Huddleston v. Tristar Northcrest Medical Center

IN THE UNITED STATES DISTRICT COURT FOR THE

MIDDLE DISTRICT OF TENNESSEE

NASHVILLE DIVISION

ASHLEY HUDDLESTON, )

)

Plaintiff, )

)

v. ) NO. 3:22-cv-00718

)

SPRINGFIELD HEALTH SERVICES, ) JUDGE CAMPBELL

LLC d/b/a TRISTAR NORTHCREST ) MAGISTRATE JUDGE HOLMES

MEDICAL CENTER, et al., )

)

Defendants. )

MEMORANDUM

Pending before the Court are Defendants’ motion to exclude testimony of Plaintiff’s expert

Steven Stogner, M.D. (Doc. No. 79) and Plaintiff’s motion to exclude testimony from Defendants’

expert witnesses (Doc. No. 82). The motions are briefed and ripe for review. (See Doc. Nos. 90,

85, 97). For the reasons discussed below, the motions will be DENIED.

I. BACKGROUND

This is a medical negligence/health care liability case arising from medical care Plaintiff

received at TriStar Northcrest Hospital (the “Hospital”) in Springfield, Tennessee in December

2021. Plaintiff was born with a genetic condition called muscular dystrophy, which required her

to be in a wheelchair and utilize a tracheostomy since age 11.

On December 25, 2021, at around 2:36 p.m., Plaintiff presented to the Hospital with low

oxygen, shortness of breath, and a history of muscular dystrophy requiring tracheostomy.

Approximately an hour later, Plaintiff had a chest x-ray taken, which was normal. At some point,

Plaintiff complained of low back pain. A physician’s assistant in the emergency room, Defendant

Samantha Stephens, ordered and administered 0.5 milligrams of Dilaudid to Plaintiff for her back

pain. Five minutes later, Plaintiff was in cardiac arrest and CPR was initiated. Emergency room

physician and supervising physician of Stephens, Defendant James Nell, ordered Narcan, and

Plaintiff was alert soon thereafter.

Chest x-rays taken after Plaintiff received CPR showed a pneumothorax (collapsed lung).

Plaintiff had a chest tube inserted and was flown by helicopter to St. Thomas Hospital, where she

stayed until January 22, 2022. She was transferred to a different hospital, where she stayed until

March 3, 2022, after which she received treatment at home until April 4, 2022.

Plaintiff brings this case against Defendants Samantha Stephens, P.A., and James Nell,

M.D. under Tennessee Code Annotated Section 29-26-115 for their alleged negligence in

providing her medical care on December 25, 2021. (Doc. No. 1).1 Specifically, Plaintiff claims

Defendants negligently ordered and administered Dilaudid, which proximately caused her

respiratory arrest, cardiac arrest and subsequent pneumothorax, pain/suffering, and long-term

hospitalization.

II. STANDARD OF REVIEW

State law determines expert witness competency in health care liability cases, and federal

law determines whether a witness is qualified to testify as an expert. See Legg v. Chopra, 286 F.3d

286, 291 (6th Cir. 2002). “Thus, if a witness is deemed competent to testify to the substantive issue

in the case, such as the standard of care, his or her testimony should then be screened by Rule 702

to determine if it is otherwise admissible expert testimony.” Id. at 292.

1 Defendants Springfield Health Services, LLC d/b/a TriStar Northcrest Medical Center, Kimberly

Rice, APRN, and Rebekah Kollar, M.D. were dismissed from this action in 2024. (See Doc. Nos. 46, 48).

III. LAW

A. Competency under Tennessee Law

Subsection (b) of Tennessee Code Annotated Section 29–26–115 prescribes who is

competent to testify as an expert in a health care liability action:

No person in a health care profession requiring licensure under the

laws of this state shall be competent to testify in any court of law to

establish the facts required to be established by subsection (a),

unless the person was licensed to practice in the state or a contiguous

bordering state a profession or specialty which would make the

person's expert testimony relevant to the issues in the case and had

practiced this profession or specialty in one (1) of these states during

the year preceding the date that the alleged injury or wrongful act

occurred. This rule shall apply to expert witnesses testifying for the

defendant as rebuttal witnesses. The court may waive this subsection

(b) when it determines that the appropriate witnesses otherwise

would not be available.

