Clarissa Bidwell, By Next Friend and Husband, James Bidwell v. Timothy A. Strait, M.D. ( 2019 )


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  •                                                                                              09/18/2019
    IN THE COURT OF APPEALS OF TENNESSEE
    AT KNOXVILLE
    August 22, 2019 Session
    CLARISSA BIDWELL, DECEASED, BY NEXT FRIEND AND HUSBAND, JAMES
    BIDWELL, ET AL. V. TIMOTHY A. STRAIT, M.D., ET AL.
    Appeal from the Circuit Court for Hamilton County
    No. 17-C-832             Kyle E. Hedrick, Judge
    ___________________________________
    No. E2018-02211-COA-R3-CV
    ___________________________________
    Plaintiff, James Bidwell, took his wife, Clarissa Bidwell, to Starr Regional Medical
    Center for treatment. She was transferred to Chattanooga-Hamilton County Hospital
    Authority dba Erlanger Health System, a governmental hospital authority, where she was
    treated, but later died. Plaintiff provided statutorily compliant pre-suit notice of his intent
    to file a health care liability action against each health care provider that was named as a
    defendant in the complaint. See Tenn. Code Ann. § 29-26-121(a). Plaintiff did not
    provide pre-suit notice to Erlanger. Tenn. Code Ann. § 29-26-121(a)(5) requires a
    recipient of pre-suit notice to give written notice to a claimant of any other person, entity,
    or health care provider who may be properly named a defendant within thirty days of
    receiving pre-suit notice. However, Dr. Jeffery Colburn and Dr. Timothy A. Strait failed
    to identify Erlanger as their employer, i.e. a known and necessary party to the suit.
    Plaintiff timely filed his complaint within the 120-day extension of the statute of
    limitations provided by Tenn. Code Ann. § 29-26-121. Defendants answered plaintiff’s
    complaint, each raising the affirmative defense of comparative fault. Dr. Colburn and Dr.
    Strait then moved for summary judgment arguing that, pursuant to the Governmental Tort
    Liability Act, without Erlanger as a party defendant no judgment could be rendered
    against them. See Tenn. Code Ann. § 29-20-310(b). In response, plaintiff filed two
    motions to amend his complaint to add Erlanger as a defendant, in reliance upon the
    extension to the statute of limitations provided in Tenn. Code Ann. § 20-1-119(a). After a
    hearing, the trial court held that plaintiff’s failure to provide pre-suit notice to Erlanger
    prevents him from adding them to his complaint. It granted Dr. Colburn and Dr. Strait’s
    motions for summary judgment. Plaintiff appeals. We hold that Tenn. Code Ann. § 29-
    26-121(a)(5) required Dr. Colburn and Dr. Strait to identify Erlanger as a known and
    necessary party within thirty days after receiving pre-suit notice; they failed to comply
    with § 29-26-121(a)(5). We hold that, pursuant to Tenn. Code Ann. § 20-1-119, their
    subsequent declaration of the necessity of the nonparty to the suit, after the complaint
    was filed, granted plaintiff an additional ninety days following the filing of the first
    answer to amend his complaint in order to add the nonparty as a defendant. See Tenn.
    -1-
    Code Ann. § 20-1-119; see also Tenn. Code Ann. § 20-1-119(g) (stating that this section
    applies to suits involving governmental entities). In addition, we hold that, pursuant to
    Tenn. Code Ann. § 29-26-121(c), plaintiff’s addition of the nonparty is not barred for
    failure to provide pre-suit notice. See Tenn. Code Ann. § 29-26-121(c). Therefore, we
    vacate the trial court’s award of summary judgment to defendants Dr. Colburn and Dr.
    Strait. We remand this matter for further proceedings, pursuant to applicable law, and
    consistent with this opinion.
    Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court
    Vacated; Case Remanded
    CHARLES D. SUSANO, JR., J., delivered the opinion of the court, in which JOHN W.
    MCCLARTY and THOMAS R. FRIERSON, II, JJ., joined.
    Jimmy W. Bilbo and Daniel W. Clanton, Cleveland, Tennessee, for the appellant,
    Clarissa Bidwell, deceased, by next friend and husband, James Bidwell, and James
    Bidwell, individually, and as personal representative of the Estate of Clarissa Bidwell,
    deceased.
    Joshua A. Powers and Alexandra E. Weiss, Chattanooga, Tennessee, for the appellee,
    Jeffrey Colburn, M.D.
    Laura Beth Rufolo, Keith H. Grant, and P. Aaron Wells, Chattanooga, Tennessee, for the
    appellee Timothy A. Strait, M.D.
    OPINION
    I.
    On March 28, 2016, Clarissa Bidwell was hospitalized at Starr Regional Medical
    Center for various cranial ailments. A computed tomography (CT) scan revealed a nine
    millimeter rounded density just lateral to her pituitary; this was concerning for an
    aneurysm and she was transferred by ambulance to the emergency department at Erlanger
    Medical Center for a neurosurgical consultation. A neurosurgical consultation was
    performed by Timothy A. Strait, M.D. A computed tomography angiography of Mrs.
