Seavers v Oak Ridge Methodist Med. Ctr.

• Citation: 9 S.W.3d 86
• Decision Date: 29 November 1999
• Docket Number: 97-00044
• Court: Supreme Court of Tennessee
• Parties: BERDELLA VAUGHN SEAVERS & EDDIE THOMAS SEAVERS, Plaintiffs/Appellants, v. METHODIST MEDICAL CENTER OF OAK RIDGE, Defendant/Appellee. NO. E1997-00044-IN THE SUPREME COURT OF TENNESSEE AT KNOXVILLE FILED:

BERDELLA VAUGHN SEAVERS & EDDIE THOMAS SEAVERS, Plaintiffs/Appellants v METHODIST MEDICAL CENTER OF OAK RIDGE, Defendant/Appellee

NO. E1997-00044-SC-R11-CV

IN THE SUPREME COURT OF TENNESSEE AT KNOXVILLE

FILED: November 29, 1999

ANDERSON CIRCUIT

HON. JAMES B. SCOTT, JR., JUDGE

For the Appellee:

Robert W. Knolton, Oak Ridge, Tennessee

AMICUS CURIAE

R. Hunter Cagle, Tennessee Defense Lawyers Association

For the Appellants:

Elizabeth Ann Rowland, Knoxville, Tennessee

Janet Edwards, Knoxville, Tennessee

AMICUS CURIAE

R. Sadler Bailey, Tennessee Trial Lawyers Association

C. Philip M. Campbell, Tennessee Trial Lawyers Association

FOR PUBLICATION

REVERSED AND REMANDED

BARKER, J.

OPINION

We granted this appeal to address whether the doctrine of res ipsa loquitur, as codified at Tennessee Code Annotated section 29-26-115(c), is applicable in medical malpractice cases where the plaintiffs must rely upon expert testimony to prove the elements of causation, standard of care, and that the injury does not ordinarily occur in the absence of negligence. Upon review of Tennessee's medical malpractice law and the authority in other jurisdictions, we conclude that the doctrine of res ipsa loquitur may be applied under those circumstances. The judgments of the lower courts are reversed, and the case is remanded to the trial court for further proceedings in accordance with this opinion.

BACKGROUND

The appellants, Berdella Vaughn Seavers and Eddie Thomas Seavers,(FN1)appeal from the intermediate appellate court's decision affirming the entry of summary judgment in favor of the appellee, Methodist Medical Center of Oak Ridge ("medical center"). The basis of appellant's suit is an injury she received to the ulnar nerve in her right arm while she was a patient at the medical center.(FN2) For the purposes of summary judgment, the parties stipulated to the essential facts in this case.

The appellant was admitted into the medical center on March 1, 1993, after she was diagnosed with bilateral viral pneumonia. At that time, she was able to use her right arm and hand normally and there were no signs of injury to her right ulnar nerve. Three days later, the appellant was transferred to the medical center's intensive care unit (ICU) for treatment of the pneumonia. Treatment included intubation, heavy sedation, intravenous injections, and placement on a respirator. The nurses' notes reflect that the appellant had full use of her left and right extremities at that time, and again, there was no indication that she had any problems or dysfunctions with her right ulnar nerve.

The appellant stayed in the medical center's ICU for approximately one month, during which time, she was heavily sedated and unable to care for herself in any way. In addition, she was unable to talk during most of her stay in the ICU due to an endotracheal tube positioned through her mouth and into her trachea. The ICU nursing staff monitored the appellant and was responsible for turning, positioning, and restraining her body in the hospital bed.

While in the ICU, the nursing staff noted for the first time that the grip in appellant's right hand was weaker than in her left hand. Both of her hands had been placed in wrist restraints, fastened to the hospital bed rails, to prevent her from pulling or removing the endotracheal tube and the IV. When the endotracheal tube was removed and the appellant could talk, she complained that her right arm was numb and that she had difficulty using her right hand. She was taken out of the ICU on March 31, 1993, and was moved into a private room at the medical center for further recovery. Dr. James Lynch, a neurologist at the medical center, administered an electromyelogram (EMG) on the appellant approximately one week later. The examination revealed that she had suffered severe damage to her right ulnar nerve.(FN3)

Based upon the nerve injury, the appellant and her husband filed suit against the medical center for malpractice. The appellant alleged that the medical center's nurses negligently restrained or positioned her arm while she was under their care, resulting in the damage to her right ulnar nerve. She later amended her complaint to include the theory of res ipsa loquitur. Tenn. Code Ann. 29-26-115(c) (1980).

