Background
Riley Davidson received an intramuscular steroid injection at Tennova Family Care in Shelbyville, Tennessee in February 2020 for treatment of an upper respiratory infection and sinusitis. The injection was administered by a licensed practical nurse under the supervision of a family nurse practitioner. Davidson developed severe pain immediately after the injection and was subsequently diagnosed with foot drop and right sciatic nerve injury. She sued Shelbyville Hospital Company, LLC and the nurse practitioner for medical negligence, alleging the injection was administered in the danger zone rather than the safe zone, thereby damaging her sciatic nerve. The nurse practitioner was dismissed in July 2024, and the case proceeded to trial against the hospital.
The trial centered on whether the injection was administered in the safe zone (upper outer quadrant of the buttocks), which all experts agreed would not cause sciatic nerve injury, or in the danger zone (center of the buttocks), which could cause such injury. Davidson presented expert testimony that the injection was given in the danger zone and caused sciatic nerve damage. The hospital presented expert testimony, including neurologist Dr. Paul Carney, that the injection did not hit the sciatic nerve. The jury returned a verdict for the hospital.
The Court’s Holding
The Tennessee Court of Appeals vacated the jury verdict and remanded the case for a new trial on the basis of two expert witness errors. First, the court held that the trial court abused its discretion by allowing Dr. Carney to testify about his interpretation of the February 2020 MRI image. While the hospital’s expert disclosures stated that Dr. Carney reviewed “the MRI report,” they did not clearly disclose that he would interpret the actual MRI images at trial. At his deposition, when asked if he had looked at the MRI imaging, Dr. Carney responded “I’m not a radiologist,” which a reasonable person could interpret as indicating he had not reviewed the images. Yet at trial, Dr. Carney showed the jury the MRI image and opined it was “unequivocal” that a spot on the image indicated where the injection was administered. This testimony was undisclosed and amounted to the type of “hide-the-ball legal maneuvering” that Tennessee’s discovery rules prohibit.
The court found this disclosure error more probably than not affected the judgment because the MRI image interpretation was central to the hospital’s causation defense. Second, the court held the trial court erred in allowing nurse practitioner expert Ms. Hogeland to testify without satisfying the locality rule required under Tennessee’s Health Care Liability Act. Ms. Hogeland was licensed in Alabama and testified that Shelbyville, Tennessee was similar to her area in North Alabama based on “Google” research, but had no specific factual knowledge of the Shelbyville medical community. However, the court concluded this error did not more probably than not affect the judgment because all parties’ experts agreed on the applicable standard of care; the only disputed issue was whether the injection was actually administered above or below that line.
Key Takeaways
- Expert witness disclosures must clearly identify the actual basis for opinions, not just general topics reviewed; vague supplemental disclosures that change the scope of testimony constitute discovery violations
- Reviewing a written report differs materially from interpreting images or other source materials, and this distinction must be clearly disclosed
- Discovery violations that deny the opposing party fair notice and adequate preparation time warrant exclusion of testimony or reversal, even if the trial court permits the evidence
- The locality rule in health care liability actions requires specific factual knowledge of the relevant medical community, not general assumptions based on population similarity
- A discovery error requires reversal only if it more probably than not affected the judgment; errors that do not meet this standard may be harmless
Why It Matters
This decision reinforces strict compliance with Tennessee’s discovery rules in medical negligence cases. The court’s holding that the hospital could not shift the basis of its expert’s opinions at trial without clear notice provides important protection for plaintiffs’ ability to prepare adequate counter-evidence. The ruling establishes that supplementing expert disclosures requires specificity; parties cannot use vague language changes to introduce materially different testimony while claiming the information was previously disclosed. For defendants and their counsel, the decision makes clear that expert opinions must be fully and explicitly disclosed in their actual form, not in general categories that might encompass broader testimony later.
The court’s treatment of the disclosure violation—finding it more probably than not affected the judgment based on the central role of the MRI interpretation in the hospital’s defense—signals that Tennessee courts will scrutinize trial-by-ambush tactics closely in medical negligence cases, particularly when the undisclosed evidence directly contradicts the expert’s deposition testimony about what materials he reviewed.