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George v. Alexander
931 S.W.2d 517
Tenn.
1996
Check Treatment

*1 517 rulеs, v. procedural Maisonet under the diction the termination of benefits Services, judicial N.J. petition Human 140 program. Department In her for AFDC of (1995); Develop review, requested attorney 214, fees Human she under A.2d 1209 657 Erie, Supreme Hearing Bd. Zoning 1988. The Massachusetts Section Inc. v. ment of of 675, plaintiff was to attor- Court held that entitled Township, 143 Pa.Cmwlth. Millcreek ney though (1991). court rested fees even lower 600 658 A.2d law, not but “en- its decision on federal persuades in us Nothing those cases tirely law Commonwealth.” allowing plain- conclusion retreat from our Welfare, Johnson v. Commissioner Public of attorney fees under Section 1988 tiff to seek 643 at 445. The court noted that N.E.2d judicial in review when petition an to vindi- Section 1988 “creates incentive wrongful from deni- petition relief seeks federally protected rights.... cate The fee law, al, rights, privi- state of under color of necessary equally useful incentive is by leges, the federal or immunities secured question whether the is secured we laws. For these reasons constitution and alone, law State law Federal well.” Chancery judgment of the Court affirm the Id. 445-46. also v. Commis- See Gaulin Appeals granting plaintiff and the Court of 1001, Welfare, 515 sioner Public 401 Mass. of 1988. attorney fees under Section (1987); Department 583 Stratos v. N.E.2d of Welfare, 439 Public 387 Mass. N.E.2d BIRCH, C.J., DROWOTA,ANDERSON (1982). 778 REID, JJ., concur. Likewise, and also context enforc- rights ing appeals from federal termi- benefits, Supreme AFDC

nation of Court joinder Nebraska has allowed the attorney claim Section 1988 fees with judicial review an administrative action. Department In Maldonado v. Nebraska Welfare,

Public 223 Neb. 391 N.W.2d (1986), ap- 105 state contended Faye GEORGE, Plaintiff- Ethel peal agency an from state was not action Appellant, authorizing under the award of Section 1983 attorney pursuant to 1988. fees Section Supreme disagreed up- Nebraska Court Phillip Wayne ALEXANDER, Clyde despite held fact the fee award Jones, M.D., R. Defendants- petition judicial review did not cite Sec- Appellees. tion 1983.3 Tennessee, Supreme Court We are aware that courts have ruled con at Nashville. trary we take and taken contrary in these cases. In some of the 7,Oct. 1996. rulings, plaintiffs sought under remedies Sec tion which to those 1983 were inconsistent review, Partners, judicial

available on Tatten County L.P. v. New Castle Bd. Assessment Review, (Del.Super.Ct.1993); 642 1251 A2d others, plaintiffs sought remedies state, Hardges v. De available Services, partment Mich.App. 201 Social (1993); N.W.2d 532 still others juris- interpretations of court turned on state attorney fees award for under Section 3. case is consistent In this the Maldonado party successful in enforc- Bloomingdale’s Ltd. a case in which the our decision in Mail Huddleston, 1992), (Term. specifi- rights party did even if the federal § cally plead 42 U.S.C. 1983. we held that a is entitled recover