    Bidwell’s head and neck revealed a medially directed aneurysm. On March 29, 2016, a
    cerebral angiogram was performed by Blaise Baxter, M.D., an interventional radiologist.
    On March 30, 2016, after testing and overnight evaluation, Mrs. Bidwell was ultimately
    released by Jeffrey Colburn, M.D., with the consent of Dr. Strait and Dr. Baxter. On the
    way home from Erlanger, she experienced stroke-like symptoms; her husband
    immediately took her back to the hospital where a CT scan revealed that Mrs. Bidwell
    suffered an acute right frontal intracranial hemorrhage. She was returned to Erlanger by
    helicopter ambulance.
    -2-
    On April 1, 2016, Mrs. Bidwell underwent an emergency craniotomy with
    evacuation of intracranial hematoma. On April 4, 2016, she was transitioned to comfort
    care. On April 6, 2016, Mrs. Bidwell died.
    Plaintiff alleges that defendants failed to adequately and timely treat Mrs.
    Bidwell’s condition and negligently discharged her from the hospital. In addition,
    plaintiff alleges that defendants’ negligence fell below the applicable standard of care,
    and Mrs. Bidwell’s injuries and death would not have occurred absent the defendants’
    negligence.
    On March 24, 2017, pursuant to Tenn. Code Ann. § 29-26-121, plaintiff provided
    pre-suit notice of his intent to bring a health care liability action against each health care
    provider that was named as a defendant in the complaint. Plaintiff delivered statutorily
    compliant pre-suit notice to Dr. Strait at Neurosurgical Group of Chattanooga, which was
    the address listed for him on the Department of Health’s website. Plaintiff believed this
    was Dr. Strait’s correct employer; however, his practice had been acquired by
    Chattanooga-Hamilton County Hospital Authority dba Erlanger Health System. Erlanger
    was Dr. Strait’s actual employer during the events comprising plaintiff’s claim. Plaintiff
    did not provide pre-suit notice to Erlanger, nor name it as a defendant. In addition,
    plaintiff sent pre-suit notice to EmCare, Inc. and/or Envision Healthcare Corporation
    believing that Dr. Jeffrey Colburn was an agent or employee of these entities. This was
    inaccurate; he also was an employee of Erlanger.
    As will prove central to our discussion, Chattanooga-Hamilton County Hospital
    Authority, more commonly known as Erlanger, is a governmental hospital authority
    created by Private Act in 1976. See Chattanooga-Hamilton County Hosp. Authority v.
    Bradley County, 
    249 S.W.3d 361
    (Tenn. 2008). Because the Hospital Authority, as
    owner of the Erlanger Health System and employer of Dr. Strait and Dr. Colburn, is a
    governmental entity, the lawsuit before this Court is governed in part by the Tennessee
    Governmental Tort Liability Act (GTLA), which states that:
    No claim may be brought against an employee or judgment
    entered against an employee for damages for which the
    immunity of the governmental entity is removed by this
    chapter unless the claim is one for health care liability
    brought against a health care practitioner. No claim for health
    care liability may be brought against a health care practitioner
    or judgment entered against a health care practitioner for
    damages for which the governmental entity is liable under
    this chapter, unless the amount of damages sought or
    judgment entered exceeds the minimum limits set out in § 29-
    20-403 or the amount of insurance coverage actually carried
    -3-
    by the governmental entity, whichever is greater, and the
    governmental entity is also made a party defendant to the
    action.
    Tenn. Code Ann. § 29-20-310(b). Pursuant to the GTLA, in order to maintain its suit
    against Dr. Colburn and Dr. Strait, plaintiff must have also sued Erlanger. As stated infra,
    despite the statutory mandate, plaintiff failed to serve pre-suit notice to Erlanger, and did
    not name it in his complaint.1
    Defendants Dr. Colburn and Dr. Strait failed to provide plaintiff with “written
    notice” of “any other person, entity, or health care provider who may be a properly
    named defendant,” within thirty days of receiving pre-suit notice, as required by Tenn.
    Code Ann. § 29-26-121(a)(5).2 Significantly, defendants Dr. Colburn and Dr. Strait did
    not notify plaintiff that Erlanger was their actual employer.
    Following the filing of plaintiff’s complaint on July 24, 2017, Dr. Baxter and
    Tennessee Interventional & Imaging Associates, PLLC, Dr. Colburn, and Dr. Strait each
    filed an answer. On August 28, 2017, Dr. Strait filed his answer. On August 28, 2017, Dr.
    Baxter and Tennessee Interventional & Imaging Associates, PLLC filed their answer. On
    September 11, 2017, Dr. Colburn filed his answer.
    In their respective answers, Dr. Colburn, Dr. Baxter, and Dr. Strait raised the
    affirmative defense of comparative fault – more on this later. Additionally, Dr. Colburn
    and Dr. Strait identified Erlanger as the location of the events underlying the present suit
    and the location from which plaintiff was discharged prior to her death, which are central
    components of plaintiff’s health care liability action. In their answer, for the first time,
    Dr. Strait and Dr. Colburn identified nonparty Erlanger as their actual employer during
    the timeframe relevant to plaintiff’s complaint. Dr. Strait and Dr. Colburn both denied
    their individual liability.
