Donna S. Young sued Dr. Fred C. Hartley for negligence, alleging that during a tubal ligation, he performed unauthorized additional surgeries on her vaginal area, resulting in physical and emotional harm. After a jury trial, the verdict favored Dr. Hartley, leading Young to appeal, particularly questioning the admissibility of evidence during the trial. The Court of Appeals affirmed the lower court's judgment.
Young had visited Dr. Hartley in 1999 for a tubal ligation, unaware she was pregnant, and subsequently had an abortion. Post-abortion, Dr. Hartley performed the tubal ligation, during which he claimed Young requested the removal of a skin tag. He removed the tag and stitched the area, while Young contended she did not have a skin tag and did not consent to any additional procedures.
Young's recollections of the hospital experience were vague; she remembered minimal details prior to surgery and reported severe pain and considerable bleeding post-surgery, which she claimed was significant despite initially being only slightly bleeding before discharge. The case also involved testimonies from various witnesses, necessitating a thorough discussion of the evidence presented at trial.
Pamela Johnson, a registered nurse, testified that Plaintiff was in the post-anesthesia care unit (PACU) for approximately forty-five minutes, during which she assessed Plaintiff's condition. Johnson reported that there was no vaginal bleeding upon Plaintiff's admission, midway through her stay, or at discharge. Plaintiff was comfortable, breathing well, and reported reduced pain at discharge, despite receiving a smaller than usual dose of pain medication. Although Plaintiff's blood pressure was elevated upon arrival, it normalized before her departure. Johnson noted she had never seen a patient with ten to twenty stitches in the clitoral area.
Plaintiff expressed not recalling her time in PACU and disagreed with the records. Pat Bishop, a licensed practical nurse, stated she did not hear Plaintiff in pain and documented that Plaintiff experienced no pain post-operatively, with only scant bleeding noted. Bishop recorded Plaintiff's blood pressure as 110/70, contradicting Plaintiff's claim that it was not taken. Bishop confirmed that specific criteria must be met for discharge, including pain and nausea control, and that she ensured Plaintiff left with someone. A follow-up appointment was scheduled for Plaintiff with the Defendant for June 3rd.
Plaintiff alleged that Defendant informed her of two additional procedures performed without charge, including the removal of an inclusion cyst and a skin tag, assuring her there was no cancer and no need for pathology. After Defendant's visit, Plaintiff claimed she was hurried to leave despite not having contacted her sister, and she purportedly drove herself home without recalling how. Discharge notes indicated she received instructions, was stable, and left with a friend.
Upon returning home, Plaintiff experienced increasing pain and swelling in the clitoral area and took Tylenol. She communicated with her sister, boyfriend, and friends about her condition and allowed friends to view her injuries, with some photos taken that were presented at trial. At her follow-up visit on June 3rd for stitch removal, Plaintiff expressed fears of severe bleeding, and Defendant reiterated explanations of the surgeries, assuring her again that she did not have cancer.
Plaintiff suspected Defendant was dishonest regarding her medical condition, leading her to secretly record a conversation with Defendant after a surgical procedure. She claimed to have no skin tag or inclusion cyst and believed Defendant misled her. Following the surgery, Plaintiff alleged that Defendant either removed or damaged parts of her clitoris, resulting in her inability to engage in sexual intercourse or experience pleasurable sexual stimulation, which she had previously enjoyed.
After the surgery, Plaintiff dated David Cross, who noted her complaints of pain and stated their relationship deteriorated, with no sexual activity occurring post-surgery. Subsequently, Plaintiff began dating Alan Gates, asserting that they never had sex, despite spending intimate time together. Gates, however, contradicted her claims, stating they had sexual relations multiple times over their relationship and that Plaintiff never complained of pain during these encounters.
Additionally, Gates testified to various sexual experiences they shared and suggested that Plaintiff had orgasms during their encounters. In contrast, Plaintiff claimed she only rode an ATV and a Sea Doo once each, both of which caused her pain, while Gates’ son testified that he never heard her complain of pain during various recreational activities.
Plaintiff alleged Gates purchased her a $50,000 Mercedes for her birthday, while Gates claimed she borrowed that amount from him to make the purchase, asserting they had sex prior to the loan. Gates also mentioned Plaintiff expressed ambitions of wealth, indicating a potential motive related to the trial's timing.