OPINION

DROWOTA, Justice. ease, malpractice

In this plain- medical tiff, Faye George, Ethel appeals from the Appeals’ judgment Court of affirmance of a jury based on a verdict in favor dants, Alexander, Clyde Wayne M.D. and Jones, Phillip presents R. M.D. This ease the following issue for our determination: whether a defendant in a case must, pursuant to Rule 8.03 of the Tennessee Procedure, plead comparative Rules of Civil fault as an affirmative if the defense defen- dant wishes to introduce evidence that a other than itself injury. We conclude that the defendant is required affirmatively plead comparative situation; fault in such a and because that case, was not done this we reverse the judgment Court of Appeals. FACTS AND PROCEDURAL HISTORY In October 1989 the was admitted Hospital gyne- to West Side Nashville for cological surgery. prepare In order to Jones, surgery, Dr. an anes- thesiologist, ‍‌​​​​​‌​‌‌​‌‌​​‌​​‌​​‌​‌‌‌​‌‌​‌​​​​​​‌‌​​‌​​​‌​‌‍began spinal to administer anes- thesia. As he tried to a needle insert into however, her for purpose, lower back this George allegedly experienced Ms. pain in her right leg pain. Dr. and told Jones of this Dr. attempt- Jones then withdrew the needle and anesthesia; ed twice more administer the George allegedly experienced pain but Ms. Thereafter, right her each leg time. Alexander, Jones called another anesthe- siologist, room to him. into the assist When attempted Dr. Alexander to insert the nee- dle, allegedly experienced George again Ms. pain. eventually The defendants were suc- anesthetizing plaintiff; cessful in she placed position” “lithotomy surgery by nurses under direction of Jr., Daniell, M.D., surgeon. James surgery. Daniell then out carried Weed, Hubbard, Stephen Doughty, R. Ber- Nashville, ry Doughty, Plaintiff-Appel- & Immediately operation, after Ms. lant. George extending experienced pain down her Cantrell, Dean, foot; Parker, right George leg Rose P. A. into her she was unable to flex Lawrence, Dean, Nashville, pain pressure & Cantrell foot and felt when applied It Defеndants-Appellees. leg. to her has since here, thereoretieally possible clear, though it undisputed and it become George’s injuries have been caused damage to different could Ms. suffered Ms. anesthetic, highly unlike- during operation. spinal a re- it was nerve As roots injury, possible ly. is unable flex her sult she With *3 positioning foot, reflex, proper no and Dr. Allen first stated that right right has ankle crucial, body during surgery pain patient’s a is to have and loss of sensation continues leg. patient properly is portions ensuring her that in her foot and condition, primary responsibility a positioned she must wear is the Because of Allen performing operation. a Dr. surgeon uses brace and sometimes crutches wheelchair; moreover, per- improper positioning of her condition is testified that injury” body a manent. could cause “stretch nerves, injury highly a is but that stretch George brought In an October Ms. actually positioned unlikely patient if the is Alexander, action Doctors Jones and correctly. point, to the latter With alleging that their administer- ques- as Dr. Allen follows when testified ing proximately spinal anesthesia caused attorney: by plaintiffs tioned injuries. The defendants answered denying any negligence re- complaint, Doctor, you opinion Q: have an within do serving certainty to assert defens- degree additional a of medical reasonable through they es as became known the discov- positioning George improper that of Ms. ery process. The amended defendants never surgery she the cause of for this had was their answеr to include additional defenses. leg? damage to her her nerve Furthermore, plaintiff propounded inter- plau- be my opinion A: that would rogatories asking if it was cause, yes sible sir. injuries that their had been Q: your opinion a So that would be within by person. caused The defendants certainty? degree of medical reasonable they responded opinion that had no definitive injuries. as to cause of This Yes, A: it would. response also never amended. Q: your you opin- have it is an And —do took the October counsel degree of medical ion within a reasonable Allen, Vaughn M.D., deposition of the neuro- doctor, positioning certainty, improper that surgeon George had Ms. for her who treated occur, normally patient would injuries. Dr. deposition, In the coursе of the positioned if the v/as not occur George that explained Allen Ms. had suffered physi- within standard of care separate Dr. two nerve roots. cians involved? opinion Allen stated in his there also that before, un- I testified A: Yes. As have inju- possible explanations were two underlying was some anatomic less there (1) occurred a result of ries: that as George I reason don’t believe Ms. (2) anesthetic; spinal they had has, accurate statement that would an improper positioning as a result of occurred as well. during possible surgery. As to the