ARNOLD B. GOLDIN, J., delivered the opinion of the Court, in which J. STEVEN STAFFORD P.J., W.S., and BRANDON O. GIBSON, J., joined.
This interlocutory appeal concerns the trial court's partial dismissal of a case concerning alleged negligence committed against Plaintiff/Appellee Brenda Osunde ("Mrs. Osunde"). Mrs. Osunde filed a complaint in the trial court alleging a medical malpractice claim against DMC-Memphis, Inc. ("DMC"), as well as a claim for common law negligence, after she sustained a fall while at DMC's hospital, Delta Medical Center. When Mrs. Osunde failed to disclose any experts pursuant to the trial court's scheduling order, DMC moved for
On October 14, 2011, Mrs. Osunde presented to Delta Medical Center complaining of pain in her left ankle.
Shortly after her fall from the stool, Mrs. Osunde was taken to the operating room at Delta Medical Center to repair the fibular fracture she sustained. A syndesmotic screw was placed in her right ankle during the course of surgery, and a few weeks later, she was fitted for a leg cast. On March 1, 2012, Mrs. Osunde underwent a second surgery to have the syndesmotic screw in her right ankle removed, and on March 23, 2012, sutures were removed. Although she was subsequently discharged from medical treatment, Mrs. Osunde was instructed to follow up on an as-needed basis. According to Mrs. Osunde, the injuries she sustained as a result of her fall prevented her from returning to her job as a registered nurse, and she was eventually terminated from her employment.
On January 30, 2013, Mrs. Osunde
DMC filed an answer to Mrs. Osunde's complaint on February 22, 2013. In its answer, DMC denied any negligence on its part and moved for a dismissal of all claims filed against it. Nearly a year later, on February 14, 2014, the trial court entered a scheduling order pursuant to Rule 16 of the Tennessee Rules of Civil Procedure. In relevant part, the scheduling order required that Mrs. Osunde reveal her expert witnesses to defense counsel by April 28, 2014. No witnesses were ultimately disclosed in accordance with this deadline.
On October 31, 2014, DMC moved for summary judgment based on Mrs. Osunde's failure to disclose any expert witnesses. A statement of undisputed material facts and a supporting memorandum of law were filed contemporaneous to the motion. In its supporting memorandum of law, DMC argued that the adjudication of Mrs. Osunde's lawsuit would involve "complicated and technical information which is beyond the general knowledge of a jury," and as a result, contended that the case could not go forward without expert proof.
On December 1, 2014, Mrs. Osunde filed a response opposing DMC's motion for summary judgment. Mrs. Osunde's response argued that DMC's motion had completely ignored her assertion of a common law negligence claim. Moreover, Mrs. Osunde noted that it had become apparent through discovery that her case against DMC sounded only in ordinary negligence and not medical malpractice. She stated that she was willing to amend her complaint to strike the medical malpractice claim, while preserving her asserted claim for common law negligence. With respect to the latter claim, Mrs. Osunde contended that no expert proof was required to support it. She argued that an ordinary trier of fact would be able to determine, based on everyday experiences, that providing a faulty stool to her constituted negligence on the part of DMC. Inasmuch as expert proof was not required to establish her claim, Mrs. Osunde contended that DMC's motion for summary judgment should be denied.
On March 16, 2015, the trial court entered an order granting in part and denying in part DMC's summary judgment motion. Specifically, the trial court's order stated as follows:
Subsequent to the entry of this order, DMC filed a motion for leave to file an interlocutory appeal. In a memorandum filed in support of its motion for leave, DMC argued that all of Mrs. Osunde's theories of liability, including the denominated ordinary negligence claim, should have been considered as being contained within a single "health care liability action." DMC contended that the trial court's order would likely be reversed on appeal,
After the trial court granted DMC leave to file an interlocutory appeal, an application for a Rule 9 appeal was filed in this Court. In its Rule 9 application, DMC proposed that the following question should be presented for our review:
Mrs. Osunde filed a response to DMC's Rule 9 application on June 12, 2015, and on July 2, 2015, we granted the application for appeal.
We granted this interlocutory appeal to determine whether the trial court erred in its adjudication of DMC's motion for summary judgment in light of the standards and definitions contained within the Tennessee Health Care Liability Act.
