e s d ur i ng one ope r a t i on. Se c ond, Dr .
Co o p e r t e s t i f i e d t ha t he br e a c he d t he s t a nda r d of c a r e by not
t a k i n g a c ul t ur e t o de t e r mi ne i f a n i nf e c t i on wa s pr e s e nt i n t h e
o p e n wo u nd. Fi na l l y, Dr . Coope r t e s t i f i e d t ha t he br e a c he d t h e
s t a n d a r d of c a r e by not pe r f or mi ng a s e c ond s ur ge r y t o c ove r a n
e x p o s e d wound. Howe ve r , Dr . Coope r t e s t i f i e d t ha t he ha d onl y
s e e n M . Sc ot t on t wo oc c a s i ons a nd wa s not i n a pos i t i on t o s
4
t e s t i f y a bout a ny da ma ge s t ha t ma y ha ve r e s ul t e d f r om Dr . Ca l i a ' s
n e g l i g e nc e .
The pa r t i e s do not di s put e t ha t Dr . Coope r ’ s t e s t i mo n y
s a t i s f i e d t he s t a nda r d of c a r e r e qui r e me nt s s e t out i n T. C. A. 2 9 -
2 6 - 1 1 5 ( 1 ) a nd ( 2) , but t ha t hi s t e s t i mony di d not s a t i s f y t he
c a u s a t i on r e qui r e me nt s e t out i n T. C. A. 29- 26- 115( 3) . M . Sc ot t
s
a t t e mp t e d t o s a t i s f y t hi s s t a t ut or y r e qui r e me nt wi t h t he
t e s t i mo ny o f Dr . M r i on Ha r pe r who, a s s t a t e d e a r l i e r , be c a me M .
a s
Sc o t t ’ s t r e a t i ng p hys i c i a n. Dr . Ca l i a ma de a mot i on i n l i mi ne t o
e xc l u d e a ny r e f e r e nc e t o c a us a t i on a s i t r e l a t e s t o a ny a l l e ge d
d e vi a t i on o n t he pa r t o f Dr . Ca l i a be c a us e Dr . Ha r pe r r e a di l y
a d mi t t e d t ha t he l a c ke d a ny knowl e dge c onc e r ni ng t he r e c ogni z e d
s t a nd a r d o f a c c e pt a bl e , p r of e s s i ona l pr a c t i c e i n t he pr of e s s i o n
a n d s p e c i a l t y of podi a t r y. The Tr i a l Cour t gr a nt e d Dr . Ca l i a ’ s
mo t i o n i n l i mi ne a s t o s ome of Dr . Ha r pe r ' s t e s t i mony be c a us e h e
wa s u n f a mi l i a r wi t h t he s t a nda r d of c a r e . M . Sc ot t i ns i s t s t ha t
s
s h e c o u l d ha ve s a t i s f i e d t he c a us a t i on r e qui r e me nt t hr ough t he
d e p o s i t i on t e s t i mony of Dr . Ha r pe r .
Cont r a r y t o t he hol di ng of t he Tr i a l Cour t , a pl a i nt i f f
i n a me di c a l ma l pr a c t i c e s ui t ma y s a t i s f y t he c a us a t i on
r e q u i r e me nt f ound i n T. C. A. 29- 26- 115( 3) wi t h t e s t i mony f r om a
d o c t o r unf a mi l i a r wi t h t he s t a nda r d of c a r e . For e xa mpl e , a
d o c t o r , who i s unf a mi l i a r wi t h t he s t a nda r d of c a r e , ma y
n e ve r t h e l e s s t e s t i f y t ha t a s pe c i f i c a c t of t he de f e nda nt , s uc h
a s p r e s c r i bi ng a c e r t a i n dr ug t o whi c h t he pl a i nt i f f i s a l l e r g i c ,
5
c a u s e d t he pl a i nt i f f t o s uf f e r i nj ur i e s whi c h woul d not ha ve
o c c u r r e d i f t he pl a i nt i f f ha d not t a ke n t he dr ug. Thus , we mus t
r e v i e w t he de pos i t i on t e s t i mony of Dr . Ha r pe r t o de t e r mi ne
wh e t h e r t he Tr i a l Cour t pr ope r l y gr a nt e d a di r e c t e d ve r di c t f o r
Dr . Ca l i a .