first Allen Dr. testified because small, during spinal very needle used Allen as deposition Later testified hitting the likelihood because “lithotomy po- follows when asked about negli- separate nerve roots with needle n sition”: injury have caused gible, the could not Doctor, Q: assuming properly had a someone the anesthetic unless ..., lithotomy position do “conjoined positioned con- nerve rare anatomic root” —a opinion you in a within reasonable whereby two are dition nerves enclosed certainty per- degree single discount- of medical protective sheath. Allen son, in a however, positioned if they properly his possibility, based on ed this have an analysis report lithotomy position, an MRI would myelogram of a Thus, as has? that al- such Ms. scan. Allen concluded (cid:127)profoundly unlikely A: It preceding pleading, party would be to a shall set proper positioning affirmatively plain forth in short one would facts up compara- end with terms relied ... a nеrve constitute (including identity descrip- Q: you opinion So would have an within a alleged tortfeasors) tion ”. ... degree certainty reasonable of medical added.) (Emphasis “comparative fault” if, you opine, this was that — language July was added to the rule in injury, you stretch have an Commission, Advisory which ex- degree within a reasonable of medical cer- plained the amendment as follows: tainty improper position- there ‘Comparative fault’ is substituted for ‘con- ing? tributory negligence’ light McIntyre A: initially Either *4 positioning Balentine, (Tenn.1992). v. 833 52 S.W.2d injury or as the case went stretch in- identify Note must defendant volving push- improper positioning such as alleged describe other who tortfeasors ing against legs or something of that fault, should share or else the defendant nature, my yes. answer would be nоrmally shifting, would be barred from to blame others at trial. added). (Emphasis added.) (Emphasis subsequently The defendants filed a notice plaintiff argues depo- The because deposition intent to offer the of Dr. Allen sition of Allen was offered for the sole plaintiff responded filing at trial. The purpose shifting the blame testimony, contending motion to exclude the away from the onto Dr. Dan- that, pursuant 8.03, P., to Rule Tenn. R. Civ. surgeon primarily responsible iell—the duty plead compara- the defendants had to positioning required 8.03 —Rule they tive fault as an if affirmative defense affirmatively plead the defendants to Dan- person wished to offer evidence support as a iell’s fault defense. As for this injury, had caused the and that defen- argument, also cites the follow- plead. dants failed to so The trial court ing language McIntyre: from motion, plaintiff’s denied the video- [Fjairness require efficiency that de- tape deposition played Dr. Allen’s to upon allegations called answer fendants to Moreover, jury. the defendants’ counsel permitted allege, to as an deposition cap closing to used off his defense, nonparty affirmative that a argument, contending that: “[Radies injury damage or contributed to the gentlemen, proof looked at demonstrates recovery sought. which is cases where conclusively through Dr. Allen the li- raised, such a defense is the trial court thotomy position may very well jury assign shall instruct the to this non- here, way was caused party the percentage negli- of the total surgery position. you very Thank much.” gence responsible for which he is ... jury The verdict in returned a favor McIntyre, 833 S.W.2d at 58. defendants; judg- trial and the court entered response, argue the defendants ment that verdict. triggered only when Rule 8.03 Ap- appealed to the Court dant to show that another seeks peals, judg- the trial affirmed court’s legally injuries. plaintiffs granted 11 ment. We Rule negligence, legal type Because fault at im- application to address this issue of first here, requires proof of the issue elements of 8.03, pression concerning Rule Tenn. R. Civ. fact, duty, duty, proxi- breach causation P. injury, see mate causation and McClenahan (Tenn.1991), Cooley, 774 S.W.2d ANALYSIS the defendants contend that Rule 8.03 does they attempted apply prove 8.03 of the Tennessee Rules of Civil not unless Procedure, Defenses,” that Dr. Daniell’s conduсt satisfied all entitled “Affirmative these pertinent part plead- then provides that: The defendants contend that “[i]n elements. its intent to do so. testimony simply plaintiff notice of they Dr. Allen’s introduced the Therefore, that Dr. Daniell’s to show actions of Rule would be purpose Be- factual cause ‍‌​​​​​‌​‌‌​‌‌​​‌​​‌​​‌​‌‌‌​‌‌​‌​​​​​​‌‌​​‌​​​‌​‌‍of the harm. degree if the to a substantial undermined assert, overly argument were technical defendants’ negligence, only pertains to one element of prevail. fact, not cover that of causation does accepts concurring proximate causa- the additional element of —which is re- proximate causation contention that tion, they attempt