IN THE SUPREME COURT OF TENNESSEE
AT NASHVILLE
THERESA STANBURY and spouse, ) FOR PUBLICATION
JOHN STANBURY, )
) Filed: October 20, 1997
Plaintiffs-Appellants, )
) DAVIDSON COUNTY
v. )
) Hon. Hamilton V. Gayden, Jr.,
BRIAN E. BACARDI, ) Judge
)
Defendant-Appellee. ) Appeal No.
) 01S01-9609-CV-00178
FILED
October 20, 1997
Cecil W. Crowson
Appellate Court Clerk
For Plaintiffs-Appellants: For Defendant-Appellee:
Helen Sfikas Rogers Lela M. Hollabaugh
JONES, ROGERS & FITZPATRICK MANIER, HEROD, HOLLABAUGH & SMITH
Nashville, Tennessee Nashville, Tennessee
OPINION
COURT OF APPEALS AFFIRMED. DROWOTA, J.
In this appeal we must determine whether the common law “continuing
medical treatment doctrine” remains viable in Tennessee and operates to toll the
statute of limitations in medical malpractice cases until the termination of treatment
or the physician/patient relationship. Relying upon that doctrine, the plaintiffs,
Theresa and John Stanbury, argue that the Court of Appeals erred by dismissing this
medical malpractice action which was filed within one year of Theresa Stanbury’s last
office visit with the defendant Dr. Brian E. Bacardi, a podiatrist. The Court of
Appeals found the doctrine inapplicable under the facts of this case, and, in addition
observed that its applicability has been eroded or eliminated in this State by judicial
and legislative adoption of the discovery rule.1 In a separate opinion, Judge Koch
concluded that the doctrine has been completely subsumed into the discovery rule,
and he urged that its abolition be expressly recognized.
We conclude that the common law doctrine of continuing medical treatment
has been completely abrogated by adoption of the discovery rule in Tennessee.
Accordingly, for the reasons explained hereafter, we affirm the decision of the Court
of Appeals dismissing the plaintiffs’ complaint.
BACKGROUND
In 1991, Theresa Stanbury worked on the assembly line at the Saturn
Corporation in Spring Hill, Tennessee. She developed a corn on the fifth toe of her
right foot which caused discomfort while she stood during her ten hour shift. A
1
Teeters v. Currey, 518 S.W.2d 512, 517 (Tenn. 1974); Tenn. Code Ann. § 29-26-
116(a)(2)(1980).
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physician removed the corn and recommended that Stanbury consult a podiatrist.
On November 22, 1991, Stanbury met with Dr. Brian Bacardi. After a cursory
examination, Dr. Bacardi recommended a minor surgical procedure to prevent the
fifth toe on Stanbury’s right foot from lying on top of her fourth toe. Dr. Bacardi
assured Stanbury that recovery time following the surgery would be short and her
work schedule would not be interrupted.
Stanbury signed two consent forms prior to the December 11, 1991 surgery.
One document on Dr. Bacardi’s stationery entitled “Surgery Informer” contained a
brief discussion of the general risks and complications of surgery, but did not identify
the type of surgery Dr. Bacardi planned to perform. The second document was a
Centennial Medical Center form entitled “Consent for Operation, Administration of
Anesthesia and Other Procedures.” In the space provided for describing the
operation to be performed, someone hand wrote: ”Bilateral Osteotomy, Bilateral
Repair Tailor Bunion, Bilateral Arthroplasty, Bilateral Realignment Digit 4 and 5,
Bilateral Removal 5th Toenail.” Stanbury asserts that she was not informed about
the nature of these procedures and that she did not know that she had consented to
surgical procedures on both her feet. Stanbury said that she did not knowingly
consent to anything other than the minor procedure Dr. Bacardi had described in his
office on November 22.