Upon c ons i de r a t i on of a mot i on f or di r e c t e d ve r di c t ,
t he t r i a l c our t mus t l ook t o a l l t he e vi de nc e , t a ke t he mos t
l e g i t i ma t e vi e w of i t i n f a vor of t he oppone nt of t he mot i on, a n d
a l l o w a l l r e a s ona bl e i nf e r e nc e s f r om i t i n hi s f a vor a nd di s c a r d
a l l c o u nt e r va i l i ng e vi de nc e . A di r e c t e d ve r di c t i s onl y pr ope r
wh e n t h e r e i s no c ont r ove r s y a s t o a ny ma t e r i a l f a c t t ha t woul d
b e de t e r mi na t i ve of t he c a s e . Se e Cr os s l i n v. Al s up, 594 S. W 2 d .
3 7 9 ( Te nn. 1980) . W r e t he pr of f e r e d e vi de nc e l e a ve s t o he
s p e c u l a t i on a d e t e r mi na t i ve f a c t i n a l a ws ui t , t h e pa r t y ha vi ng
t h e b u r de n of pr ovi ng t he f a c t mus t s uf f e r t he l os s . Le ona r d v .
Gi l r e a t h, 625 S. W 2d 722 ( Te nn. App. 1981) , c i t i ng Re s e r ve Li f e .
I n s u r a n c e Co. v. W t t e mor e , 59 Te nn. App. 495, 442 S. W 2d 266 hi .
( 1969) . A c a s e doe s not h a ve t o be s ubmi t t e d t o a j ur y whe r e t h e
p l a i n t i f f ’ s ve r di c t woul d be ba s e d on s pe c ul a t i on, c onj e c t ur e , o r
a me r e gl i mme r o f e vi de nc e . Sa de k v. Na s hvi l l e Re c yc l i ng Co . ,
7 5 1 S. W 2d 428 ( Te nn. App. 1988) .
.
Dur i ng di r e c t e xa mi na t i on of Dr . Ha r pe r i n hi s
d e p o s i t i on t he f ol l owi ng t e s t i mony wa s e l i c i t e d:
Q Doc t or , ha ve you f or me d a n opi ni on ba s e d upon a r e a s ona bl e de gr e e of me di c a l c e r t a i nt y a s t o whe t he r or
6
n o t t ha t di a gnos i s of c hr oni c os t e omye l i t i s [ i nf e c t i on o f t he bone ] wa s c a us a l l y r e l a t e d t o t he s ur ge r y p e r f or me d by Dr . Ca l i a on 5- 17- 89?
. . . .
A Ye s , I b e l i e ve i t wa s r e l a t e d.
. . . .
Q Oka y. W t a bout t he gr e a t r i ght t oe , Doc t or ?
ha
W a t di d i t l ook l i ke pr i or t o s ur ge r y - - c or r e c t i ve h s u r ge r y by you?
A I t a s s ume d a p os i t i on of e xt e ns i on, i . e . , i t wa s t e ndi ng t o c oc k up a nd a l s o de vi a t e t owa r d t he mi d l i ne , t owa r d t he mi d por t i on of t he body.
Q I s t ha t nor ma l ?
A No.
Q W t wa s t he c a us e of t ha t , p l e a s e , Doc t or , wi t hi n ha
a r e a s ona bl e de gr e e of me di c a l c e r t a i nt y?
A The pr i or s ur ge r y.
. . . .
Q Oka y. On 2- 5- 90, Doc t or , t he f i r s t t i me you p e r f or me d a de br i de me nt or de br i de me nt on he r , we r e t h e r e a ny ki nd of pa t hol ogy r e por t s a t t ha t t i me ?
A Ye s .
Q W t d i d t he y r e ve a l , pl e a s e ?
ha
A The s ur gi c a l pa t hol ogy not e da t e d 2- 5- 90, or r e f e r r i ng t o t he s pe c i me n obt a i ne d on 2- 5- 90, i s r e a d o u t a s f i na l di a gnos i s be i ng bone de br i de me nt of r i ght g r e a t t oe , c ol on, f oc a l a c ut e i nf l a mma t i on c ompa t i bl e wi t h o s t e omye l i t i s , g r a m- pos i t i ve c oc c i pr e s e nt .
Q Oka y. Doc t or , a ga i n, ba s e d upon a r e a s ona bl e d e gr e e of me di c a l c e r t a i nt y, ha ve you f or me d a n opi ni on a s t o t he e t i ol ogy or c a us e of t ha t pa t hol ogy r e por t ?