Plaintiff asserts she ended her relationship with Alan Gates upon discovering his involvement in drug activities. She alleges Mr. Gates threatened to claim sexual relations to prevent her from testifying against him regarding these activities. Following surgery, she reports being unable to work, experiencing severe bleeding that necessitated frequent changes of pads and towels, and ultimately closing her business, Sea Scape, which operated from September 1998 to August 2000. Her shop was reportedly thriving until her surgery, after which she suffered debilitating pain that hindered her mobility.
Despite her claims, Plaintiff admitted to previously writing bad checks when starting her business and noted she could no longer participate in activities such as biking or jogging due to persistent pain. After the surgery, her next medical consultation was with Dr. Link for a cosmetic procedure, during which she did not mention any complications from the earlier surgery. She scheduled and subsequently canceled liposuction surgery shortly after the surgery in question.
Plaintiff delayed seeking medical attention for her alleged issues for approximately 18 months, citing fear of serious diagnoses. Following the initiation of her lawsuit, she was examined by Dr. Christine Neal, an expert in obstetrics and gynecology. Dr. Neal observed significant abnormalities in Plaintiff's genital region but could not conduct a thorough examination due to Plaintiff's pain. Although Dr. Neal noted that Plaintiff's symptoms corresponded with her findings, she acknowledged the possibility that prior surgical procedures, including an abortion, could account for some bleeding and complications. Dr. Neal, unfamiliar with clitoral circumcision except in this instance, referred Plaintiff to social worker Lauree Ramsden, who recommended medication, leading to a prescription for Zoloft.
Plaintiff underwent examination by Dr. William Saye, a gynecology expert, who testified about his findings at trial. He noted asymmetrical features in the perineal area, specifically that the right side of the clitoris was absent, presenting a crater-like appearance at its base. He observed a scar on the right side of the vagina, approximately 1.5 cm long, with evidence of sutures. Dr. Saye concluded that the abnormalities were consistent with either an injury or an electrical burn, possibly from electrocautery used during the surgery in question.
Additionally, Dr. Neal conducted a joint examination with Dr. Saye, where they took pictures for trial evidence. Dr. Neal reported that during this examination, Plaintiff exhibited less tenderness and suggested that what they observed might be remnant clitoral tissue, though he was not as certain as Dr. Saye.
Defendant, who performed the surgery, testified that Plaintiff had requested the removal of a skin tag prior to the procedure. He claimed she was lucid and aware during their interactions, but admitted there were no witnesses to this consent conversation, nor did he obtain a signed consent form. This discussion took place after Plaintiff received Valium but before she was administered Versed, which is known to cause amnesia.
Defendant detailed the surgical procedure in which he removed a skin tag from Plaintiff’s right labia minora using tweezers and scissors, followed by stitching the area. He clarified that the skin tag was located at approximately the eleven o’clock position, while an earlier cyst removal by Dr. Gant was on the left labia minora. Defendant asserted that he adhered to standard care practices, emphasizing that minor procedures requested by patients are typically performed if they pose no harm. He stated that he only performed a tubal ligation and the skin tag removal, and there was no need to send the skin tag for lab testing, unlike a cyst which he would have sent for analysis.
Defendant noted that Plaintiff had two stitches from the skin tag and additional stitches from the tubal ligation, using separate suture sets for each area due to differing sterility requirements. In contrast, Plaintiff’s expert, Dr. Neal, indicated that a higher number of stitches would necessitate multiple suture sets, while Plaintiff claimed to have had 10 to 12 stitches but told Dr. Neal there were 15 to 20 stitches. Defendant argued that the surgery, lasting approximately twenty-three minutes, was efficient and without complications, contradicting Plaintiff's claims regarding the number of stitches and duration. He indicated that the scar from the surgery matched a previous laceration from Plaintiff’s childbirth in 1978 and denied the use of electrocautery during the procedure.
Dr. Christopher Mitchell, a resident who assisted in the surgery, corroborated Defendant’s account, stating the procedure was straightforward and involved grasping the skin tag and removing it with scissors, followed by a few interrupted sutures. He noted that the skin tag was located around the nine to ten o’clock position, several centimeters from the clitoris, and confirmed that they subsequently performed the tubal ligation.