    On October 19, 2017, Dr. Strait filed a motion for summary judgment. As stated
    previously in this opinion, Tenn. Code Ann. § 29-20-310(b) allows a physician employed
    by a governmental entity to be personally liable only when the governmental entity is
    also a party defendant. Dr. Strait argued that “[d]uring the time I provided care and
    treatment to Clarissa Bidwell beginning on March 28, 2016, I was an employee of
    Erlanger Medical Center.” He argued that
    As Dr. Strait is an employee of Erlanger Medical Center, any
    medical malpractice lawsuit brought against him, as a
    1
    On March 29, 2019, this Court denied Erlanger’s motion “seeking leave to appear and file a
    brief as an amicus curiae.”
    2
    Effective April 24, 2015, the legislature amended Tenn. Code Ann. § 29-26-121 to add section
    121(a)(5).
    -4-
    governmental employee, must also be brought pursuant to and
    in strict compliance with the Tennessee Governmental Tort
    Liability Act.
    He argued that, “without Erlanger Medical Center as a party defendant, no judgment can
    be rendered against Dr. Strait.” He requested dismissal.
    On November 3, 2017, in response to Dr. Strait’s motion for summary judgment,
    plaintiff filed a motion for leave to amend his complaint. Plaintiff argued that defendant
    failed to adhere to Tenn. Code Ann. § 29-26-121(a)(5), because he failed to notify
    plaintiff that Dr. Strait was actually employed by and/or an agent of Erlanger. In addition,
    plaintiff argued that Dr. Strait had placed comparative fault at issue by alleging in his
    answer that an entity not a party to the suit caused or contributed to the injury or damage
    for which plaintiff was seeking recovery. Plaintiff argued that, pursuant to Tenn. Code
    Ann. § 20-1-119 and Tenn. R. Civ. P. 15.01, and so that the proper parties are before the
    court, plaintiff should be permitted to amend his complaint to add Erlanger and cure the
    alleged error. He argued that, pursuant to Tenn. Code Ann. § 20-1-119, his motion to
    amend was timely, because it was submitted within the ninety day extension of the statute
    of limitations granted by § 20-1-119.
    On November 14, 2017, Dr. Colburn also filed a motion for summary judgment.
    Therein, similar to Dr. Strait, he stated that he was employed by “Chattanooga-Hamilton
    County Hospital Authority [dba] Erlanger Health System…during the time that [he]
    provided care and treatment to Clarissa Bidwell related to this action.” He also argued
    that Erlanger is a governmental hospital entity governed by the Tennessee Governmental
    Tort Liability Act, and that because Erlanger, a governmental entity and employer of Dr.
    Colburn, was not made a party, then no judgment could be rendered against him. He
    requested dismissal.
    In response, on November 20, 2017, plaintiff filed his second motion for leave to
    amend his complaint as to Dr. Colburn. He reiterated the same arguments made in his
    first motion to amend.
    On February 23, 2018, the trial court heard oral argument on the motions for
    summary judgment and on plaintiff’s motions to amend. It took the matter under
    advisement. On September 25, 2018, it entered a separate memorandum and order for Dr.
    Colburn and Dr. Strait granting their motions for summary judgment. The trial court held
    in both that
    under the relevant and applicable provisions of the GTLA and
    the HCLA, the Hospital Authority is a proper and necessary
    defendant to this case and its absence as a party defendant, as
    is required under the Governmental Tort Liability Act, makes
    -5-
    Plaintiff’s case fatally defective. Furthermore, the pre-suit
    notice requirement of the HCLA and Plaintiff’s failure to
    conform therewith prevents the Plaintiff from curing the
    Hospital Authority’s absence by adding it as a party via
    amendment. Finally, Tennessee jurisprudence shows that the
    relation back doctrine under Rule 15.03 is altogether
    inapplicable to HCLA pre-suit notices…because Plaintiff
    cannot amend the complaint to add the Hospital Authority as
    a named defendant without violating the explicit pre-suit
    requirements of the HCLA…
    The trial court denied plaintiff’s motion for leave to amend. Plaintiff filed a motion to
    alter or amend the judgment, to make additional findings of fact, or for a new trial. The
    plaintiff’s motions were denied. Plaintiff appeals.
    II.
    On appeal, we consider whether the trial court erred by denying plaintiff’s motions
    to amend and instead granting Dr. Colburn and Dr. Strait’s motions for summary
    judgment.
    III.
    A trial court’s decision to grant a motion for summary judgment presents a
    question of law. Our review is therefore de novo with no presumption of correctness
    afforded to the trial court’s determination. Bain v. Wells, 
    936 S.W.2d 618
    , 622 (Tenn.
    1997).
    IV.
    A.
    The trial court held that plaintiff’s attempt to amend his complaint in order to add
    the Hospital Authority (dba Erlanger) was futile, because plaintiff failed to provide
    Erlanger pre-suit notice prior to filing the complaint:
    In order to have validly named the Hospital Authority as a
    party defendant, Plaintiff had to have delivered to the
    Hospital Authority a compliant pre-suit notice before filing a
    complaint and before the passing of the applicable statute of
    limitations. It is undisputed that Plaintiff failed to do either.