prove did not Thus, legal “blame-shifting” negligent quired in a to establish Daniell sense. —dis- conclude, did into doing, Rule 8.03 not come first In so it putes this conclusion. play. language Ridings from following cites Co., Ralph M. Parsons. While the defendants’ (Tenn.1996): “[fjailure of the defendant blush, plausible assumption seems at first its identify potential tortfeasors necessary proof of of fault such preclude the attribution to another is unfounded. “shift blame” persons would result actually just poli proximate cause is Since damages except those being liable for all judiciary liability cy “deny decision harm,”1 plaintiff.” to the fault of the attributable for otherwise actionable causes of *5 594, reasons Kilpatrick Bryant, 598 The concurrence then that because see Carnation, (Tenn.1993); Jr., King, Joseph H. for all not defendant is liable Injury in Valuation and Chance Personal plead if it plaintiff does not Involving Preexisting and Torts Conditions 8.03, incen- under Rule it will have sufficient Consequences, Future 90 Yale L.J. potential identify to other tortfeasors tive (1981), position n. 7 the defendants’ accept argument. if we the defendants’ even ignores “blame-shifting” that in a fact actually negligence with the context has to do readily acknowledge fact- We that the element of causation in fact. the defen Once may formally fault to finder not attribute per dant introduces evidence that another persons if the does other at trial defendant element, conduct son’s fits this it has effec 8.03; thus, identify under Rule not them tively person. to shifted the blame plead to does have some incentive defendant Therefore, position if the defendants’ were to This, however, not does under the rule. аccepted, any trans wishing be defendant change the fact that if the advocated person fer blame another at trial could the concurrence were defendants and always trying maintain that it is not to show defendant, by carefully lim prevail, then the legal the other’s conduct satisfies the person’s role in iting its of another evidence merely negligence, definition of but that it is causing the to the causation element trying person’s to establish that the other fact, effectively shift completely could and actually injury. In the conduct caused the affording person the blame to that without however, situation, latter has defendant plaintiff any of its notice whatsoever fully accomplished in what Rule 8.03 justified A would still intent. be prevent: effectively tended to it has shifted plaintiff foisting person giving totally surprising the blame without legal policy, turn so 1. Prosser and Keeton define the troublesome tance conclusions concept essentially causation depend as follows: whether the on responsibility policy is that the con- of the law will extend the Once it established defendant’s consequences duct has in fact been one of the causes of conduct plaintiff's injury, question there remains the legal on the in fact occurred ... limitation legally held whether the defendant should be poli- scope liability with [thus] associated responsible causation, injury. Unlike inadequately cy fact ex- more or less our —with hopelessly which it is often demands, justice pressed what or of ideas of confused, problem primarily a law. It this is administratively possible and conve- what is depend whether is sometimes said on nient. significant important so conduct has been Torts, (5th § ed. Prosser Keeton legally a cause that the defendant should be added.) 1984) (Emphasis significance impor- responsible. But both blame persons, on other analysis result articulation pleadings, the purpose facts, violates legal Rule 8.03. issues. As an exam- ple, the statement the issue decided argument One final advanced defen- majority’s introductory paragraph the—if They argue dants remains to be addressed. defendant wishes to introduce evidence that purpose that the of Rule 8.03 was not violat- than itself plain- caused the ed case because injury encompasses tiffs various situations — clearly aware possibility thаt Dr. Dan- by different rules be controlled and cannot iell caused the The defendants decided as stated. Since the rules of sub- point plaintiffs actually out that the counsel law, pleading stantive and evidence are cor- Allen; quoted testimony elicited from Dr. related, my I can best state views an inte- they also contend that counsel grated opinion commentary rather than in a with Dr. met Daniell well trial before majority’s opinion. on the discuss whether he should included in that, suit. The defendants conclude because INTRODUCTION regarding knew all the facts involvement, opportuni- DanielTs and had the malpractice presents This medical ease toty simply include him in the suit but chose Appeals review the decision of the Court of so, to do compara- their failure to raise evidence of a non- fault as an did affirmative defense inju- party proximately caused the

