Plaintiff, Mikhaila Lenoir filed this healthcare liability action on March 15, 2023, regarding care that occurred at Regional One Health from October 8, 2021 through January 21, 2022. Plaintiff alleged that Regional One Health and its nurses, nurses’ assistants, and other employees allegedly breached the applicable standards of care by:
. . . failing to properly turn Plaintiff in her bed, failing to restrain and attend to plaintiff while sitting in a chair, failing to properly clean and treat Plaintiff’s bed/pressure sores, failing to place Plaintiff’s call device, performing medical procedures on Plaintiff without her informed consent and in blatant disregard for her clearly expressed non-consent, and by severely limiting Plaintiff’s family visitation.
Plaintiff designated Dr. Richisa Salazar as her expert witness. She was responsible for establishing the relevant standard of care. Defendant Shelby County Health Care Corporation filed a motion to exclude the opinions of Plaintiff’s medical expert witness Salazar.
Emergency Medicine Expert Witness
Richisa Salazar is a licensed physician in Mississippi, Texas, Florida and Georgia. She is currently practicing as an emergency room physician with multiple hospitals including several in the Atlanta, Georgia area.
Discussion by the Court
Defendant argued that Salazar’s testimony should be excluded because she (1) is not licensed in a profession or specialty that would make her testimony relevant; (2) does not satisfy Tennessee’s locality rule; and (3) improperly relies on a national standard of care.
A. Whether Salazar is Licensed in a Profession or Specialty that Would Make Her Testimony Relevant
Defendant contended that Salazar’s license in emergency medicine does not amount to a license in a practice or specialty that makes her testimony relevant. Apparently, the issue is that Salazar is not a “wound care specialist.” Defendant insists that Salazar’s experience in the emergency room is irrelevant because the complaint’s allegations pertain to events that occurred while Plaintiff was under continuous care. As they see it, “the issue in this case is the prevention, development and appropriate treatment of pressure injuries.”
The Court finds that Salazar is licensed in a profession or specialty that would make her testimony relevant. The Tennessee Supreme Court has made clear that Tenn. Code. Ann. § 29-26-115 does not require that an expert witness practice the same specialty as the Defendant. 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.”
The Court finds there to be little reason to require that any medical expert witness in this case be licensed as a wound-care specialist; this case turns on whether Defendant’s medical personnel failed to follow basic patient-care protocols as opposed to wound care specialist-specific standards. To that end, Salazar’s license in emergency medicine, her training in Geriatrics, and her experience with pressure ulcers all demonstrate that she is licensed to practice in a profession or specialty that makes her testimony relevant.
B. Whether Salazar Satisfies the Locality Rule
Defendant contended that Salazar failed to establish that she is familiar with the Memphis medical community, or that she practices medicine in a medical community similar to Memphis, and she has not testified as to the Memphis medical community’s standard of care.
i. Whether Salazar’s Deposition Testimony Satisfies the Locality Rule
It is given that Salazar does not practice medicine in Memphis. Defendant argued that the only basis Salazar gave for her conclusion that she practiced medicine in a similar community was her statement that she was familiar with the standard of care in Memphis because it seemed very similar to Jackson, Mississippi where she grew up.
Defendant, however, noted that Salazar never practiced medicine in Jackson, Mississippi. Specifically, Plaintiff acknowledged that Salazar did not know the specific population of the Memphis area, its demographic or socioeconomic makeup, or the exact number of hospitals.
Plaintiff insisted that Salazar’s testimony reflects that she did know that the University of Tennessee Medical School was in the Memphis area and that Regional One Health was Level 1 trauma center which offered a wide range of specialties.
Based on a review of the deposition transcript, the Court held that it would be quite charitable to conclude that Salazar knew either of these facts. Nowhere in this response did Salazar affirm that she “knows” that there are medical schools in Memphis. To the contrary, her response reflects that she is uncertain. Moreover, all of Salazar’s purported knowledge regarding Regional One Health appears to have been derived from a string of assumptions she made because the hospital was treating Plaintiff.
The Court held that Salazar’s deposition testimony does not establish that she is familiar with the Memphis medical community or its standard of care.
ii. Whether Salazar Satisfies the Locality Rule with the Addition of her Affidavit
Plaintiff included a supplemental affidavit, in seeming acknowledgment of the inadequacy of Salazar’s testimony on this matter. Here, Salazar’s familiarity with the Memphis medical community and its standard of care turns on two facts: (1) that she earned her Master’s Degree in Public Health with a concentration in Health services and Doctorate of Medicine from Meharry Medical College in Nashville, and (2) that Memphis is very similar to Atlanta—where she has practiced medicine since 2018—with respect to size, population, medical facilities, and access to medical information.
Concerning (1), Salazar appears to be suggesting that she became familiar with the Memphis standard of care via her “Tennessee medical education.” She also mentions that she frequently visits her family in Memphis. Defendant argued that Plaintiff’s attempt to connect Salazar’s time in medical school in Nashville, Tennessee still fails to satisfy the locality rule because Salazar was in medical school 13 years before the time that the events in this case took place, and her history in Nashville still does not establish her familiarity with Memphis’s medical community.
The Court is not persuaded that Salazar satisfies the locality rule even with the additional information from her affidavit. She fails to explain how her Nashville education provided her with any insight into the Memphis medical community and provides a hazy rationale on why she believes that Atlanta’s medical community is similar to Memphis’s. She also conceded that she was applying a national standard of care when she was testifying.
Held
The Court granted the Defendant’s motion to exclude the opinions of Plaintiff’s medical expert witness Richisa Salazar, M.D.
Key Takeaway:
Given Plaintiff’s concession that Salazar did not know the specific population of the Memphis area, its demographic or socioeconomic makeup, or the exact number of hospitals and the Court’s finding that Salazar has failed to make a strong enough affirmative showing that she has any familiarity with the Memphis medical community and standard of care, the Court concluded that Salazar did not satisfy the locality rule.
Case Details:
| Case Caption: | Lenoir V. Shelby County Health Care Corporation |
| Docket Number: | 2:23cv2138 |
| Court: | United States District Court, Tennessee Western |
| Order Date: | December 16, 2024 |
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