    As was decided in Shockley and re-affirmed in Runions, the
    omission of the pre-suit notice cannot be cured via
    -6-
    amendment under Rule 15.03. Because the pre-suit notice
    cannot be retroactively amended to add the Hospital
    Authority, Plaintiffs motion to amend the complaint is futile.
    As can be seen, in reaching its holding, the trial court considered the Supreme
    Court’s recent decision, in Runions v. Jackson-Madison Cty. Gen. Hosp. Dist., 
    549 S.W.3d 77
    , 85–86 (Tenn. 2018) (citations omitted). In Runions, the plaintiff and her
    infant daughter had been treated at the defendant hospital. The infant daughter died due
    to the alleged medical negligence of several health care providers. Plaintiff sent pre-suit
    notices to several entities, all of whom had the same registered agent. Defendants filed
    for summary judgment, because plaintiff failed to give pre-suit notice to, and ultimately
    add to the complaint, Jackson-Madison County General Hospital, which was a necessary
    defendant. Plaintiff argued that they intended to file suit against the proper entity, but got
    the name wrong, and sought to substitute a health care provider as a defendant after the
    expiration of the statute of limitations. 
    Id. Despite proffered
    evidence that Jackson-
    Madison was put on constructive notice of the lawsuit, because it’s registered agent was
    identical to that of several already-named defendants, the Supreme Court held that such
    constructive notice was insufficient to satisfy the requirements of Section 121(a)(1). 
    Id. The Runions
    case followed another Supreme Court decision, in Shockley v.
    Mental Health Coop., Inc., 
    429 S.W.3d 582
    (Tenn. Ct. App. 2013), that reached a
    similar conclusion regarding the addition of a nonparty to a health care liability action. In
    Shockley, the plaintiff named a fundraising organization, rather than the corporate body
    that managed the facility and provided care to the patient, as a defendant. See Shockley v.
    Mental Health Coop., Inc., 
    429 S.W.3d 582
    (Tenn. Ct. App. 2013). The Supreme Court
    held that pre-suit notice to a corporate health care provider that contained a misnomer
    was insufficient to constitute notice to the proper defendant. 
    Id. While the
    Supreme Court held, in Runions, that, “[w]e [] cannot vary the language
    of the statute to allow a plaintiff to avoid compliance with the pre-suit notice statute when
    she does not correctly identify the potential defendant,” it is important to recognize that
    the applicable statute has since been amended by the legislature. Auspiciously, following
    the Supreme Court’s decision in Shockley, and after Runions began its journey through
    the courts, the legislature amended Tenn. Code Ann. § 29-26-121 to add Section
    121(a)(5). Following the amendment, the onus is no longer on the plaintiff alone to
    correctly identify all potential defendants to a health care liability action.
    Effective April 24, 2015, and applicable to the present matter, Tenn. Code Ann. §
    29-26-121(a)(5) states that
    [i]n the event a person, entity, or health care provider receives
    notice of a potential claim for health care liability pursuant to
    this subsection (a), the person, entity, or health care provider
    -7-
    shall, within thirty (30) days of receiving the notice, based
    upon any reasonable knowledge and information available,
    provide written notice to the potential claimant of any other
    person, entity, or health care provider who may be a properly
    named defendant.
    This provision is mandatory. See Tenn. Code Ann. § 29-26-121(a)(5) (stating
    “shall…provide written notice”); Myers v. AMISUB (SFH), Inc., 
    382 S.W.3d 300
    , 308
    (Tenn. 2012) (holding that the use of the word “shall” in statutes indicates that the
    legislature intended the requirements to be mandatory, not directory).
    As mentioned above, Tenn. Code Ann. § 29-26-121(a)(5) was enacted after
    Shockley was decided, and was not yet applicable to the factual scenario before the
    Supreme Court in Runions. Additionally, neither matter addressed the issue of
    comparative fault. Therefore, the matter before this Court arises in both a different
    statutory and situational context, and is therefore distinct from Runions and Shockley.
    B.
    This matter implicates the amendment in Section 121(a)(5), and we are tasked
    with interpreting and applying it in the matter presently before this Court. In so doing, we
    are asked to consider: what is the result when a recipient of pre-suit notice fails to comply
    with § 29-26-121(a)(5), and then requests the dismissal of a matter based upon a
    claimant’s failure to add a necessary party that was known to the recipient of pre-suit
    notice and should have been identified to claimant following receipt of pre-suit notice
    and prior to the claimant filing the complaint, pursuant to § 29-26-121(a)(5)?
    In order to resolve this issue, we must first determine what Tenn. Code Ann. § 29-
    26-121(a)(5) requires of a recipient of pre-suit notice. Defendants argue that Tenn. Code
    Ann. § 29-26-121(a)(5) only requires the recipient of pre-suit notice to correct a
    misnomer, and that it does not require the recipient to identify additional parties not
    named by claimant. The plain language of the statute renders the defendants’
    interpretation untenable.
    In § 29-26-121(a)(5), the enacted language instructs the recipient of pre-suit notice
    to provide a claimant with “written notice” of
    any other person, entity, or health care provider who may be a
    properly named defendant.