On December 11, 1991, Dr. Bacardi performed extensive surgery on both of
Stanbury’s feet while she was under a general anesthetic. During the mid-afternoon,
Stanbury was released from the hospital, and exited in a wheelchair with both feet
heavily bandaged. Although she could remember very little about the afternoon
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following surgery, Stanbury said that over the following days she realized that surgery
had been performed on both her feet, and she described her feet as “[t]wo big white
blobs.” When Dr. Bacardi removed the surgical dressing during her first office visit
on December 20, 1991, nine days after surgery, Stanbury said she was in “complete
and utter shock” and that she “couldn’t believe all that had been done. There were
so many stitches and so many things, it was just unbelievable.” Stanbury also
noticed that the fifth toe of her right foot was not touching the floor but rather was
pointing straight up in the air. Stanbury said she did not specifically ask Dr. Bacardi
why he had performed surgery on her left foot; however, she asked him generally
what he had done to her feet. According to Stanbury, Dr. Bacardi was very vague
and told her the surgery was necessary to correct hereditary problems.
Stanbury had four more office visits with Dr. Bacardi between January 10 and
March 17, 1992. On April 3, 1992, Dr. Bacardi performed additional surgery to
correct the misalignment of the fifth toe on Stanbury’s right foot. During a post-
operative visit on May 5, 1992, Dr. Bacardi told Stanbury that there was nothing more
he could do for her and that it would take approximately one year for her feet to fully
heal.
Theresa Stanbury2 filed a malpractice action against Dr. Bacardi and Hospital
Corporation of America3 on April 30, 1993. She alleged that Dr. Bacardi had been
negligent in advising her to have surgery, in performing the surgery, and in providing
2
John Stanbury claimed loss of consortium.
3
On June 9, 1993, the plaintiffs voluntarily dismissed all claims against Hospital Corporation
of Am erica , d/b/a Cen tenn ial Ho spita l, and it is not a par ty to this appe al.
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her post-operative care. Stanbury also alleged that Dr. Bacardi had performed
unnecessary surgery, that he had failed to obtain her consent to the surgery
performed on December 11, 1991, that he had ignored her complaints of pain and
infection, and that he had falsified office notes to conceal her actual condition. Dr.
Bacardi responded, denying all wrongdoing and asserting that the claims were barred
by the statute of limitations.
At the close of the plaintiffs’ proof in the jury trial, the trial court directed a
verdict in favor of Dr. Bacardi on the theories of negligent post-operative care,
ignoring Stanbury’s complaints of pain and infection, and intentionally falsifying office
notes to conceal her true condition. The defendant moved for a directed verdict on
the basis that all claims were barred by the one year statute of limitations of the
Tennessee Medical Malpractice Act,4 but the trial court denied that motion finding that
Dr. Bacardi had provided continuing care to Stanbury through the final office visit on
May 5, 1992, which was within one year of the date she filed suit. The trial court
submitted to the jury the plaintiff’s claims concerning lack of informed consent,
advising and performing unnecessary surgery, and negligently performing the
surgeries. In response to a question which arose during jury deliberations, however,
the trial court withdrew the claim for negligently performing the surgeries. The jury
returned a general verdict in favor of the plaintiffs awarding Theresa Stanbury
$211,000 and John Stanbury $10,000.
4
Tenn. Code A nn. § 29-26-116(1980).
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The defendant appealed, and the Court of Appeals reversed the judgment in
favor of the plaintiffs and dismissed the complaint, finding that the claims were barred
by the one year statute of limitations. The intermediate court found the continuing
medical treatment doctrine inapplicable under the facts of this case, and, in addition,
observed that its applicability has been eroded or eliminated in this State by judicial
and legislative adoption of the discovery rule. Judge Koch, in a separate opinion,
agreed with the majority that the informed consent claims were barred by the statute
of limitations. Finding that the continuing medical treatment doctrine has been
completely subsumed into the discovery rule, Judge Koch urged that its abolition be
expressly recognized. However, he dissented from dismissal of the entire case.
Since Stanbury’s unnecessary surgery claim was filed within one year of the time she
was informed by another health care professional that the initial surgery was
unnecessary, Judge Koch opined that it had been timely filed within one year of its
discovery.
Thereafter, we granted the plaintiffs permission to appeal to determine
whether the common law “continuing medical treatment doctrine” remains viable in
Tennessee. For the reasons that follow, we conclude that the common law doctrine
has been subsumed by the discovery rule and therefore affirm the judgment of the
Court of Appeals dismissing the complaint.