Tenn. Code Ann. § 29-26-115(b); Shipley v. Williams, 350 S.W.3d 527, 550 (Tenn. 2011) (“when

determining whether a witness is competent to testify, the trial court should look to subsection (b),

not subsection (a).”). Although subsection (b) requires that the medical expert be licensed in a

profession or specialty which makes the testimony relevant in malpractice action, there is no

requirement that the expert be licensed in the same profession or specialty as the defendant.

Stanfield v. Neblett, 339 S.W.3d 22, 36–37 (Tenn. Ct. App. 2010).

B. Qualifications under Rule 702 and Daubert

Federal Rule of Evidence 702 governs the admissibility of an expert witness’s testimony

at trial. Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 589 (1993). Under Rule 702,

A witness who is qualified as an expert by knowledge, skill,

experience, training, or education may testify in the form of an

opinion or otherwise if:

(a) the expert’s scientific, technical, or other specialized knowledge

will help the trier of fact to understand the evidence or to

determine a fact in issue;

(b) the testimony is based on sufficient facts or data;

(c) the testimony is the product of reliable principles and methods;

and

(d) the expert has reliably applied the principles and methods to the

facts of the case.

“[T]he trial judge has discretion in determining whether a proposed expert’s testimony is

admissible based on whether the testimony is both relevant and reliable.” Palatka v. Savage Arms,

Inc., 535 F. App’x 448, 453 (6th Cir. 2013) (quotation omitted). The Court’s task is to assess

“whether the reasoning or methodology underlying the testimony is scientifically valid and...

whether that reasoning or methodology properly can be applied to the facts in issue.” Daubert, 509

U.S. at 592–93. In Kumho Tire Company, Ltd. v. Carmichael, 526 U.S. 137 (1999), the Supreme

Court extended Daubert to nonscientific expert testimony, requiring that, “where such testimony's

factual basis, data, principles, methods, or their application” are called sufficiently into question,

the trial judge must determine whether the testimony has “a reliable basis in the knowledge and

experience of [the relevant] discipline.” Kumho Tire, 526 U.S. at 149.

However, the court will not exclude expert testimony “merely because the factual bases for

an expert's opinion are weak.” Daniels v. Erie Ins. Grp., 291 F. Supp. 3d 835, 840 (M.D. Tenn.

2017) ( quoting Andler v. Clear Channel Broad., Inc., 670 F.3d 717, 729 (6th Cir. 2012)). “Indeed,

rejection of expert testimony is the exception rather than the rule—the gatekeeping function

established by Daubert was never intended to serve as a replacement for the adversary system.”

Id. (internal quotation marks and citation omitted). Rule 702 does not “require anything

approaching absolute certainty.” Tamaraz v. Lincoln Elec. Co., 620 F.3d 665, 671–72 (6th Cir.

2010) (citing Daubert, 509 U.S. at 590). Under Daubert, experts are “permitted wide latitude in

their opinions, including those not based on firsthand knowledge, so long as the expert’s opinion

has a reliable basis in the knowledge and experience of the discipline.” Dilts v. United Grp. Servs.,

LLC, 500 F. App’x 440, 445 (6th Cir. 2012) (quoting Daubert, 509 U.S. at 592).

IV. ANALYSIS

The Court will first consider competency challenges before turning to whether a witness is

qualified to testify as an expert under Federal Rule of Evidence 702 and Daubert.

A. Competency under Tennessee Code Annotated Section 29–26–115(b)

Defendants challenge Dr. Stogner’s competency to testify in this case on the grounds that

he “is a pulmonologist and not an emergency medicine physician or physician’s assistant like the

Defendants.” (Doc. No. 80 at 1). In support, Defendants contend that “the issue” in this case was

“administering pain medication for Plaintiff’s musculoskeletal [back] pain” and that Dr. Stogner

does not treat patients for “trauma such as this.” (Id. at 7).