prejudice plaintiff. plea general ries was admissible under a Court finds denial. This that such evidence accept We decline to this “harmless only when de- admissible the affirmative argument. prophylactic error” Rule 8.03 is a fense of pled. has been rule of strictly ad must be *6 to if it purposes. hered is to achieve It its THE CASE designed appellate to obviate the need courts look into for actual the record plaintiff, Faye George, The Ethel ad- was prejudice each time a hospital defendant introduces mitted to in a Nashville October proof at trial of unpleaded an defense. To surgery performed by 1989 for to be Dr. accеpt Daniell, the argument defendants’ on this a gynecologist. prepara- James point clearly-stated would invite evasion of a surgery, George posi- tion for Ms. the procedure of equita rule that is crucial to the side tioned on her for the administration of compara ble and efficient administration of spinal by anesthesia the defendant Dr. system. Jones, fault Phillip anesthesiologist. R. When Dr. the Jones inserted needle into her low- Because the defendants contravened Rule back, patient reported sharp pain er the by attempting to shift the blame to leg. her After several unsuccessful person affirmatively at trial without attempts complete procedure, the each comparative fault, pleading judgment the of by accоmpanied reports pain, Dr. Jones reversed, lower hereby the courts is and the requested the assistance of another anesthe- proceedings remanded for further con- siologist, Clyde Wayne defendant Dr. the opinion. with sistent this Despite patient’s complaints Alexander. inserted, pain time the each needle was BIRCH, C.J., and and ANDERSON procedure accomplished by the de- WHITE, JJ., concur. fendants. REID, J., separate concurring opinion. Daniell, direction of surgical Under the Dr. placed REID, Justice, nurses on her back with concurring. legs by stirrups, supported agree by I with the result reached lithotomy position, known a modified majority. impor- resolution of the during surgery. where she remained principles comparative tant and rules operation, pleading prеsented plaintiff experi- and evidence After the view, requires, my precise extending pain right leg a more down her and ease enced time, injuries opera- foot, signif- during the she sustained and since that has deposition, icantly permanently impaired. and The tion. In the course of proof explained Ms. had suffered shows that the condition Allen that roots, by damage to roots. injuries separate severe two nerve to two nerve and that caused plausible expla- in his there were plaintiff suit In October filed this “injection injuries: that an nations malpractice medical the defen- injury” had occurred administration dants, plaintiff Alexander. Jones and The defendants; by spinal anesthesia did not sue Daniell. had occurred as the result complaint alleges that The the defendants’ patient by Dr. positioning of the spinal anesthesia was below administration during surgery. Dr. also testi- Daniell Allen applicable and was standard care “extremely unlikely” it fied that was injuries proximate cause of the sustained. injuries by caused were complaint alleges specifically that “the dants, .likely diagnosis” “the most injuries plaintifPs leg and foot injuries caused dur- would be were by caused trauma to nerve roots were surgery by Dr. Daniell. by during the ad- structures trial, a notice Prior to the defendants filed of spinal ministration anesthesia.” The com- depo- into of intent introduce evidence plaint charges injuries further “the plaintiff responded sition of Allen. sustained testimony, by filing a motion to exclude the proximately contending re- defendants were fault” of thе defendants. plead affir- quired fault as an com- The defendants filed answers to the presenting mative defense before evidence plaint They on December 1990. admitted that another caused the they performed de- trial, day first On the of the performance that their nied was below the limine, asking the filed a second motion applicable pro- standard of care exercised prohibit court to exclude practicing in the of an- specialty fessionals any questioning any cause of with esthesiology in Nashville similar commu- plaintiff’s other than the defen- they complied nities and stated that injection spinal dants’ anesthesia. specifical- standard of care. The defendants *7 plaintiff the that: the second motion asserted ly allegatiоn plaintiff’s the denied the injuries procedure per- were the caused grounds plaintiff this motion As formed, they specifically the alle- denied show the Court that Defendants have injuries gation plaintiff’s proxi- an an affirma- raised alternative as mately they caused the manner in which the defense in their to either answers answers, performed procedure. the In their com- original complaint or amended right to assert “reserve[d] any alterna- plaint and have not set forth may they additional affirmative defenses as Rule 26 tive cause in their statement through discovery appear and further inves- interrog- expert testimony or in answer tigation.” atory interrogatories eight of the number many propounded on each defendant plaintiff propounded The to the defendants ago. months interrogatory eliciting on an their plaintiff’s had been whether trial court the motions to exclude The denied defendants, by persons plead- other than the deposition. Dr. Allen’s No additional responded they parties, by any of the and on which defendants was filed opinion of cause or had “no definitive the case to trial November went plaintiff’s complaints.” complaint and the plaintiff’s causes amended defendants’ answers. 1993, approximately one month October defendants, trial, jury went to The found for before case Allen, judgment accordingly. deposition court Vaughan took the of Dr. trial entered admis- neurosurgeon Appeals found that the had treated the The Court who (Tenn. error, tyre Balentine, sion of Dr. Allen’s was not v. 833 S.W.2d 52 1992). аnd affirmed. Note that the defendant must iden tify alleged or describe other tortfeasors ANALYSIS fault, who should share or else the defen though normally Even of action in dant the cause arose ‍‌​​​​​‌​‌‌​‌‌​​‌​​‌​​‌​‌‌‌​‌‌​‌​​​​​​‌‌​​‌​​​‌​‌‍would be barred from shift October, 1989, had not this case been tried ing blame trial. to others at Balentine, McIntyre when the decision in Advisory Tenn. R. Civ. P. 8.03 Commission (Tenn.1992), 833 S.W.2d 52 was released on Comments [1993]. 4,1992. May Consequently, the case became subject fault, principles comparative law, Despite in change significantly id. at altered the sub- plead comparative dants did not fault and procedural rights parties. stantive identify any thus failed to describe or “other time, At that the statute limitations had alleged The Court tortfeasors.” stated against any run on claim other Co., Ridings Ralph Parsons M. person, including Dr. Daniell. “[fjailure (Tenn.1996), McIntyre gave significant the defendants a identify potential the defendant to other tort- available, previously preclude feasors would the attribution of defense, “allege, as an affirmative that a fault persons such and would result nonparty [had] caused contributed to the being liable for all injury,” liability in and thus avoid whole or in except those attributable to the fault of the part. Id. An amendment to Tenn. R. Civ. case, plaintiff.” Consequently, in this 8.03, adopted P. prior also trial of this “shifting defendants were barred from blame case, asserting defined the to others at trial.”1 defense. plaintiff argues that because Al- 8.03, Defenses,” entitled “Affirmative deposition pur- len’s that, was offered sole provides pertinent part pleading “[i]n pose “shifting the blame” for the a preceding pleading, shall set injuries away from affirmatively plain forth in short and onto facts Daniell, compara- deposition terms ... was not relied to constitute admissi- identity tive fault (including descrip- response, ble. defendants contend ” tortfeasors).... alleged tion of deposition other did not Allen’s offer Advisory explained the 1993 “legally Commission to show that Dr. Daniell was amendment as follows: disprove fault” element of the case, fact, plaintiffs prima