CONTINUING MEDICAL TREATMENT DOCTRINE
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Until December 1974,5 negligence actions against health care providers, like
all other actions for injuries to the person in Tennessee, were required to be filed
within one year after the date of the wrongful act that caused the plaintiff’s injury.
Albert v. Sherman, 167 Tenn. 133, 135, 67 S.W.2d 140, 141 (1934); Bodne v. Austin,
156 Tenn. 353, 364-65, 2 S.W.2d 100, 103 (1928); Tenn. Code Ann. § 28-304. The
two most common exceptions to this rule involved continuing torts and fraudulent
concealment of the injury.6
In 1938, the intermediate appellate court adopted the continuing tort principle
in a case involving an employee who had become disabled by breathing chemical
particles in his employer’s plant over an extended period of time. Noting that the
employer had a duty to protect its employees from breathing these particles, the court
held that the employer had committed “one continuous tort, beginning with the
employment and ending only at the time of total disability of the employee and the
termination of his employment.” Tennessee Eastman Corp. v. Newman, 22 Tenn.
5
Teete rs v. Currey, 518 S.W .2d 512, 5 17 (Te nn. 1974 ); Tenn . Code A nn. §29-26-
116(a)(2)(1980).
6
As Judg e Ko ch re cog nized , the fa cts o f this c ase do no t sup port th e pla intiff’s claim of
fraudulent conc ealm ent. T o est ablish frau dulen t con cea lme nt a p laintiff must prove (1) that the
defendant took aff irmative action to co nceal the cause of action o r rem ained silen t and failed to
disclose essen tial facts des pite a duty to do so and (2) the plaintiff could not have discovered the cause
of action de spite exe rcising rea sonab le diligence. Benton v. Snyder, 825 S.W.2d 409, 414 (Tenn.
1992). Because Dr. Bacardi affirmatively and repeatedly advised the plaintiff to wait a year (the precise
statutory time period within which she had to file a malpractice action) for he r fee t to co mp letely h eal,
the proo f in this record supports the first prong of the fraudulent concealment exception. However, the
defense does not a pply because, as we hold, the plaintiff could have discovered the injury through the
exercise of reaso nable diligen ce. Comp are Hall v. De Saussure, 297 S.W.2d 81 (Tenn. App. 1956)
(A physician performed surgery upon the spine of the plaintiff which had not been authorized. The
physician did not inform the plaintiff about the unauthorized procedure. The plaintiff did not discover
the injury until after the expiration of the one year statute of limitations when another physician made
an x-ra y and in form ed th e plain tiff of th e true char acte r of th e sur gery. T he pla intiff b roug ht su it and
the defendant alleged that th e suit was barred by the statute of limitations. Finding that the physician
had a duty to disclose the nature of the surgery because of the confidential physician-patient
relatio nsh ip and conc luding that th e plain tiff could not have discovered the cause of action by
reaso nab le diligence, the intermediate court applied the fraudulent concealment exception and held
that the su it had bee n timely filed.)
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App. 270, 279, 121 S.W.2d 130, 135 (1938). Accordingly, the employee’s action filed
within one year of the onset of his disability and the termination of his employment
was held to be timely filed. Id.; see also Steiner v. Spencer, 24 Tenn.App. 389, 145
S.W.2d 547 (1940).
Several years later, the intermediate appellate court extended the continuing
tort principle to medical malpractice actions. In Frazor v. Osborne, 57 Tenn.App. 10,
414 S.W.2d 118 (1966), the plaintiff brought a medical malpractice action against her
physician and the hospital in which she had undergone surgery over ten years earlier.
During the operation, in 1952, a surgical sponge was placed in her body and
negligently left there upon the operation’s completion. Over the next ten years, the
plaintiff was under the defendant doctor’s care and throughout that time, the incision
from plaintiff’s operation remained open and infected, and as a result, she suffered
severe pain and was eventually totally disabled. On May 2, 1961, some members
of the plaintiff’s family noticed that threads were beginning to work out of the incision.