A motion for summary judgment should only be granted when "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Tenn. R. Civ. P. 56.04. Far from a disfavored procedural shortcut, summary judgment procedure remains an "important vehicle for concluding cases that can and should be resolved on legal issues alone." Byrd v. Hall, 847 S.W.2d 208, 210 (Tenn.1993) (citations omitted). Although a grant of summary judgment can save both the parties and the court the time and expense of trial, a request for summary judgment should be denied when genuine issues or disputes of material fact are present. Action Chiropractic Clinic, LLC v. Hyler, 467 S.W.3d 409, 411 (Tenn.2015) (citing Parker v. Holiday Hosp. Franchising, Inc., 446 S.W.3d 341, 346 (Tenn.2014)). Because the trial court's ruling on a summary judgment motion is a question of law, we review the matter de novo. Revis v. McClean, 31 S.W.3d 250, 252 (Tenn.Ct.App.2000) (citing Robinson v. Omer, 952 S.W.2d 423, 426 (Tenn.1997); McClung v. Delta Square Ltd. P'ship, 937 S.W.2d 891, 894 (Tenn. 1996)).
As we have already discussed, DMC moved for summary judgment when Mrs. Osunde failed to identify any expert witnesses in accordance with the trial court's scheduling order. DMC argued that the absence of expert testimony was fatal to the maintenance of Mrs. Osunde's cause of action. When the trial court reviewed DMC's request for summary judgment, it dismissed Mrs. Osunde's "health care liability action" for her failure to produce an expert, but it allowed her common law negligence claim to proceed to trial. As is evident from its oral ruling on the motion
Under traditional legal principles, our courts recognized that not every negligence action asserted against a hospital or doctor was one for medical malpractice. Estate of Doe v. Vanderbilt Univ., Inc., 958 S.W.2d 117, 120 (Tenn.Ct.App.1997). Indeed, the courts recognized that some claims against medical providers sounded only in ordinary negligence. Drawing this distinction had several important consequences. For example, although medical malpractice claims typically required expert proof, claims asserting ordinary negligence did not. See, e.g., Peete v. Shelby Cnty. Health Care Corp., 938 S.W.2d 693, 696 (Tenn.Ct.App.1996) (holding that expert proof was not required for an asserted claim of ordinary negligence). In addition, distinguishing a medical malpractice claim from an ordinary negligence claim was significant in determining the applicable statute of limitations that governed a plaintiff's case. See Gunter v. Lab. Corp. of Am., 121 S.W.3d 636, 639 (Tenn.2003) ("To determine which limitations statute controls Gunter's claim against the laboratory, we must first decide whether the claim sounds in medical malpractice or negligence."). However, because "[m]edical malpractice is but one particular type of negligence," Patterson v. Arif, 173 S.W.3d 8, 11 (Tenn.Ct.App.2005) (citing Gunter, 121 S.W.3d at 639), the distinction between a malpractice claim and an ordinary negligence claim was often a subtle one for the courts. In Graniger v. Methodist Hospital Healthcare Systems, Inc., No. 02A01-9309-CV-00201, 1994 WL 496781 (Tenn. Ct.App. Sept. 9, 1994), this Court opined that the distinction between a malpractice claim and an ordinary negligence claim lied in the nature of whether knowledge of medical science was necessary to assess the alleged wrongful conduct. We explained:
Id. at *3 (citing Pearce v. Feinstein, 754 F.Supp. 308, 310 (W.D.N.Y.1990)). Moreover, as our Supreme Court once held, a claim was considered as one for medical malpractice when it alleged "negligent conduct which constitutes or bears a substantial relationship to the rendition of medical treatment by a medical professional." Gunter, 121 S.W.3d at 641.
Id. at 555-56 (alteration in original) (citations omitted); see also Draper v. Westerfield, 181 S.W.3d 283, 290 (Tenn. 2005) ("[I]n determining whether an action is for medical malpractice or for common law negligence, the issue is whether the alleged negligent conduct `bears a substantial relationship to the rendition of medical treatment by a medical professional.'" (citing Gunter v. Lab. Corp. of Am., 121 S.W.3d 636, 641 (Tenn.2003))). The Court ultimately concluded that it is "the responsibility of the courts to ascertain the nature and substance of a claim" and that the "designation given those claims by either the plaintiff or the defendant is not determinative." Estate of French, 333 S.W.3d at 557.
Ellithorpe, 479 S.W.3d at 824-26 (internal footnote omitted).
Squarely at issue in this case is the effect of the recent amendments that were discussed in Ellithorpe.
When the parents appealed to this Court, we vacated the trial court's order
Id.