Dr. Mitchell testified that no electrocautery was used in the vaginal area during the surgery. Catherine Hooten, the surgical technician, confirmed that the bipolar electrocautery device is approximately eighteen inches long and indicated that skin tags sometimes removed during surgery were not listed on the consent form, often at the patient’s request post-consent. She noted that removed skin tags are typically discarded and not sent for lab analysis. Hooten observed both the vaginal and abdominal surgical areas and confirmed that neither the clitoris nor the frenulum was removed. She stated that an uncomplicated bilateral tubal ligation typically takes about thirty minutes.
Emma Rastell, a retired practical nurse, observed one stitch in the vaginal area during a post-surgery visit. Dr. Charles Hillman, an expert witness, explained that Valium, administered to the Plaintiff before surgery, is an anti-anxiety medication, not a sedative or anesthetic, and is used to calm patients prior to procedures. He opined that the Defendant adhered to the standard of care regarding the skin tag removal, noting that such tags are usually not sent to pathology at the physician's discretion.
Dr. John Rock, another expert witness and reconstructive surgeon, asserted that the Defendant did not remove any part of the clitoris, prepuce, or frenulum, affirming that only a skin tag was removed. Upon examining the Plaintiff in January 2001, Dr. Rock confirmed the presence of the clitoris and its intact structures. He criticized the examining doctors for a lack of knowledge regarding clitoral anatomy, stating that if part of the clitoris had been removed, it would have required specific surgical techniques that were not applied.
The case was brought forth by the Plaintiff under allegations of "intentional conduct and/or negligence" and "medical battery." The jury ruled in favor of the Defendant, leading to a judgment that dismissed the Plaintiff’s claims. The Plaintiff's subsequent motion for a new trial was denied, and she has appealed the decision.
Plaintiff's appeal presents eleven issues, several of which involve newly discovered evidence or post-judgment facts. The Court previously denied Plaintiff's requests to supplement the record with this evidence on September 19, 2003, and December 5, 2003. Consequently, issues related to newly discovered evidence or post-judgment facts will not be considered. The Court identifies the following issues for appeal:
1. Whether the Trial Court erred in admitting Plaintiff’s abortion consent form into evidence.
2. Whether the Trial Court erred in admitting evidence of Plaintiff’s personal finances, company status, and failure to file income taxes.
3. Whether the Trial Court erred in admitting evidence regarding the birth of Plaintiff’s second child.
4. Whether the Trial Court erred in excluding the last page of a hospital bill as evidence.
5. Whether the Trial Court erred in allowing Dustin Gates to testify.
6. Whether there was sufficient material evidence to support the jury’s verdict.
Defendant questions whether the appeal is frivolous. The admission of evidence in Tennessee is reviewed for abuse of discretion, with trial courts having considerable latitude in their determinations. The Supreme Court in Eldridge v. Eldridge outlines that a trial court's ruling will be upheld if reasonable minds can disagree about it, and an abuse occurs only if the court applies an incorrect legal standard or makes an illogical decision causing injustice. Appellate courts generally defer to the trial court's discretionary decisions.
The review begins with whether the Trial Court erred in admitting Plaintiff’s abortion consent form. Plaintiff sought to exclude all evidence regarding her abortions, but the Court ruled on August 20, 2002, that evidence of an abortion one month prior to the relevant surgery was admissible, while excluding prior abortions. At trial, only the consent form from this recent abortion, which included possible complications, was introduced as evidence.
Dr. Neal, the Plaintiff's expert witness, testified that bleeding is a potential complication of an abortion, which is pertinent given Plaintiff's complaint about heavy bleeding following a surgical procedure one month prior. The Trial Court informed potential jurors about the Plaintiff's recent abortion during voir dire and excused those who indicated it could bias their verdict. Ultimately, the final jurors stated their views on abortion would not influence their decision. The Court found no abuse of discretion in admitting the abortion consent form, asserting that any potential error did not likely impact the trial’s outcome, reinforcing this with Dr. Neal's testimony and the voir dire measures.