When Frazor’s family was unable to locate Dr. Osborne, one of his associates made
a house call, probed the incision, and removed portions of the embedded sponge.
The remainder of the embedded sponge was removed shortly thereafter, and within
a few days, the incision completely healed and never caused the plaintiff further
problems.
The plaintiff brought suit in 1962, within one year of the date the sponge was
discovered and removed. The trial court directed a verdict for the defendant doctor
and hospital finding the action barred by the one year statute of limitations. The
Court of Appeals affirmed the trial court’s judgment as to the hospital, but reversed
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as to the doctor, finding that the plaintiff’s cause of action did not accrue until the
physician/patient relationship terminated. Accordingly, in the context of medical
malpractice cases, the continuing tort principle became known as the continuing
medical treatment doctrine.
Six years after Frazor was decided, this Court, in Teeters v. Currey, 518
S.W.2d 512 (Tenn. 1974), adopted the discovery rule for determining when the
statute of limitations begins to run in medical malpractice actions. In that case, the
continuing treatment doctrine was unavailable because the doctor-patient relationship
had terminated approximately three years before the suit was filed. Teeters,
following the birth of a normal child, developed medical complications which led Dr.
Currey, her attending physician, to recommend a tubal ligation to prevent future
pregnancies. Teeters followed his advice and Dr. Currey performed the procedure
on June 6, 1970. On December 6, 1972, Teeters was informed that she was
pregnant, and on March 9, 1973, Teeters gave birth to a premature child with severe
complications. Following a second bilateral tubal ligation, Teeters brought suit
against Dr. Currey on November 15, 1973, almost three and one-half years after the
initial surgery, but only eleven months after discovering her pregnancy.
In concluding that the plaintiff’s claim was timely filed, this Court held that “the
cause of action accrues and the statute of limitations commences to run when the
patient discovers, or in the exercise of reasonable care and diligence for his own
health and welfare, should have discovered the resulting injury.” Teeters, 518
S.W.2d at 515. In choosing to adopt the discovery rule, this Court refused to
embrace a rule of law which would require a plaintiff to sue to vindicate a non-existing
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wrong at a time when the injury is “unknown and unknowable.” Id. This Court did not
address the relationship between the newly adopted discovery rule and the
continuing medical treatment doctrine.
Approximately six months later, the General Assembly included the discovery
rule as part of the Medical Malpractice Claims Act of 1975. Now codified at Tenn.
Code Ann. § 29-26-116, the legislative statute of limitations provides, in pertinent
part, as follows:
(a)(1) The statute of limitations in malpractice actions shall be one (1)
year as set forth in § 28-3-104.
(2) In the event the alleged injury is not discovered within the said one
(1) year period, the period of limitation shall be one (1) year from the
date of such discovery.
(3) In no event shall any such action be brought more than three (3)
years after the date on which the negligent act or omission occurred
except where there is fraudulent concealment on the part of the
defendant in which case the action shall be commenced within one (1)
year after discovery that the cause of action exists.
(4) The time limitation herein set forth shall not apply in cases where a
foreign object has been negligently left in a patient’s body in which case
the action shall be commenced within one (1) year after the alleged
injury or wrongful act is discovered or should have been discovered.
Tenn. Code Ann. § 29-26-116 (1980). The statute of limitations has several key
elements. Section 1 grants an injured party one year within which to bring suit after
the cause of action has accrued. If an injury is not discovered within the one year
time period, Section 2 allows the injured party one year within which to bring suit from
the date of discovery, but Section 3 (a statute of repose) imposes a three-year ceiling
upon that right. If there is fraudulent concealment on the part of the physician or if
a foreign object has been negligently left in a patient’s body by the physician, as was
the case in Frazor, supra, the injured party is entitled to commence a lawsuit within
one year after discovery of the fraudulent concealment or foreign object. Hoffman
v. Hospital Affiliates, Inc, 652 S.W.2d 341 (Tenn. 1983).
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Neither this Court in Teeters, nor the General Assembly in the statute,
explicitly addressed the viability of the continuing medical treatment doctrine.