What we glean from Ellithorpe is the primacy of the recent statutory amendments to the THCLA, formerly known as the Tennessee Medical Malpractice Act. The "nuanced" approach for distinguishing an ordinary negligence claim from a medical malpractice claim has been displaced because the statute now contains a comprehensive definition of what constitutes a "health care liability action." Indeed, because this definitional meaning controls whether a claim falls within the aegis of the THCLA, the Estate of French analysis is, to quote our Supreme Court, "effectively moot." Id. The THCLA's definition of a "health care liability" action is conclusive, see Igou v. Vanderbilt Univ., No. M2013-02837-COA-R3-CV, 2015 WL 1517794, at *5 n.6 (Tenn.Ct.App. Mar. 27, 2015), no perm. app. filed, and courts do not need to conduct an Estate of French analysis to see whether the framework of the statute applies. A claim will be subject to the THCLA if the facts of the case show that it qualifies as a "health care liability action" as that term is statutorily defined. See Estate of Thibodeau v. St. Thomas Hosp., No. M2014-02030-COA-R3-CV, 2015 WL 6561223, at *6 (Tenn.Ct.App. Oct. 29, 2015), perm. app. filed.
As was discussed in Ellithorpe, the General Assembly has defined a "health care liability action" as follows:
Tenn.Code Ann. § 29-26-101(a)(1) (2012). Under the statute, a "health care provider" includes the employee of a health care provider, such as a physician, nurse, or technician, and the meaning of "health care services" includes "staffing, custodial or basic care, positioning, hydration and similar patient services." Tenn.Code Ann. § 29-26-101(a)(2), (b) (2012). Given the breadth of the statute, it should not be surprising if most claims now arising within a medical setting constitute health care
Indeed, the consequences of falling within the ambit of the THCLA are significant. Not only is a health care liability action subject to the pre-suit notice requirement contained in Tennessee Code Annotated section 29-26-121, but potentially, it is subject to the certificate of good faith requirement in section 29-26-122, as well as the expert proof requirement in section 29-26-115. That these latter two requirements are subject to qualification is an important point that should not be ignored. This remains especially true in light of the facts implicated in this case.
On its face, section 29-26-115 broadly imposes a requirement that health care liability actions be proven by expert testimony. Specifically, it provides as follows:
Tenn.Code Ann. 29-26-115 (2012).
Notwithstanding the general requirement that an action filed under the THCLA be supported by expert proof, it is not absolute. As our Supreme Court acknowledged in Ellithorpe, expert proof is not required in a health care liability action where the claim "falls within the `common knowledge' exception." Ellithorpe, 479 S.W.3d at 829. Reviewing the case law in Tennessee reveals that the "common knowledge" language has been referred to in two contexts regarding claims asserted against medical providers. First, expert proof may be dispensed with when the trier of fact can determine, based on common knowledge, that the direct allegations against a defendant constitute negligence. See, e.g., Rural Ed. Ass'n v. Anderson, 37 Tenn.App. 209, 261 S.W.2d 151, 155 (1953) ("It is a matter of common knowledge and common sense of laymen that a patient in such a condition should be watched and protected and not left unattended on an upper story by an unguarded window through which he might, and ultimately did, fall or jump to his death."). When courts use the "common knowledge" language in this sense, they are directly referencing the "common knowledge" exception. We note, however, that the "common knowledge" language has also been referred to in cases involving the application of res ipsa loquitur, which "allows an inference of negligence where the jury has a common knowledge or understanding that events which resulted in the plaintiff's injury do not ordinarily occur unless someone was negligent." Seavers v. Methodist Med. Ctr. of Oak Ridge, 9 S.W.3d 86, 91 (Tenn.1999) (citations omitted). A res ipsa loquitur instruction is often necessary in cases where "direct evidence of a defendant's negligence is either inaccessible to or unknown by the plaintiff." Id. (citations omitted). Under the traditional articulation of the doctrine of res ipsa loquitur, which is now codified at Tennessee Code Annotated section 29-26-115(c), "there was considerable overlap with the common knowledge exception, inasmuch as the res ipsa loquitur requirement that the injury be one which ordinarily does not occur in the absence of negligence was often phrased in terms of `common experience' or `ordinary experience.'" Deuel v. Surgical Clinic, PLLC, No. M2009-01551-COA-R3-CV, 2010 WL 3237297, at *11 (Tenn.Ct.App. Aug. 16, 2010) (citations omitted). Once, this Court went so far as to liken res ipsa loquitur and the common knowledge exception as "Siamese twins." Murphy v. Schwartz, 739 S.W.2d 777, 778 (Tenn.Ct. App.1986). Notwithstanding the differences in context in which the common knowledge language has been discussed, one salient point emerges as it concerns expert proof and the application of the "common knowledge" exception itself: expert testimony is not required where the act of alleged wrongful conduct lies within the common knowledge of a layperson. See Baldwin v. Knight, 569 S.W.2d 450, 456 (Tenn.1978); Bowman v. Henard, 547 S.W.2d 527, 530-31 (Tenn.1977); Tucker v. Metro. Gov't of Nashville & Davidson Cnty., 686 S.W.2d 87, 92 (Tenn.Ct.App.