Regarding Plaintiff's financial status, the Trial Court allowed evidence of her financial difficulties and business practices only if it contradicted her statements or related to credibility. During cross-examination, Plaintiff denied financial distress, but evidence emerged suggesting insolvency, including a letter indicating her potential bankruptcy. Additionally, despite her claims of timely tax filings, she later admitted she had not filed taxes for several years, contradicting her earlier sworn statements. The Trial Court concluded that the inconsistencies in Plaintiff's testimony warranted the admission of evidence concerning her financial issues, affirming the relevance to her motivation and credibility.
Reasonable minds could disagree on the Trial Court's decision to admit evidence regarding the Plaintiff’s financial condition for credibility impeachment, a discretionary choice. The Court found no abuse of discretion in that admission. Similarly, the admission of evidence about the birth of the Plaintiff's second child, which included vaginal scarring relevant to the claimed unwanted surgery, was deemed appropriate. Relevant evidence, per Tennessee Rule of Evidence 401, is defined as evidence that makes a consequential fact more or less probable. Since the evidence of scarring was relevant to the damages claimed, the Court found no abuse of discretion in admitting this evidence.
Regarding the exclusion of the last page of a hospital bill, which only described miscellaneous charges without explanation, the Trial Court ruled it inadmissible due to the potential for jury speculation, a violation of Tennessee Rules of Evidence 401 and 402. The Court upheld the exclusion as reasonable minds could disagree on the propriety of this decision, finding no abuse of discretion.
Lastly, the Court addressed the Plaintiff's objection to Dustin Gates testifying, arguing that his identity and testimony were not properly disclosed during discovery. Although Gates was listed in the Defendant's witness list, the Plaintiff claimed the Defendant failed to identify him in response to interrogatories requesting all possible witnesses. The Court’s handling of this matter was also examined but is not detailed in the excerpt.
Plaintiff alleges that Defendant failed to adhere to discovery rules, asserting that Dustin Gates should have been barred from testifying. However, the appellate record lacks copies of the interrogatories and Defendant’s responses, which are central to Plaintiff's argument. Since Plaintiff conceded that Defendant timely submitted a witness and exhibit list naming Gates, the appellate court found no error in allowing his testimony.
The court then evaluated whether there was material evidence supporting the jury's verdict, emphasizing that jury findings can only be overturned if there is a lack of material evidence. The appellate review is confined to assessing whether any material evidence exists to uphold the verdict, taking the strongest view of the evidence in favor of it.
Defendant testified that his only actions regarding Plaintiff involved performing a tubal ligation and removing a skin tag, asserting he met the standard of care. He described Plaintiff as lucid and aware during the procedure. Additional testimony from Dr. Mitchell and surgical tech Ms. Hooten corroborated that only a skin tag was removed and the tubal ligation was uncomplicated. Nurse Ms. Johnson reported that Plaintiff's post-anesthesia care unit (PACU) stay was uneventful, with no signs of excessive pain or complications, which contradicted Plaintiff's claims. Nurse Ms. Bishop further confirmed that Plaintiff was stable upon discharge and did not exhibit signs of distress.
Ms. Bishop testified that the Plaintiff did not have twelve to eighteen stitches in the clitoral area. Nurse Rastell, who attended to the Plaintiff post-surgery, confirmed only one stitch in the vaginal area. Dr. Hillman, the Defendant’s expert, stated that assessing a patient’s awareness for decision-making is subjective and opined that the Defendant adhered to the standard of care in removing a skin tag, which is typically not sent for pathology unless deemed necessary by the physician. Expert Dr. Rock examined the Plaintiff and concluded that no part of the clitoris, prepuce, or frenulum was removed; only a skin tag was excised. He indicated the surgery did not cause any injury, confirming the presence of the clitoris and its components. He criticized Dr. Neal’s examination techniques, suggesting a lack of understanding of clitoral anatomy. Alan Gates, who had a sexual relationship with the Plaintiff, reported no complaints of pain or lack of sensation during their intimate encounters and believed the Plaintiff experienced orgasms. Both Alan and Dustin Gates testified that the Plaintiff engaged in activities like riding a Sea Doo and an ATV without complaints of pain. The jury found the Defendant's evidence more credible and affirmed the jury’s verdict in favor of the Defendant. The court concluded that the appeal was not frivolous and declined to award attorney's fees to the Defendant. The judgment of the Trial Court was affirmed, with costs assessed against the Appellant, Donna S. Young, and her surety.
