January 10, 2018

“Fights begin and end with handshakes,” at least in the mixed martial arts world, according to Cameron Conaway’s Caged:  Memoirs of a Cage-Fighting Poet.  A handshake between a Tennessee doctor and a patient began a legal fight after the physician allegedly squeezed the patient’s hand too hard.  The doctor scored a pretrial knockout when the trial court dismissed the patient’s claims on the basis that they fell under the medical malpractice act.  But before the bell signaled the fight’s end, the Tennessee Court of Appeals pulled the patient’s claim back off the mat in a December 19, 2017 opinion, Lacy v. Meharry General Hospital, et al.  In medical malpractice fights, this decision potentially increases the liability risks for providers and their insurers by creating uncertainty regarding what claims give rise to a medical malpractice action instead of one for ordinary negligence.


In 2015, Deborah Lacy saw Dr. Nagendra Ramanna, a cardiologist, for shortness of breath.  Dr. Ramanna shook Ms. Lacy’s hand.  Ms. Lacy evidently did not anticipate the strength of Dr. Ramanna’s handshake.  Ms. Lacy, acting as her own lawyer, sued for injuries allegedly caused by the handshake.  She claimed her fingers were “squeezed” too hard and described the handshake as an assault or beating that led to constant pain in her hand and a loss of strength.  Ms. Lacy also alleged Dr. Ramanna was negligent for reading a sonogram and failing to include it in her medical records.

Dr. Ramanna moved to dismiss Ms. Lacy’s Complaint because the claims fell under Tennessee’s Health Care Liability Act and because Ms. Lacy failed to satisfy certain procedural requirements of the Act.  The trial court agreed and dismissed both claims.


Ms. Lacy appealed.  The Tennessee Court of Appeals addressed Ms. Lacy’s claims separately.  The court agreed that Ms. Lacy’s claim about reading and failing to document the sonogram was a medical malpractice claim governed by the Health Care Liability Act.  “[W]e conclude that any claim describing a doctor’s failure to analyze a diagnostic test result and to properly document the result in a patient’s medical records clearly ‘relate[s] to the provision of, or failure to provide, health care services.’”  This claim’s dismissal was affirmed.

But the handshake claim found a way to roll with the doctor’s punches.  The appellate court questioned whether shaking a hand too hard “‘relate[s] to the provision of, or failure to provide, health care services.’”  Utilizing a standard of review that favored the plaintiff, the court re-framed the pro se patient’s claim as alleging the handshake was either an assault or a “non-verbal greeting unconnected to any health care service.”[1]

The court stated, “one reasonable inference [from Ms. Lacy’s allegations] is that Ms. Lacy extended her hand merely as a greeting, a formality upon meeting, and Dr. Ramanna shook Ms. Lacy’s hand either with the same intent or to cause harm.”  Because of this inference, the appellate court could not conclude the handshake claim fell under the Healthcare Liability Act in the case’s procedural posture.  The appellate court reversed the trial court’s dismissal of the handshake claim.


The Lacy case serves as a reminder that state courts are reluctant to dismiss claims in litigation, no matter how trivial or unfounded the claims may seem.  While medical malpractice statutes enacted in the last few decades offer some protections from frivolous claims, those protections may not apply to claims for ordinary negligence, battery, or other torts—even if the claims arise from events occurring in an examination room of a hospital or medical office.  Even the mundane act of greeting a patient with a handshake may create a basis for liability that is beyond the reach of medical malpractice statutes.

Although this doctor’s handshake led to a legal fight, health care providers cannot and should not discard their warmth, kindness, and respect for patients solely to minimize the threat of litigation.

A copy of the opinion is available here.  If you have any questions about the Lacy decision, medical malpractice claims, other claims against health care providers, or how these issues impact your practice, please contact a member of Hancock Daniel’s Medical Malpractice Defense team.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel, Johnson & Nagle, PC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel, Johnson & Nagle, PC be liable for any direct, indirect, or consequential damages resulting from the use of this material.

[1] The appellate court disregarded Dr. Ramanna’s efforts to relate the handshake to the provision of health care services, reasoning that Dr. Ramanna’s unspoken intent behind the handshake was irrelevant at that stage of the case.