Given this understanding, a determination that a claim falls within the THCLA does not automatically trigger all of the statute's requirements. The need for expert proof will not lie if the matter is within the common knowledge of a layperson, and if there is no need for expert proof, a plaintiff's complaint will not fail for failure to attach a certificate of good faith under section 29-26-122. See Tenn. Code Ann. 29-26-122(a) (2012) ("In any health care liability action in which expert testimony is required by § 29-26-115, the plaintiff or plaintiff's counsel shall file a certificate of good faith with the complaint.") (emphasis added). Thus, although determining that a claim constitutes a health care liability action will subject it to the pre-suit notice requirement in section 29-26-121, additional analysis is needed to determine whether expert proof is necessary. See Smith v. Testerman, No. E2014-00956-COA-R9-CV, 2015 WL 1118009, at *5 (Tenn.Ct.App. Mar. 10, 2015), perm. app. denied (Tenn. June 15, 2015).
Previously, we noted that an analysis of the trial court's actions could be guided by two questions: (1) whether the claims asserted within Mrs. Osunde's complaint are cognizable outside the context of a "health care liability action," and (2) assuming that our answer to the first question is in the negative, whether Mrs. Osunde's allegations can nevertheless be supported in the absence of expert proof.
The first question requires us to examine whether Mrs. Osunde's asserted claims constitute a health care liability action as that term is statutorily defined in Tennessee Code Annotated section 29-26-101. As we previously indicated, such an action includes "any civil action ... alleging that a health care provider or providers have caused an injury related to the provision of, or failure to provide, health care services to a person, regardless of the theory of liability on which the action is based[.]" Tenn.Code Ann. § 29-26-101(a)(1) (2012). In this case, although Mrs. Osunde originally asserted a claim for medical malpractice in addition to a claim for common law negligence, she later clarified that she only sought to recover on her common law negligence claim. According to her, it had become apparent through discovery that her claim sounded only in ordinary negligence, and during oral argument on appeal, her counsel stressed that the only negligence she was alleging was on account of the radiology technician's providing a faulty stool. Although Mrs. Osunde's counsel has argued
Given our conclusion on this issue, we agree with DMC that the trial court erred, from a definitional perspective, in how it treated the asserted common law negligence claim as somehow separate from the THCLA. As previously noted, the trial court allowed Mrs. Osunde's common law negligence claim to proceed to trial, while simultaneously dismissing her "health care liability action" as a matter of law. This result is incongruous. Indeed, at the time of summary judgment, Mrs. Osunde was pursuing a legal theory that qualified as a health care liability action. Inasmuch as the trial court purported to dismiss Mrs. Osunde's "health care liability action" but allowed allegations that constituted a claim under the THCLA to survive, the trial court's order is devoid of definitional clarity. Of course, our determination that Mrs. Osunde's denominated common law negligence theory constitutes a health care liability action does not ipso facto mean that it should have been dismissed on account of her failure to identify an expert. As we have discussed, whether her allegations of negligence should have been dismissed for lack of an expert is a question separate and apart from whether they give rise to a claim under the THCLA.
In order to reverse the trial court's disposition of this case and hold that Mrs. Osunde's allegations should not go to trial, we would be required to come to the conclusion that expert proof is necessary in order to support her case-in-chief. In light of the allegations of negligence that are involved in this case, this is something that we cannot do. As we have previously explained, expert proof is not required "where the alleged acts of negligence are so obvious that they come within the common knowledge of laymen." Kennedy v. Holder, 1 S.W.3d 670, 672 (Tenn. Ct.App.1999), overruled on other grounds. In this case, as clarified in her response to DMC's summary judgment motion and in her argument on appeal, Mrs. Osunde is asserting that negligence was committed through the radiology technician's provision
In this case, the trial court's order adjudicating DMC's motion for summary judgment is devoid of clarity in light of the definitions contained within the THCLA. Although DMC is correct in its assertion that Mrs. Osunde's allegations of negligence give rise to a health care liability action, this determination does not compel a dismissal of Mrs. Osunde's case. The allegations of negligence pursued by Mrs. Osunde give rise to a health care liability action pursuant to the THCLA, but under the facts of this case, expert proof is not required to support them. For these reasons, the trial court's ultimate disposition is not in error. We only modify the trial court's summary judgment order to the extent that its analysis does not comport with the definitional framework contained herein. Specifically, we reverse the trial court's order to the extent that it purports to dismiss Mrs. Osunde's health care liability action. This cause is remanded to the trial court for such further proceedings as are necessary to adjudicate Mrs. Osunde's health care liability action as to her ordinary negligence claim, as well as her husband's claim for loss of consortium. The costs of this appeal are assessed against the Appellant, DMC-Memphis, Inc., and its surety, for which execution may issue if necessary.