    (Emphasis added). Here, the word “other” is used as an adjective modifying “person,
    entity, or health care provider” in the sentence. The word “other” is not a technical term;
    it is defined in common parlance as:
    -8-
    being the one (as of two or more) remaining or not included;
    being the one or ones distinct from that or those first
    mentioned or implied; not the same; additional.
    See Merriam-Webster Dictionary, Other, (Sept. 4, 2019) merriam-webster.com
    /dictionary/other (adjectival definition). As used in § 29-26-121(a)(5), “other,” in the
    most plain terms, indicates that the legislature intended the recipient of pre-suit notice to
    identify “person[s], entit[ies], or health care provider[s]” not included, additional, or
    distinct from that or those first mentioned by the claimant in the pre-suit notice.
    Furthermore, by modifying the word “other” with “any,” the enacted language
    clarifies that the recipients of pre-suit notice are to provide the claimant with what
    amounts to a complete and total identification of all those “who may be a properly named
    defendant” based upon the “reasonable knowledge and information available” to the
    party that received the pre-suit notice. See Tenn. Code Ann. § 29-26-121(a)(5).
    This understanding is not only in accordance with the plain language of the statute,
    but is also consistent with the statute’s purpose; as stated by the Supreme Court, “[p]re-
    suit notice benefits the parties by promoting early resolution of claims, which also serves
    the interest of judicial economy.” Runions v. Jackson-Madison Cty. Gen. Hosp. Dist.,
    
    549 S.W.3d 77
    , 86 (Tenn. 2018). Section 121(a)(5) further promotes judicial economy
    and the early resolution of claims by ensuring that all proper parties are identified by
    claimants. Correspondingly, this promotes a decrease in the addition of unnecessary
    parties to health care liability actions, i.e. those whom claimants may otherwise
    unnecessarily include in an abundance of caution.
    The onus is no longer solely on the claimant to identify all necessary parties to a
    health care liability action. Following the addition of § 29-26-121(a)(5), it therefore
    stands to reason that a defendant may not withhold the identity of a known or necessary
    person, entity, or health care provider who may be a properly named defendant.
    C.
    Returning to the present matter, it is clear that defendants Dr. Colburn and Dr.
    Strait did not comply with Tenn. Code Ann. § 29-26-121(a)(5); as a matter of fact, they
    did not even attempt to comply.3 Instead, they let the thirty days expire, and filed answers
    to plaintiff’s complaint. The first time Dr. Colburn and Dr. Strait identified Erlanger as
    3
    Defendants Dr. Colburn and Dr. Strait argue that if they had provided written notice plaintiff
    would not have been able to provide pre-suit notice to Erlanger in a timely manner. This argument is
    immaterial given that Dr. Colburn and Dr. Strait did not, in fact, provide the written notice mandated by
    Tenn. Code Ann. § 29-26-121(a)(5).
    -9-
    their actual employer, and as a nonparty health care provider who should be a properly
    named defendant, was in their answers.
    Interestingly, and as will prove relevant to our resolution, their respective answers
    included: (1) notice of the identity of a potential nonparty tortfeasor, (2) facts that
    reasonably support a conclusion that the nonparty caused or contributed to the plaintiff’s
    injury, (3) a denial of individual liability, and (4) statements placing comparative fault at
    issue. In their respective answers, Dr. Colburn and Dr. Strait raised, and/or otherwise
    placed at issue, the affirmative defense of comparative fault. Dr. Colburn stated that
    …Dr. Colburn raises the affirmative defense of comparative
    fault. Should the evidence, as developed through the course of
    investigation and discovery, or at trial, indicate that others,
    including but not limited to the other parties in this matter,
    were guilty of negligence that caused or contributed to the
    injuries and damages alleged in the Complaint, if any, then
    Dr. Colburn reserves the right to amend his Answer and to
    show the same at trial.
    In his answer, Dr. Strait also stated that
    This defendant reserves the right, should discovery or
    evidence, including that presented at trial, indicate it
    appropriate, to plead the comparative negligence of the
    decedent or any other person or entity, as a proximate or
    contributing cause of all or a portion of the alleged injuries
    and damages, and to take into account such evidence in
    apportioning or comparing negligence or fault, causation or
    damages, whether in apportionment or mitigation. At this
    time, this defendant has no knowledge of any persons except
    the parties identified and as set forth in the plaintiff's
    Complaint to which this doctrine would apply.
    In addition to raising comparative fault, Dr. Strait and Dr. Colburn identified
    Erlanger as the location of the events underlying the present suit, the location from which
    plaintiff was allegedly improperly discharged, and as the actual employer of alleged at-
    fault doctors Dr. Strait and Dr. Colburn. In his answer, Dr. Strait stated that
    It would be shown that at all material times Dr. Strait was
    employed by Erlanger Health System and provided healthcare
    services to Clarissa Bidwell in the course and scope of his
    employment with Erlanger Health System.
    -10-
    *     *      *
    It is admitted Clarissa Bidwell was transferred from Starr
    Regional Medical Center to Erlanger Medical Center.
    *     *      *
    It is admitted Mrs. Bidwell was discharged from Erlanger on
    March 30, 2016.
