HCLA expert failed to satisfy locality rule.

An expert witness in an HCLA case who admittedly did not know any information about the hospital that administered treatment, including what services it offered or its size, and had never spoken to anyone who worked there or been there in person, did not satisfy the locality rule.

In Bowen v. Nelson, No. W2024-00749-COA-R3-CV (Tenn. Ct. App. May 27, 2025), the plaintiff filed an HCLA action based on her treatment and the transfer process at Jackson-Madison County General Hospital. The plaintiff identified Dr. Jim as her standard of care and causation expert. In his deposition, Dr. Jim stated that he had spent many years working at a hospital in St. Lous, Missouri. When questioned about his familiarity with the hospital where the plaintiff was treated, he admitted to knowing very little. He did not know the population of the city, did not know how many beds were in the hospital (and guessed very inaccurately), and did not know what services the hospital offered. He stated that he had never spoken to anyone who worked at the hospital or visited the hospital.

Based on this testimony, the defendants filed a motion to exclude Dr. Jim pursuant to the locality rule, as well as a motion for summary judgment based on the plaintiff’s inability to prove the necessary elements of her HCLA claim by expert proof. The trial court granted both motions, and the Court of Appeals affirmed.

The standard of care in an HCLA case must be proven through expert testimony. Expert witnesses in HCLA cases must comply with the locality rule, meaning “a medical expert must demonstrate a modicum of familiarity with the medical community in which the defendant practices or a similar community.” (internal citation omitted).  In Shipley v. Williams, 350 S.W.3d 527 (Tenn. 2011), the Tennessee Supreme Court listed three ways an expert can satisfy the locality rule. The expert can (1) “testify 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;” (2) the expert can state that he or she has “discussed with other medical providers in the pertinent community or a neighboring one the applicable standard of care relevant to the issues presented;” or (3) the expert can visit “the community or hospital where the defendant practices.” (citing Shipley) (internal quotations omitted).

On appeal, the plaintiff did not argue that Dr. Jim satisfied the locality rule by one of the three options set out in Shipley. Instead, she asserted that he demonstrated compliance with the locality rule “through a novel method of establishing familiarity with a similar community.” The plaintiff argued that “a demonstration of relative experience of a professional at a particular juncture within the overall health care delivery system should be an alternative method of complying with the requirements imposed by § 29-26-115(a).”

While the Court acknowledged that there is no case law expressly holding that the Shipley methods are the exclusive methods for satisfying the locality rule, it stated that “Tennessee courts have consistently applied them in these matters.” (internal citations omitted). Whether the Shipley methods were exclusive or not, however, the Court explained that the plaintiff’s “proposed relevant experience within the healthcare system method does not address the locality rule’s function of ensuring a medical expert demonstrates a modicum of familiarity with the medical community in which the defendant practices or a similar community.” (internal citation and quotations omitted).

The Court wrote:

Dr. Jim’s experience within the health care system does not demonstrate any level of familiarity with Jackson or a similar community. We fail to see the connection between Dr. Jim’s experience in the health care system and knowledge of Jackson or a similar community. This type of experience is certainly a relevant consideration for the competency of a witness in this type of case, but the locality rule is separate from the competency requirements of Tennessee Code Annotated section 29-26-115(b). None of the experience Dr. Jim testified to indicates that he had the knowledge of Jackson or a similar community necessary to comply with the locality rule. During his deposition, Dr. Jim was asked whether he was “familiar with hospitals similar to Jackson-Madison County General Hospital?” Dr. Jim responded by stating simply, “Yes.” However, this claim was unsupported by his own testimony and was merely a bare assertion of familiarity. Dr. Jim did not explain how the hospital he worked at in St. Louis, Missouri at the beginning of his career was similar to JMCGH. Likewise, he failed to describe the equipment or staff available in JMCGH or to demonstrate that the resources available at JMCGH were similar to those available at the hospital he claimed was similar. Additionally, any of Dr. Jim’s testimony describing his knowledge of JMCGH demonstrated a lack thereof and rendered any comparison he intended to make inefficacious. It is unclear how Dr. Jim could have determined that a community or hospital he worked in was similar to Jackson or JMCGH, when he did not demonstrate that he had a benchmark knowledge for either comparison. For example, when asked about the number of beds in JMCGH, Dr. Jim speculated that it was “in the range of a couple hundred, maybe, or less than that.” This speculation was incorrect as impeachment information provided by the appellees indicated there were approximately 642 beds in JMCGH in 2018 when the events leading to this lawsuit occurred. This demonstrates that Dr. Jim did not have an adequate knowledge of JMCGH to determine whether it was a hospital similar to one in which he had worked.

(internal citations omitted).

The Court ruled that the trial court did not err in excluding the plaintiff’s expert, and because there was no other expert standard of care testimony, summary judgment for the defendant was also affirmed.

Expert testimony is almost always critical to a successful HCLA claim. Choosing the correct expert, and ensuring that the expert is well prepared, are critical to surviving a summary judgment motion.  That said, we have all had cases where even well-prepared clients, lay witnesses, and experts became flustered under oath and, when that happens, the results can be devastating.

 

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