“Comparative causation fault” substituted for facie that, therefore, “contributory light negligence” apply. of McIn- Rule 8.03 does not pleading identify po- 1. A defendant's Failure of the defendant to preclude an affirmative defense under Tenn. R. Civ. P. tential tortfeasors would attribu- *8 8.03, triggers plaintiff's opportunity persons limited against tion of fault such and would 20-1-119(a) (1994) § under being Tenn.Code Ann. to result in the defendant liable for all any party alleged make tortfeasor a other damages except those attributable to the fault Co., Ralph Ridings suit. In M. Parsons 914 plaintiff. of the of the Failure to as- 79, (Tenn. 1996), S.W.2d plained the Court 83-84 ex against persons sert such its cause of action interplay between Tenn. R. Civ. P. pursuant alleged by who are the defendant to § Tenn.Code Ann. 20-1-119: Section caused or contribut- 20-1-119 to have injury damage, preclude ed to the or would not 8.03, P., Civ. Rule Tenn. R. insures that the against persons the assessment of fault such rights parties subject of the liabilities to preclude damages but the award of would suit be action. Section resolved in one 20-1- persons. such provides procedure joining addi- present defendants, Since case the defendants in did not tional it does not address the Daniell, allege person, that Dr. caused or allege effect of a defendant’s failure to that a injuries, plaintiff's or contributed to the the issue nonparty plain- contributed to the caused or joined any of could have plaintiff's whether the tiff’s or failure to make § pursuant third persons defendants 20-1-119 is those defendants. Rule 8.03 presented requires "comparative (including See Owens v. Truck that this case. America, (Tenn. stops identity description any alleged or of other 915 S.W.2d 1996). tortfeasors)” pled as an be affirmative defense. testimony scan. admissibility analysis myelogram an MRI of Dr. Allen’s although theoretically the issues depends its relevance to the He concluded by have by pleadings. See Tenn. R. Evid. could plaintiff’s raised anesthesia, unlikely. charges professional highly it was complaint spinal 402. The deny malpractice. The defendants do cause, possible regard the other With of the a cause of essential elements of proper positioning Dr. Allen testified that the negligence duty based of care and action — body during the sur- patient’s of a described Cooley, 806 See McZClenahan v. crucial, ensuring gery and that is (Tenn.1991). The denials properly positioned primarily is patient is put other stated the answer issue the surgeon performing the responsibility of the duty, three essential elements —breach having the operation. Allen testified that Dr. fact, proximate legal causation cau during body improper position patient’s in an words, de sation. other injury” surgery could a “stretch they negligent, nied that their and, conversely, that a nerves stretch was procedure administration of the medical highly unlikely patient positioned if is care; they applicable below the standard of correctly. point, to this With denied was an antecedent Allen testified as follows: injuries; cause of Doctor, Q: you opinion within do procedure performed denied that certainty degree of medical reasonable proximate legal them was cause of the George positioning of Ms. plaintiffs injuries. pleadings Their do not the cause of surgery for this she charge plain cause of the leg? damage her nerve to her injuries.were tiffs the acts or omissions persons. my opinion A: that would be the most рlausible yes, sir. any legal Evidence is- relevant of the pleadings sues raised admissible. your Q: within So would Evidence, Tennessee Rules de- certainty? degree reasonable of medical having fines relevant evidence as “evidence Yes, A: it would. any tendency to make the existence Q: your you opin- itAnd have an consequence that is fact the determina- —do degree medical ion within a reasonable probable of the tion action more or less doctor, certainty, improper positioning probable than it would be evi- without the occur, normally patient of the would not Consequently, testimony dence.” Dr. Allen’s positioned not occur if the if it was admissible tends to establish physi- of care within the standard degree of care exercised the dеfendants cians involved? relationship, any, or the causal if between procedure performed by before, un- A: Yes. I have testified As then, plaintiffs injuries. question, underlying anatomic less there was some testimony is—what does Dr. Allen’s tend I Ms. reason which don’t believe establish? has, that be an accurate statement as well. to two alter- Allen’s related (not joint) native common or causes —the ad- added). (Emphasis spinal by the ministration of the anesthesia respond- deposition, Later Allen pa- positioning defendants and the *9 question lithotomy position: to a about ed body surgery by As tient’s Dr. Daniell. first, Doctor, injury assuming properly Q: someone is to the Dr. Allen testified that ..., lithotomy do positioned not have two nerves could been injection within you opinion have an a reasonable of anesthesia unless the certainty “conjoined per- degree a nerve rare ana- of medical root” —a son, positioned in a properly are if tomical in which nerves condition two injury lithotomy position, single protective would have an enclosed sheath. his as Ms. has? possibility, Allen discounted this based on such A: It profoundly unlikely would be otherwise actionable causes of harm.” proper with positioning Thus, that one would cause, proximate legal or con- up end injury. with a nerve cerns a legal determination of whether lia- Q: you So would opinion bility have an imposed within a should be where cause in degree reasonable certainty medical fact has been established. if, you opine, this was caused that — (quoting Jr., Id. at Joseph King, H. injury, you stretch have an Causation, Valuation and Chance in Person- degree within a reasonable of medical cer- Injury Involving al Torts Preexisting Condi- tainty improper there position- was Consequences, tions and Future 90 Yale L.J. ing? (1981)). Therefore, 1355 NSF. 7