    *     *      *
    it is denied this defendant was negligent in the care and
    treatment he provided to Clarissa Bidwell or that he was a
    direct or proximate cause of any alleged injuries and death
    suffered by Mrs. Bidwell.
    *     *      *
    this defendant is without information or knowledge sufficient
    to form a belief as to what occurred on the way home from
    Erlanger Medical Center... It is admitted Mrs. Bidwell was
    returned to Erlanger for a higher level of care. It is
    specifically denied this defendant was negligent in the care
    and treatment of Mrs. Bidwell or that he was a direct or
    proximate cause of any alleged injuries or death suffered by
    Mrs. Bidwell.
    *     *      *
    It would be shown that in April, 2015, The Neurosurgical
    Group of Chattanooga, P.C., sold its assets to Erlanger
    Medical Center and ceased conducting business.
    -11-
    Dr. Colburn stated that
    Dr. Colburn admits that he provided medical care to Clarissa
    Bidwell in Hamilton County at the Chattanooga-Hamilton
    County Hospital Authority d/b/a Erlanger Health System
    (“Erlanger”) in 2016.
    *     *      *
    Dr. Colburn admits upon information and belief that Clarissa
    Bidwell presented to Starr Regional Medical Center in
    Athens, Tennessee, and on March 28, 2016 Clarissa Bidwell
    was transferred from Starr Regional Medical Center to
    Erlanger for possible aneurysm.
    *     *      *
    Dr. Colburn admits that Clarissa Bidwell was prescribed
    Plavix and aspirin, was discharged from Erlanger on March
    30, 2016 by Dr. Colburn with the consent of Dr. Strait and
    Dr. Baxter
    *     *      *
    Dr. Colburn admits that Clarissa Bidwell returned to Erlanger
    for further care on March 30, 2016.
    *     *      *
    Dr. Colburn admits that he provided care to Clarissa Bidwell
    at Erlanger on the dates as reflected in the medical records.
    -12-
    *      *      *
    To the extent that Plaintiffs allege any negligence or deviation
    from the applicable standard of care by Dr. Colburn, Dr.
    Colburn would show that at all material times, the services,
    care and treatment provided to Clarissa Bidwell were
    performed in accordance with that degree of skill, learning
    and experience ordinarily used, possessed and practiced by
    such healthcare practitioners in the Chattanooga, Hamilton
    County, Tennessee community and/or similar communities;
    that accepted and proper methods were used; that Dr. Colburn
    met the standard of care set forth in T.C.A. § 29-26-101, et
    seq.; and that the services, care and treatment delivered to
    Clarissa Bidwell at all times were in accordance with the
    reasonable requirements of good care and practice, and in
    accordance with the generally accepted standard of care and
    practice in the Chattanooga, Hamilton County, Tennessee
    community and/or similar communities. It is specifically
    denied that the matters set forth in the Complaint were a
    result of any negligent act or omission by Dr. Colburn, or the
    failure on the part of Dr. Colburn to act with ordinary and
    reasonable care.
    As outlined above, both Dr. Colburn and Dr. Strait also denied they were at fault for any
    injuries that occurred to Mrs. Bidwell. Furthermore, Dr. Baxter also raised the issue of
    comparative fault, and argued for its application to the present matter at a later hearing.
    After filing their answers, Dr. Colburn and Dr. Strait moved for summary
    judgment based upon plaintiff’s failure to add a necessary party – Erlanger – to his
    complaint. As stated earlier in this opinion, Erlanger must be a party in order to sustain
    the cause of action against Dr. Colburn and Dr. Strait, pursuant to the GTLA. On
    November 3, 2017 and on November 20, 2017, as to Dr. Strait and Dr. Colburn
    respectively, plaintiff filed motions to amend his complaint in order to add Erlanger as a
    defendant. In his motion, plaintiff argued that:
    Tenn. Code Ann. § 20-1-119(a)(1)-(2) provides for the
    joinder of third party defendants when comparative fault is or
    becomes an issue.
    *      *      *
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    As a result, defendant [] has placed comparative fault at issue
    in this case by alleging in his Answer to the original
    Complaint that an entity not a party to the suit caused or
    contributed to the injury or damage for which Mr. Bidwell is
    seeking recovery.
    Tenn. Code Ann. § 20-1-119 states that
    if a defendant named in an original complaint initiating a suit
    filed within the applicable statute of limitations…alleges in
    an answer…that a person not a party to the suit caused or
    contributed to the injury or damage for which the plaintiff
    seeks recovery, and if the plaintiff’s cause or causes of action
    against that person would be barred by any applicable statute
    of limitations but for the operation of this section, the plaintiff
    may, within ninety (90) days of the filing of the first answer
    or first amended answer alleging that person’s fault, either:
    (1) Amend the complaint to add the person as a defendant
    pursuant to Tenn. R. Civ. P. 15 and cause process to be issued
    for that person…
    Tenn. Code Ann. § 20-1-119(a). Plaintiff argued that his motion to add Erlanger was not
    barred by the statute of limitations, because § 20-1-119(a) permitted him an additional
    ninety days in which to file his amended complaint.
    Regarding comparative fault, the Supreme Court has held that there is no specific
    formula required in a pleading in order to place it at issue. In Austin v. State, automobile
    accident victims brought an action against a county to recover for negligence. Austin v.