In her response, Plaintiff correctly notes that there is no requirement that Dr. Stogner be

licensed in the same profession or specialty as the defendants. (Id. (citing Stanfield v. Neblett, 339

S.W. 3d 22, 37 (Tenn. Ct. App. 2010)). Plaintiff argues that Dr. Stogner’s testimony is relevant to

Defendants’ care of Plaintiff and the proximate cause of Plaintiff’s alleged injuries because Dr.

Stogner is Board Certified in the areas of Internal Medicine, Pulmonary Disease, and Critical Care

Medicine and because he works with emergency room physicians on a daily basis, including

physician assistants and nurse practitioners, and has experience ordering Dilaudid for patients in

the emergency room setting. (Id. at 9-10). Defendants do not respond or argue otherwise as they

opted not to file a reply in support of their motion to exclude Dr. Stogner’s expert testimony.

Tennessee courts have made clear that Section 29-26-115 does not require that an expert

witness practice the same specialty as the defendant. See Shipley v. Williams, 350 S.W.3d 527, 566-

67 (Tenn. 2011) (collecting cases); Stanfield, 339 S.W. 3d at 37. Instead, courts must “look

carefully at the particular issues presented in the case to determine if an expert practices a

profession or specialty that would make the expert's testimony relevant to those issues.” Shipley,

350 S.W.3d at 556. Upon review of the Complaint and the parties’ filings, the Court finds no

reason to require all medical expert witnesses in this case be licensed as an emergency medicine

physician; this case turns on whether Defendants breached the standard of care in the

administration of pain medication as opposed to emergency room-specific standards. To that end,

Dr. Stogner’s Board Certifications in internal medicine, pulmonary disease, and critical care

medicine, and his experience with ordering pain medication in the emergency room setting all

demonstrate that he is licensed to practice in a profession or specialty that makes his testimony

relevant.

B. Qualifications under Rule 702 and Daubert

Plaintiff and Defendants seek to exclude each other’s respective expert witnesses for failure

to comply with the “locality requirement” of subsection (a)(1) of Section 29–26–115.2 As only

standard of care opinions are subject to the locality rule, the parties’ motions will be denied to the

extent they seek to exclude causation opinions based on a failure to comply with subsection (a)(1).

To satisfy this “locality requirement,” an expert witness may show either that they are

“familiar” with the relevant medical community or that they are familiar with a “similar” medical

community:

A claimant is required to prove the “[t]he recognized standard of

acceptable professional practice ... in the community in which the

defendant practices or in a similar community.” Tenn.Code Ann. §

29–26–115(a)(1). The medical expert or experts used by the

2 The Sixth Circuit considered the interaction between Tennessee’s locality rule and Rule 702 in

medical negligence/health care liability cases in Gales on behalf of Ranson v. Allenbrooke Nursing &

Rehab. Ctr., LLC, 91 F.4th 433 (6th Cir. 2024), concluding that “a proffered witness in a Tennessee medical

malpractice action who is unfamiliar with the relevant medical standards cannot testify as an expert because

his opinion will not help the fact finder determine a fact at issue in the case.” 91 F.4th 433, 436.

claimant to satisfy this requirement must demonstrate some

familiarity with the medical community in which the defendant

practices, or a similar community, in order for the expert's testimony

to be admissible under Rules 702 and 703. Generally, a competent

expert's testimony that he or she has reviewed and is familiar with

pertinent statistical information such as community size, hospital

size, the number and type of medical facilities in the community,

and medical services or specialized practices available in the area;

has had discussions with other medical providers in the pertinent

community or a neighboring one regarding the applicable standard

of care relevant to the issues presented; or has visited the community

or hospital where the defendant practices, will be sufficient to

establish the expert's testimony as admissible.

Shipley v. Williams, 350 S.W.3d 527, 554 (Tenn. 2011). Thus, a competent expert may

demonstrate familiarity with the medical community in which the defendant practices – here

Springfield, Tennessee – or a similar community by:

1. testifying that they have reviewed and become familiar with pertinent information, such

as the size of Springfield’s community and hospital, the number and type of medical

facilities in Springfield, and the medical services available in the Springfield area;

2. testifying that they have had discussions regarding the applicable standard of care

relevant to the issues presented with other medical providers in the Springfield

community or a neighboring community; or

3. testifying that they have visited Springfield, Tennessee or the Hospital.