Therefore, the dispositive inquiry in this appeal is whether the common law continuing
medical treatment doctrine has been abrogated by judicial and legislative adoption
of the discovery rule in this State. We join the intermediate appellate court and
conclude that the doctrine has been abrogated.7
The common law doctrine has been described as follows:
[I]f the facts show continuing medical or surgical treatment for a
particular illness or condition in the course of which there is malpractice
producing or aggravating harm, the cause of action of the patient
accrues at the end of the treatment for that particular illness, injury or
condition, unless the patient sooner knew or reasonably should have
known of the injury or harm. . . .”
Hecht v. Resolution Trust Corp., 635 A.2d 394, 401 (Md. 1994); Robinson v. Mount
Sinai Medical Center, 402 N.W.2d 711, 716 (Wis. 1987). The rationale underlying
the rule is that a patient must trust a physician to remain in his care and during that
care, the patient is not likely to suspect negligent treatment. “It is the trust
relationship that may make discovery of a claim difficult.” Wheeler v. Schmid
Laboratories, Inc., 451 N.W.2d 133, 138 (N.D. 1990).
Considering the formulation of the doctrine, and the rationale upon which it is
based, it is clear that the continuing medical treatment doctrine is merely a
particularized application of the discovery rule. The rule presumes, for policy
reasons, that a patient has not discovered an injury during the time medical treatment
continues. If there is actual proof that the patient knows or reasonably should know
7
See also Hou sh v. M orris , 818 S.W .2d 39, 43-44 (Tenn. App. 199 1).
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of the injury or harm before termination of medical treatment, the statute of limitations
is not tolled. The rule has outlived its necessity in light of the comprehensive medical
malpractice statute of limitations which requires that suit be brought within one year
of the negligent act or within one year of discovery. The statute contains explicit
exceptions for fraudulent concealment and foreign objects which more often result
in lengthy delays. Although the common law doctrine still is recognized in some
jurisdictions,8 it has been judicially or legislatively abrogated in many states following
adoption of the discovery rule. See e.g. Jones v. McDonald, 631 So.2d 869, 873
(Ala. 1993); Ewing v. Beck, 520 A.2d 653 (Del. 1987); Cunningham v. Huffman, 609
N.E.2d 321 (Ill. 1993); Hecht v. First National Bank & Trust Co., 490 P.2d 649 (Kan
1971); Hill v. Fitzgerald, 501 A.2d 27 (Md. 1985); Crumpton v. Humana, Inc., 661
P.2d 54 (N.M. 1983); Russo v. Diethrick, 617 P.2d 30, 35 (Ariz. Ct. App. 1980). The
time for its express abolition has arrived in Tennessee as well.
Having decided that the continuing medical treatment doctrine has been
abrogated by adoption of the discovery rule, we must next determine whether the
Court of Appeals erred in concluding that the plaintiff’s claims are time-barred.
Without question, the plaintiff’s lawsuit was not filed within one year of the alleged
negligent act, the surgery on December 11, 1991. We must therefore determine
whether suit was filed within one year of discovery of an injury.
8
Com men t, When Your Doctor Says, “You Have Nothing to Worry About” Don’t Be So Sure:
The Effect of Fabio v. Bellomo on Medical Malpractice Actions in Minnes ota, 78 Minn. L. Rev. 943, n.53
(Apr il, 1994). Several of the jurisdictions which continue to apply the doctrine have not adopted the
discovery rule. See e.g. Healy v. Langdon, 511 S.W.2d 498 (N eb. 1994 ); Aubin v. Burke, 434 N.W.2d
282 (Minn. Ct. App. 1989).
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We begin our analysis of this issue with the principle that the statute of
limitations commences to run when the patient knows or in the exercise of
reasonable care and diligence should know, that an injury has been sustained.
Teeters, 518 S.W.2d at 515; see also Wyatt v. A-Best, Co., Inc., 910 S.W.2d 851,
854 (Tenn. 1995). In other words, the statute of limitations in a medical malpractice
case is tolled until the plaintiff “discovered, or reasonably should have discovered, (1)
the occasion, the manner, and the means by which a breach of duty occurred that
produced his injuries; and (2) the identity of the defendant who breached the duty.”