    State, 
    222 S.W.3d 354
    , 355 (Tenn. 2007). The county filed its answer; the victims then
    filed a complaint against the state more than one year after the accident, but within ninety
    days after the county’s answer. The Supreme Court granted review in order to determine
    whether Tenn. Code Ann. § 20-1-119 provided a plaintiff with a ninety-day extension of
    the statute of limitations when a defendant does not explicitly allege the fault of a
    nonparty. The Supreme Court held that the statute does give plaintiff an additional ninety
    days to file suit against a potential nonparty tortfeasor whenever a defendant’s answer
    gives a plaintiff notice of the nonparty’s identity and alleges facts that reasonably support
    a conclusion that the nonparty caused or contributed to the plaintiff’s injury. 
    Austin 222 S.W.3d at 355
    .
    In Austin, the Supreme Court held that Tenn. Code Ann. § 20-1-119 applies
    whether the nonparty is alleged to be partially responsible or totally responsible for the
    -14-
    plaintiff’s injuries. Because the county’s answer identified the state as a nonparty and
    alleged facts that reasonably supported a conclusion that the state caused or contributed
    to the Austins’ injuries, it held that Tenn. Code Ann. § 20-1-119 was applicable, and that
    the complaint was timely filed within the ninety day extension provided therein. 
    Id. The Supreme
    Court further clarified that a precise formula is not required for
    identifying a potential at-fault nonparty. It stated that:
    The State contends that Tennessee Code Annotated section
    20–1–119 requires defendants to allege explicitly that the
    nonparty tortfeasor caused or contributed to the plaintiff’s
    injury. However, a plaintiff should not be denied an
    opportunity to recover against that potential tortfeasor simply
    because a defendant’s answer did not follow a precise legal
    formula. See Romine v. Fernandez, 
    124 S.W.3d 599
    , 604–05
    (Tenn. Ct. App. 2003) (holding that a defendant who gave
    plaintiff sufficient notice of a nonparty tortfeasor had raised
    the defense of comparative fault even though he did not
    explicitly allege the fault of the nonparties). Moreover, under
    Rule 8.03 of the Tennessee Rules of Civil Procedure, a
    defendant may successfully raise the defense of comparative
    fault by “set[ting] forth affirmatively facts in short and plain
    terms relied upon to constitute ... comparative fault (including
    the identity or description of any other alleged tortfeasors).”
    A defendant is not required to allege the fault of the nonparty
    explicitly or use the words “comparative fault.” Consistent
    with the liberal pleading standards of the Tennessee Rules of
    Civil Procedure, the determination of whether comparative
    fault is an issue cannot turn on the presence or absence of
    such precise language. See Karash v. Pigott, 
    530 S.W.2d 775
    ,
    777 (Tenn. 1975) (stating that the Tennessee Rules of Civil
    Procedure “are designed to insure that cases and controversies
    be determined upon their merits and not upon legal
    technicalities or procedural niceties”).
    Based on the foregoing principles, we conclude that
    Tennessee Code Annotated section 20–1–119 applies
    whenever a defendant’s answer gives a plaintiff notice of the
    identity of a potential nonparty tortfeasor and alleges facts
    that reasonably support a conclusion that the nonparty caused
    or contributed to the plaintiff’s injury.
    
    Austin, 222 S.W.3d at 357
    –58.
    -15-
    In addition, in Romine v. Fernandez, this Court held that tentative statements of
    comparative fault, in a physician’s answer, were sufficient to trigger Tenn. Code Ann. §
    20-1-119’s grace period in order to permit the plaintiff to add claims against allegedly
    comparatively negligent defendants. Romine v. Fernandez, 
    124 S.W.3d 599
    (Tenn. Ct.
    App. 2003). This Court stated that
    Our Supreme Court has previously stated that section 20–1–
    119 was enacted in response to this Court’s adoption of
    comparative fault, and that the concepts of fairness and
    efficiency form the basis of such a system. The purpose
    behind the statute is to “provide an injured party with a fair
    opportunity to bring before the court all persons who caused
    or contributed to the party’s injuries.” In light of this purpose,
    this statute is not to be construed narrowly, but should be
    construed liberally.
    Romine v. Fernandez, 
    124 S.W.3d 599
    , 604 (Tenn. Ct. App. 2003) (internal citations and
    quotations omitted). Additionally, this Court clarified that the fact that plaintiff knew of
    the party’s identity, or should have known of the party’s identity, prior to filing the suit,
    is irrelevant:
    Whether the Romines knew or should have known of [the
    additional parties] and their status as potential defendants is
    irrelevant to the application of Tennessee Code Annotated
    section 20–1–119. See 
    Townes, 50 S.W.3d at 452
    –
    453 (holding that “a plaintiff’s knowledge of the existence of
    other persons who might be liable for the plaintiff’s injuries is
    irrelevant”). The Romines timely filed their amended
    complaint which saved their claims from being time barred.
    Romine v. Fernandez, 
    124 S.W.3d 599
    (Tenn. Ct. App. 2003) (affirming the trial court;
    application for permission to appeal denied by the Supreme Court).