Here, Dr. Jennifer Casaletto and Mr. Gilpatrick both testified to being familiar with

Springfield, Tennessee based on the population size of Springfield (between 20,000 and 30,000),

number of beds at the Hospital (approximately 100), and the geographic proximity of Springfield

to a major metropolitan area (Nashville 40-minute drive/ 20 to 30 miles from Springfield).3 Scott

Gilpatrick also testified that he had ridden his bicycle through Springfield before.

3 Defendants argue Dr. Casaletto and Scott Gilpatrick also qualify under the locality rule because

they practiced in similar communities to that of Springfield, Tennessee, during the year before the alleged

negligent act. (Doc. No. 85 at 3-5). However, Defendants concede that neither Dr. Casaletto nor Mr.

Gilpatrick have testified to such facts, as required. Tenn. Code Ann. § 29-26-115(a)(1).

Similarly, Dr. Steven Stogner  testified to his knowledge of the population size of

Springfield, Tennessee (between 15,000 and 20,000) and the number of beds at the Hospital (109).

Dr. Stogner also testified that he has been to Springfield, Tennessee during a trip to Knoxville and

while driving around in north Tennessee, vacationing with his family. In his affidavit, filed on

August 5, 2024, Dr. Stogner testified that, in December 2021, he practiced in Picayune,

Mississippi, a community of similar population size to Springfield, Tennessee, at hospital with a

similar number of beds (95) to the Hospital in Springfield. (See Doc. No. 58-1).

Upon review of the parties’ motions and related filings, including the deposition transcripts

of Dr. Casaletto, Mr. Gilpatrick, and Dr. Stogner, the Court finds that they have each demonstrated

familiarity with the medical community of Springfield, Tennessee, or a similar community, such

that they each satisfy the “locality requirement” of subsection (a) of Section 29-26-115.

C. Federal Rule of Civil Procedure 26(a)(2)

Plaintiff also moves to exclude Defendants’ expert testimony on the basis that defense

counsel prepared their written reports for them in violation of Rule 26(a)(2). For support, Plaintiff

cites to all three written reports as having identical factual summaries and listing the same

documents as reviewed and submits that the Casaletto and Gilpatrick reports are substantively

identical in their proffered opinions, containing only stylistic and formatting differences. (See Doc.

No. 82-1 at 1-6, 9-12).

Rule 26(a)(2) states that expert testimony “must be accompanied by a written report—

prepared and signed by the witness.” Fed. R. Civ. P. 26(a)(2)(B) (emphasis added). Although “[a]

party's attorney can reduce an expert's oral opinion to writing so long as the report reflects the

actual views of the expert,” United States v. Kalymon, 541 F.3d 624, 638 (6th Cir. 2008),

“[c]reating an expert's opinion and then asking the purported expert to sign it does not comply with

the rule's requirement.” James T. Scatuorchio Racing Stable, LLC v. Walmac Stud Mgmt., LLC,

No. CIV.A. 5:11-374-DCR, 2014 WL 1744848, at *6 (E.D. Ky. Apr. 30, 2014).

Defense counsel filed an affidavit stating that he had numerous conversations with each of

the experts related to their opinions and that he worked closely with each expert in preparing

Defendants’ expert disclosures and reports. (Doc. No. 85-1 1-4). Defense counsel further states

through his affidavit that he drafted the expert witness statements based on his conversations with

each of them and the opinions they relayed to him, and then sent each of the expert witness

statements to the experts for their review and finalization. (/d. § 5). Following their review of the

statements, defense counsel submits that he held phone calls with each of the experts to go over

the draft expert witness statements and that he made changes to the reports based on the input from

each expert witness. (/d. 6).

Here, while the preliminary components of the three reports are similar in format and

factual content, there is no evidence in the record suggesting that defense counsel created the

opinions of the defense experts out of whole cloth and then asked them to merely sign the report.

Rather, defense counsel’s affidavit affirms that he prepared the expert reports based on the

opinions conveyed to him during his conversations with the experts. Accordingly, the Court does

not find that Defendants have violated Rule 26(a)(2).

An appropriate Order shall enter.

AMX

Ll x Col

CHIEF UNITED STATES DISTRICT JUDGE