Foster v. Harris, 633 S.W.2d 304 (Tenn. 1982). However, it is not necessary that the
plaintiff
actually know that the injury constitutes a breach of the appropriate
legal standard in order to discover that he has a ‘right of action;’ the
plaintiff is deemed to have discovered the right of action if he is aware
of facts sufficient to put a reasonable person on notice that he has
suffered an injury as a result of wrongful conduct.
Roe v. Jefferson, 875 S.W.2d 653, 657 (Tenn. 1994); see also Carvell v. Bottoms,
900 S.W.2d 23, 29 (Tenn. 1995).
Applying that standard to the facts in this case, it is clear that the plaintiff’s
medical malpractice lawsuit is time-barred. Dr. Bacardi performed surgery on
Theresa Stanbury’s feet on December 11, 1991. A few days after surgery, Stanbury
realized that both feet were bandaged and she described them as “[t]wo big white
blobs.” Stanbury maintains that she knowingly consented to surgery on her right foot
only. According to Stanbury, she had no medical problems with her left foot prior to
the surgery performed by Dr. Bacardi. When she questioned Dr. Bacardi about the
reason for the surgery, Stanbury said she received a very vague response. Based on
the record, it appears that shortly after the surgery, Stanbury was aware of facts
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sufficient to put a reasonable person on notice that she had suffered an injury as a
result of wrongful conduct. Not only was she aware of the occasion, manner, and
means by which the breach of duty producing her injuries occurred, she also knew
the identity of the person who breached the duty.
Even assuming that her claim for lack of informed consent is barred by the
statute of limitations, the plaintiff maintains that she had not discovered her claim of
unnecessary surgery until she was informed by another health care professional that
Dr. Bacardi deviated from the standard of care for podiatrists by failing to follow a
conservative treatment regime before recommending surgery. Since she filed suit
within one year of receiving that information, Stanbury argues that her claim was
timely filed. We disagree.
We emphasize that under the discovery rule, the statute begins to run when
the plaintiff knows or in the exercise of reasonable care and diligence should know,
that an injury has been sustained. It is knowledge of facts sufficient to put a plaintiff
on notice that an injury has been sustained which is crucial. Again, a plaintiff need
not “actually know that the injury constitutes a breach of the appropriate legal
standard in order to discover that he has a ‘right of action.’” Roe, 875 S.W.2d at 657;
see also Carvell v. Bottoms, 900 S.W.2d at 29. In other words, a plaintiff need not
actually know the specific type of legal claim he or she has so long as the plaintiff is
“aware of facts sufficient to put a reasonable person on notice that he has suffered
an injury as a result of wrongful conduct.” Id. In this case, the plaintiff was aware of
facts sufficient to put a reasonable person on notice that she had suffered an injury
as a result of the surgery. Advice from another health care professional that a claim
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exists is not a prerequisite to accrual of a medical malpractice cause of action. In
fact, we have specifically rejected such a requirement in the context of medical and
legal malpractice actions. Roe, 857 S.W.2d at 658; Carvell, 900 S.W.2d at 29. Even
assuming Tennessee applied such a rule, which it does not, in this case the plaintiff’s
assertion that she was unaware of her claim for unnecessary surgery until advised
by another health care professional is unpersuasive because she was not so advised
until after she filed the complaint in this case alleging unnecessary surgery.
Stanbury knew or reasonably should have known that she had a right of action
against the defendant, at the latest, by the time of the February, 1992 office visit,
when she realized that the fifth toe on her foot was not in a normal position. However,
more than fourteen months had passed before suit was filed on April 30, 1993.
Accordingly, the plaintiff’s lawsuit is time-barred.
CONCLUSION
Because we conclude that the continuing medical treatment doctrine was
abrogated by adoption of the discovery rule, and the plaintiff’s action was not
instituted within one year of discovery, the lawsuit is time-barred by the statute of
limitations. Accordingly, we affirm the judgment of the Court of Appeals dismissing
the complaint.
_______________________________________
FRANK F. DROWOTA III
JUSTICE
Concur:
Anderson, C. J.
Reid, Birch, Holder, JJ.
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