A: Either positioning initially applicable 8.03 is where the defendant con- or as injury the case went on stretch from tends that the act or omission of another was involving improper positioning such as proximate injury. cause of the pushing against legs something or reading This of Rule 8.03 is consistent with nature, my yes. answer would be 20-l-119(e), § Tenn.Code Ann. pro- which added). (Emphasis vides: testimony This tends to establish con- This section shall not any limit the clusions—that spi- the administration of the allege an answer or amend- nal anesthesia was not the cause in faсt of ed answer that a not a plaintiffs injuries, position- and that the suit caused or contributed to the plaintiffs body by of the Dr. Daniell for recovery. which the seeks surgery was the cause fact of the injuries. Consequently, provides practical Section 20-1-119 Allen’s testimo- ny implementation regarding compara- of the benefits of defendants’ administration fault, relevant, and, requires special of the pleading, there- fore, However, protects and it also testimony admissible. his the defendants’ re- garding dispute all positioning liability the essentials of plaintiffs body of the under plea ‍‌​​​​​‌​‌‌​‌‌​​‌​​‌​​‌​‌‌‌​‌‌​‌​​​​​​‌‌​​‌​​​‌​‌‍surgery general plea was not relevant denial. Under a issue general denial, and, therefore, made pleadings, affirmatively and without fault, pleading comparative admissible. His relevant, and, are entitled to positioning would have show at trial that the act or (as therefore, admissible, omission of another if was the cause in fact the defendants had cause) pled distinguished proximate from affirmative defense of plaintiffs injury. fault. pleading without affirmatively, attempt the defendants cannot requires Rule 8.03 that the defendant iden “fault,” “blame,” “liability” to shift the tify or alleged describe other It tortfeasors. person. order for the defen- applicable where a defendant undertakes fault, part dants to shift all or to shift the “blame” to other “tortfeasors” affirmatively plead neg- defendants must who “should share fault.” Tenn. R. P. Civ. another, ligence words, identify or in other Advisory Commission Comments [1993]. might describe other tortfeasors who allegations proximate Such raise the issue of proximately found to plain- caused the Kilpatrick Bryant, cause. 868 S.W.2 d injuries. Ridings Ralph tiffs See M. Par- (Tenn.1993), explained the Court the dif Co., sons 914 S.W.2d at 83-84. proximate ference between cause and cause in fact: argument point The defendants’ on this (or fact) (and very