. . . .
A Ye s .
Q Oka y. And wha t i s t ha t , p l e a s e , Doc t or ?
7
A Pr i or s ur ge r y.
I n l i ght of t he f or e goi ng we c onc l ude t he r e wa s
s u f f i c i e nt e vi de nc e pr e s e nt e d a s t o c a us a t i on t o pr e c l ude t he
Tr i a l Cour t di r e c t i ng a v e r di c t .
M e ove r , a l t hou gh c ouns e l f or M . Sc ot t s e e me d t o or s
c o n c e d e Dr . Coope r ' s t e s t i mony di d not me e t t he c a us a t i on
r e q u i r e me nt , we b e l i e ve i t di d:
Q Al l r i ght . Le t ' s go on, Doc t or . You ke e p t a l ki ng a bout i nf e c t i on, a nd t he f a i l ur e t o r e c ogni z e t ha t i nf e c t i on wa s n e gl i ge nc e , t h a t you' r e f a mi l i a r wi t h t he s t a nda r d of c a r e pr a c t i c e d i n podi a t r i c s i n Kn ox Count y, a nd t ha t t he de vi a t i on c a us e d s ome da ma ge . I don' t s e e a nywhe r e i n t he r e Doc t or , t ha t you c r i t i c i z e d Dr . Ca l i a a bout t he t ype , o r t he numbe r , o f p r oc e dur e s he pe r f or me d on M . Sc ot t ; ha ve I r e a d i t
s
c or r e c t l y?
A I g ue s s , i t - - t he bot t om l i ne i s he di d t oo mu c h i n one a r e a .
Q And I don' t s e e t ha t a nywhe r e i n t hi s a f f i da vi t .
A Ye a h. But t ha t ' s wha t ha ppe ne d. I me a n, I k n ow you' r e t a l ki ng f r om t he wor ds a nd t hi ngs now - - j u s t - - t ha t ' s wha t we nt wr ong. I f he ha dn' t done s o mu c h i n t ha t one a r e a , t he n t he i nf e c t i on woul dn' t ha ve h a d a c ha nc e t o s t a r t be c a us e t he he a l i ng woul dn' t ha ve b e e n ha mpe r e d s o muc h by a l l t he l i t t l e bl ood ve s s e l s a n d a l l t he t hi ngs t ha t we r e vi ol a t e d.
. . . .
Q You t ol d me i n one of your de pos i t i ons t ha t i t woul d ha ve be e n be t t e r t o br e a k t he s e s ur ge r i e s up - - i f you' r e goi ng t o do t he s e pr oc e dur e s , Dr . Ca l i a , y o u s houl d br e a k t he m up i nt o t wo or t hr e e or f our
1 A p o r t i o n o f Dr . Ha r p e r ' s a n s we r wa s e x c l u d e d . Hi s f u l l a n s we r wa s " Th a t t h a t i n f e c t i o n wa s a c o mp l i c a t i o n o f h e r p r i o r s u r g e r y . "
8
d i f f e r e nt p r oc e dur e s - - di f f e r e nt ope r a t i ons , di f f e r e nt t i me s . Do y ou r e c a l l t ha t t e s t i mony?
A Ye s , s i r .
Q And ha ve you be e n t ol d t ha t Dr . Ake r ma n 2 i s o f t he opi ni on t ha t t ha t woul d not be a good i de a b e c a us e you woul d e xpos e t he pa t i e nt t o mul t i pl e o p por t uni t i e s f or i nf e c t i on - - t ha t t he onl y r e a s on t o d o mul t i pl e s ur ge r i e s woul d be t o c r e a t e a bi gge r f e e ? Ha ve you be e n a dvi s e d of t ha t , Dr . Coope r ?
A W l l , l e t me a ddr e s s t ha t a s e c ond.
e
Q Doc t or , c a n you a ns we r " ye s " or " no" ? The n f e e l f r e e t o e xpl a i n.
