Plaintiff, Ashley Huddleston 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, 2021, at around 2:36 p.m., Plaintiff presented to the Tristar Northcrest Medical Center ED 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 brought this case against Defendants Samantha Stephens, P.A., and James Nell, M.D. for their alleged negligence in providing her medical care on December 25, 2021.
Specifically, Plaintiff claimed Defendants negligently ordered and administered Dilaudid, which proximately caused her respiratory arrest, cardiac arrest and subsequent pneumothorax, pain/suffering, and long-term hospitalization.
Defendants sought to exclude Dr. David Wiggins for failure to comply with the “locality requirement” of subsection (a)(1) of Tennessee Code Annotated Section 29-26-115.
Emergency Medicine Expert Witness
David Wiggins is a residency trained, board certified emergency physician with over 31 years of continuous full-time emergency medicine experience.
Discussion by the Court
Locality Requirement
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.” The medical expert or experts used by the 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.”
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.
Analysis
Wiggins has: (1) reviewed and become familiar with the size of Springfield’s community and the medical services available there; and (2) had discussions regarding the applicable standard of care relevant to the issues in this case with another medical provider in a neighboring community who also frequently visits the Hospital and Springfield, Tennessee.
He testified that, in 2021, the Hospital was similar in bed-size and services offered to other medical facilities he had worked in and that he was aware that the Hospital was a 109-bed hospital that offered services such as 24-hour emergency room, cardiac, and orthopedic care.
Wiggins has also testified that his home practice is in Thomasville, North Carolina, a community with a population of approximately 27,000 people, which is similar in size to Springfield, Tennessee. Additionally, Wiggins has provided sworn testimony that he has had discussions regarding the Springfield, Tennessee medical community and local standard of care with Dr. George Thomas, a medical provider in Bowling Green, Kentucky who has visited the Hospital and is familiar with the Springfield community.
The Court found that Wiggins has demonstrated familiarity with the medical community of Springfield, Tennessee and a similar community, such that he satisfies the “locality requirement” of subsection (a) of Section 29-26-115.
Moreover, Wiggins has not provided contradictory testimony as to his professional experience or the information he has learned about the Springfield, Tennessee medical community and population size. Plaintiff disclosed Dr. Wiggins as an expert who would be offering his opinions on the standard of care, which necessarily includes his opinions on the locality rule under Tennessee law. Thus, this is not a situation where Defendants can claim surprise that Wiggins would be offering such opinions.
Held
The Court denied the Defendants’ motion to exclude testimony of Plaintiff’s expert David Wiggins, M.D. As only standard of care opinions are subject to the locality rule, the Court held that the Defendants’ motion will be denied to the extent they seek to exclude causation opinions based on a failure to comply with subsection (a)(1).
Key Takeaway:
Because Wiggins has shown familiarity with the Springfield, Tennessee medical community and a similar one, he fulfills the locality requirement under Section 29-26-115(a). His testimony about his professional background and knowledge of Springfield’s medical environment and demographics has been consistent.
Case Details:
| Case Caption: | Huddleston V. Tristar Northcrest Medical Center Et Al |
| Docket Number: | 3:22cv718 |
| Court: | United States District Court, Tennessee Middle |
| Order Date: | April 3, 2025 |
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