“Causation majority opinion) ignores is a the rela- concept different tionship from that of pleading between and evidence. cause. They acknowledge Causation refers to the cause and in their brief effect relationship between the surgical position tortious Allen testified “that the conduct and the negligent doctrine of and that the sur- *10 proximate encompasses geon the whole himself deviated from the standard of panoply may deny liability They of rules that care.” continue: “But this was not the

527 if those injuries. requires 8.03 defendants; theory they must be set upon, never, time, are to be relied facts contended the.sur plain pleadings “short argument defeats forth geon negligent.” This Otherwise, testimony regarding “theory” or “con The terms.” the defendants’ case. pleadi parties is found facts is not admissible. those tention” pleading, a ngs.2 modem Under comparative fault never argument that the facts required to set out detail not stated the above pled be overlooks defense; claim or upon which it bases its significant prac- well as of evidence as rule however, no pleadings must afford fair Tennessee, sepa- where the tical factors. and the claim or defense is tice of what the of more rate, negligent acts indeрendent 2A upon which it rests. See James grounds combined to cause tortfeasor have than one Moore, al., Federal Practice et Moore’s W. joint injury, liability is not single, indivisible 1995) Gibson, ¶ (2d Conley v. (citing ed. de- Consequently, where the and several.3 102-08, 99, 2 41, 47-48, 78 355 S.Ct. U.S. fault, it plead not fendant does (1957)). defense An affirmative L.Ed.2d 80 percent of the liable for 100 will be held plain that is not within the pleads a matter of all damages unless it is absolved plaintiffs ¶ prima 8.27[1]. facie case. Id. at tiffs words, liability. where a sole defen- In other Thus, issues to pleadings give notice of the fault, plead comparative there dant does Lien, 420, tried. v. 910 S.W.2d Castelli liability apportioning of for dam- will be no (Tenn.Ct.App.1995). 429 may have though the defendant ages even allege pleadings do not The defendants’ only partially at fault. Evidence negligent or that his that Dr. Daniell was nonparty plaintiff or a to establish the tends contributing cause of negligence was responsible for the as a tortfeasor However, evidence, injuries. their plaintiffs admissible unless alleged is not Allen, testimony Dr. tends to establish fault as an affir- pled comparative dant has his negligent and that that Dr. Daniell was mative defense. injuries. plaintiffs negligence caused Admission of Dr. Allen’s testi- portion of a Dr. Daniell That evidence tends to establish requiring the de- prejudicial error mony was tortfeasor, responsible for at fault and as a Appeals to be reversed of the Court cision injuries. an invitation It also is trial. for a new and the case remanded persons other jury to shift the fault to conclusion, than the defendants.

course, thаt since the defendants did identify other plead comparative ‍‌​​​​​‌​‌‌​‌‌​​‌​​‌​​‌​‌‌‌​‌‌​‌​​​​​​‌‌​​‌​​​‌​‌‍fault and tortfeasors, testi- portion of Dr. Allen’s the fault to Dr.

mony which tends to shift Daniell was not admissible. of causation which does Relevant evidence RAMSEY, Brian Mitchell nonparties as tortfea-

not tend to establish Plaintiff/Appellant, general denial. sors is admissible under which, as in evidence a defendant’s BEAVERS, Defendant/Appellee. case, in fact to show no causation tends James G. if it also is inadmissible Tennessee, Supreme Court negligent and that nonparty was that a shows at Knoxville. nonparty’s negligence was the damages. pres- In the cause of the 7, 1996. Oct. case, heavily relied ent patient was Dr. Allen’s surgery and that positioned for

improperly the cause of the positioning was Inc., 8; Truckstops, Vogue, 3. Owens v. R. Civ. P. Hammett 2. Tenn. (Tenn.1996). (1942). 165 S.W.2d Tenn.

Case Details

Case Name: George v. Alexander
Court Name: Tennessee Supreme Court
Date Published: Oct 7, 1996
Citation: 931 S.W.2d 517
Docket Number: 01S01-9505-CV-00084
Court Abbreviation: Tenn.
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