A Ye s , I a m a wa r e t ha t s he ha s s a i d t ha t , but s h e i s wr ong. The pr oof ' s i n t he puddi ng. For you t o r e a l l y unde r s t a nd wha t I me a n by t ha t i s t ha t - - t o h a ve a n i nf e c t i on i n a young i ndi vi dua l a f t e r f oot s u r ge r y i s r a r e . I t i s unus ua l , e s pe c i a l l y of gr e a t ma gni t ude be c a us e , i f i t we r e a nyt hi ng ot he r t ha n u n us ua l , t he n who wa nt s t o s t a r t wi t h s ome t hi ng t ha t wo ul d e nd wi t h t hi s muc h of a ha s s l e ? I t ' s t he r i s k - - I t hi nk ye s t e r da y I t a l ke d a bout t he s t a nda r d of c a r e . Th e r i s k of doi ng a l l of wha t wa s done , i n t he a r e a t h a t i t wa s done , j us t wa s t oo muc h f or t hi s f oot t o h e a l f r om. And i t put t oo muc h bur de n on i t , a nd i t ' s n o t be yond a ny ki nd of r e a s ona bl e t hi nki ng t o u n de r s t a nd how a l l t hi s i nj ur y - - s ur gi c a l t r a uma t o t h i s a r e a - - e ve n i f i t we r e done me t i c ul ous l y. I me a n, j us t - - t he r e we r e t oo ma ny bl ood ve s s e l s v i ol a t e d. The r e wa s j us t t oo muc h done i n a s ma l l ar ea. So I ' m not r e a l l y oppos e d t o mul t i pl e p r oc e dur e s . I t ' s whe r e t he y' r e done a nd t he mu l t i pl i c i t y i n a n a r e a .
Q Oka y. Doc t or , ha ve you f or me d a n opi ni on ba s e d u p on a r e a s ona bl e de gr e e of me di c a l c e r t a i nt y a s t o wh e t he r o r n ot t hi s pe r ma ne nt pa r t i a l di s a bi l i t y r a t i ng wh i c h y ou h a ve a s s e s s e d he r i s c a s ua l l y r e l a t e d or c o nne c t e d t o t he s ur ge r y t ha t Dr . Ca l i a pe r f or me d on h e r on 5- 17- 89?
A Ye s .
2 Dr . Ak e r ma n i s a l s o a p o d i a t r i s t .
9
M . Sc ot t a l s o c ompl a i ns t ha t t he Cour t s ua s pont e
s
d i r e c t e d a ve r di c t a ga i ns t he r i n t hi s c a s e . The l a w s e e ms c l e a r
t h a t a t r i a l j udge ha s t he r i ght , a l t hough he s houl d us e i t
s p a r i n g l y, t o di r e c t a ve r di c t s ua s pont e . Bur n v. Te nn- Va l
Re a l t y , I nc . , a n unr e por t e d opi ni on of t hi s Cour t , f i l e d i n
Kn o x v i l l e on J a nua r y 28, 1986. I n t he c a s e a t ba r , a f t e r t he
Tr i a l Cour t ha s i ndi c a t e d t o c ouns e l hi s i nt e nt t o gr a nt a
d i r e c t e d v e r di c t , c ouns e l f or Dr . Ca l i a be l a t e dl y, a nd a ppa r e nt l y
a s a n a f t e r t hought , s t a t e d " a nd I gue s s f or t he r e c or d, I do
mo v e f o r di r e c t e d ve r di c t , j us t s o i t ' s i n t he r e c or d. "
I n vi e w of t he f or e goi ng we be l i e ve t he Tr i a l J udge d i d
i n f a c t d i r e c t a ve r di c t s ua s pont e but , unde r Bur n , we a r e
o b l i g a t e d t o s us t a i n hi s a c t i on unl e s s di r e c t i ng of a ve r di c t
u n d e r t he pr oof a dduc e d wa s i mpr ope r .
Ha vi ng c onc l ude d t ha t t he Tr i a l Cour t wa s i n e r r or i n
d i r e c t i ng a ve r di c t , we va c a t e t he j udgme nt e nt e r e d t he r e on. Th e
c a u s e i s r e ma nde d f or f ur t he r pr oc e e di ngs not i nc ons i s t e nt wi t h
t h i s o p i ni on. Cos t s of a ppe a l a r e a dj udge d a ga i ns t Dr . Ca l i a .
_______________________________
Hous t on M Godda r d, P. J .
.
10
CONCUR:
_ _ _ _ _ _ _ _________________________ Do n T. M M r a y, J .
c ur
_ _ _ _ _ _ _ _________________________ Ch a r l e s D. Sus a no, J r . , J .