    Based on the foregoing, it is clear that comparative fault has been placed at issue
    in the present matter, and therefore Tenn. Code Ann. § 20-1-119 is applicable. According
    to the principles espoused therein, it follows that the result of defendants’ decision to
    withhold the identity of a known and necessary defendant, and decision to instead
    identify the necessary nonparty in their answer, is that plaintiff is entitled to the extension
    to the statute of limitations provided in Tenn. Code Ann. § 20-1-119(a); see also Tenn.
    Code Ann. § 20-1-119(g) (explicitly stating that this section applies to suits involving
    governmental entities). This is consistent with the legislature’s mandatory instruction that
    -16-
    all known potential defendants are to be identified in health care liability actions. See
    Tenn. Code Ann. § 29-26-121(a)(5).
    D.
    Despite the foregoing, do we not simply end up back where we began, where
    plaintiff’s failure to provide pre-suit notice to the nonparty bars its addition to the
    complaint? No, because while pre-suit notice is a precursor to filing a health care liability
    action, there are two relevant situations in Tenn. Code Ann. § 29-26-121 in which failure
    to provide written pre-suit notice of a claim may be excused. First, courts have
    “discretion to excuse compliance with this section [] for extraordinary cause.” Tenn.
    Code Ann. § 29-26-121(b). We need not consider exercising our discretion here. Second,
    Tenn. Code Ann. § 29-26-121(c) states that
    [o]nce a complaint is filed alleging a claim for health care
    liability, the notice provisions of this section shall not apply
    to any person or entity that is made a party to the action
    thereafter by amendment to the pleadings as a result of a
    defendant’s alleging comparative fault.
    Tenn. Code Ann. § 29-26-121(c). This provision clarifies that the legislature envisioned
    the interplay between health care liability pre-suit notice and comparative fault. The
    legislature’s instruction directs their reconciliation; when comparative fault is at play
    following a filed complaint, pre-suit notice takes the backseat.
    Tenn. Code Ann. § 29-26-121(a)(5) states that recipients of pre-suit notice have an
    obligation to provide a claimant written notice of a potentially proper defendant, based
    upon any reasonable knowledge and information available, within thirty days of the
    receipt of pre-suit notice. This provision is mandatory. See Tenn. Code Ann. § 29-26-
    121(a)(5) (stating “shall…provide written notice”); Myers v. AMISUB (SFH), Inc., 
    382 S.W.3d 300
    , 308 (Tenn. 2012) (holding that the use of the word “shall” in statutes
    indicates that the legislature intended the requirements to be mandatory, not directory). If
    a recipient does not identify a potential defendant, and then alleges the fault of that
    nonparty or attempts to dismiss the complaint or receive summary judgment based on the
    nonparty’s absence, it is logical that plaintiff be permitted to add that party based upon
    the concepts of fairness and efficiency at the core of comparative fault. See Austin v.
    State, 
    222 S.W.3d 354
    , 355 (Tenn. 2007); Romine v. Fernandez, 
    124 S.W.3d 599
    (Tenn.
    Ct. App. 2003); Tenn. Code Ann. § 20-1-119; Tenn. Code Ann. § 29-26-121(c). When
    this occurs, the statute of limitations is extended for ninety days following the first
    answer, pursuant to Tenn. Code Ann. § 20-1-119, and pre-suit notice to that party is no
    longer required, pursuant to Tenn. Code Ann. § 29-26-121(c) (“[o]nce a complaint is
    filed alleging a claim for health care liability, the notice provisions of this section shall
    not apply to any person or entity that is made a party to the action thereafter by
    -17-
    amendment to the pleadings as a result of a defendant’s alleging comparative fault”).
    Therefore, failure to provide pre-suit notice does not bar the addition of Erlanger to
    plaintiff’s complaint.
    E.
    As a final matter, we quickly address whether or not plaintiff successfully filed his
    motion to amend the complaint within ninety days following the filing of the first answer.
    On August 28, 2017, the first answers were filed by Dr. Baxter and Dr. Strait. Therein,
    the issue of comparative fault was first raised, nonparty Erlanger was identified, and
    correspondingly, Tenn. Code Ann. § 20-1-119 was triggered. In accordance with Tenn.
    Code Ann. § 20-1-119(a), on November 3, 2017 and on November 20, 2017, plaintiff
    filed motions to amend his complaint in order to add Erlanger. Simple math dictates that
    both motions were filed within ninety days of the first answer.
    V.
    In sum, neither the statute of limitations nor the pre-suit notice requirements of
    Tenn. Code Ann. § 29-26-121 are impediments to plaintiff’s timely filed motions to
    amend his complaint in the context of a claim for comparative fault. The addition of
    Erlanger will cure plaintiff’s failure to comply with the GTLA.
    Accordingly, we vacate the trial court’s award of summary judgment to defendants
    Dr. Jeffrey Colburn and Dr. Timothy A. Strait. Costs on appeal are taxed to the appellees,
    Dr. Jeffrey Colburn and Dr. Timothy A. Strait. This matter is remanded for further
    proceedings, pursuant to applicable law, and consistent with this opinion.
    _______________________________
    CHARLES D. SUSANO, JR., JUDGE
    -18-