The medical center filed a motion for summary judgment supported by the affidavits of Dr. Bennett Blumenkopf, a neurosurgeon, and Elizabeth Lewis, a registered nurse who works in general care and intensive care units. Both experts opined that the nerve damage in appellant's right arm was "of unknown etiology," and that the injury could have developed during her stay in the ICU without any deviation from standards of professional care. In addition, they concluded that the medical center staff had not deviated from the recognized standard of care in treating the appellant, including the manner in which they restrained her arms.

The appellant opposed the medical center's motion for summary judgment arguing that there were genuine issues of material fact. The appellant's response was supported by the deposition of Dr. Stephen Natelson, a neurosurgeon, and the affidavits of both Dr. Natelson and Sharon Woodworth, a registered nurse who works in the ICU at St. Mary's Medical Center in Knoxville. Dr. Natelson had been the appellant's neurologist since 1978, and he treated her right arm after she left the medical center.(FN4) Dr. Natelson testified in his deposition that the appellant's injury occurred as a result of prolonged pressure on the ulnar nerve in her right elbow. Although he could not offer conclusive proof of causation, he stated that the nerve injury could have occurred if a member of the ICU nursing staff failed to pad appellant's elbow or failed to prevent her arm from becoming pressed against a hard object such as a bed rail.(FN5)

Both Dr. Natelson and Ms. Woodworth opined that the appellant was under the exclusive control and care of the medical center's nursing staff when the nerve injury occurred. The ICU care included not only direct medical treatment for the appellant's pneumonia, but also the positioning and turning of appellant's body while she was sedated and confined to the hospital bed. Dr. Natelson and Ms. Woodworth stated that when treating ICU patients who are unconscious or under heavy sedation or restraint, the standard of professional care requires the protection of the patients' extremities so that injuries to the ulnar nerves do not occur. Based upon their independent review of appellant's medical records and the EMG results, they opined that the injury was the type which would not have occurred if the nursing staff had upheld the standard of care.

In reviewing the motion for summary judgment, the trial court determined that expert testimony was necessary to establish both the applicable standard of care and whether negligence could be reasonably inferred from the circumstances surrounding the appellant's injury. The trial court, therefore, concluded that the theory of res ipsa loquitur was unavailable and that the appellant's claim was otherwise insufficient as a matter of law. Finding no genuine issues of material fact, the trial court granted the medical center's motion for summary judgment.

A majority of the Court of Appeals affirmed the trial court's order granting summary judgment for the medical center. Relying upon prior decisions from both this Court and the Court of Appeals, the majority of the intermediate court held that res ipsa loquitur did not apply because the appellant's injury was not within the common knowledge of lay persons. See Poor Sisters of St. Francis v. Long, 190 Tenn. 434, 230 S.W.2d 659, 662 (1950); German v. Nichopoulos, 577 S.W.2d 197, 202-03 (Tenn. Ct. App. 1978). The need for expert testimony, according to the majority, was demonstrated by the conflicting evidence on the questions of negligence, causation, and deviations from the standards of professional care.

Senior Judge William H. Williams wrote separately in a concurring opinion to emphasize that res ipsa loquitur should never apply in medical malpractice cases where, as here, expert testimony is needed to establish both the cause of the injury and that there was a deviation from the applicable standard of care. Judge Williams opined that experts were needed in appellant's case because the causal link between the nerve injury and any negligent act by the medical center's nursing staff was not within the common knowledge of lay persons.(FN6)

Judge Crawford also wrote separately on the question of res ipsa loquitur. In a brief dissent, he agreed with the limited application of res ipsa loquitur in medical malpractice cases, but stated that the doctrine should apply in appellant's case because the nerve injury was within the common knowledge and understanding of lay persons.

The appellant requests this Court to reverse the Court of Appeals and to remand the case for a trial on the question of negligence. She contends that the doctrine of res ipsa loquitur, as provided in Tennessee Code Annotated section 29-26-115(c), should be extended and made available in medical malpractice cases where expert testimony is necessary to prove the elements of causation and that the injury does not ordinarily occur in the absence of negligence. With the application of res ipsa loquitur, the appellant argues that she has raised a genuine issue of material fact for trial.

STANDARD OF REVIEW

The standards governing an appellate court's review of a motion for summary judgment are well settled. Summary judgment is appropriate only when the moving party demonstrates that there are no genuine issues of material fact and that he or she is entitled to judgment as a matter of law. Tenn. R. Civ. P. 56.03; Byrd v. Hall, 847 S.W.2d 208, 210 (Tenn. 1993). We review the summary judgment motion as a question of law in which our inquiry is de novo without a presumption of correctness. Finister v. Humboldt General...