Sixth Circuit Reaffirms Tennessee’s Locality Rule and Permits Sua Sponte Summary Judgment After Expert Exclusion

Lenoir v. Shelby County Health Care Corporation (d/b/a Regional One Health)

Court: United States Court of Appeals for the Sixth Circuit

Date: October 20, 2025

Panel: Judges Moore, Clay, and White. Opinion by Judge Clay.

Disposition: Affirmed (exclusion of plaintiff’s expert and entry of summary judgment for defendant).

Publication Status: Not recommended for publication.

Introduction

This appeal arises from a Tennessee medical malpractice action tried in federal court under diversity jurisdiction. After excluding the plaintiff’s lone medical expert for failing to satisfy Tennessee’s “locality rule” (Tenn. Code Ann. § 29-26-115(a)(1)), the district court issued an order to show cause. Plaintiff conceded she could not proceed without the excluded expert. The court then dismissed the case with prejudice and entered judgment for the hospital. The Sixth Circuit affirmed, holding that:

An expert who lacks a modicum of familiarity with the defendant’s medical community—or a demonstrably similar community—does not satisfy Tennessee’s locality rule and may be excluded under Federal Rule of Evidence 702 because such testimony would not assist the trier of fact.
A district court may enter summary judgment sua sponte after excluding the plaintiff’s indispensable expert, so long as the losing party receives notice and a reasonable opportunity to respond (here, fourteen days was sufficient).
Competency to testify under Tenn. Code Ann. § 29-26-115(b) is distinct from proving the locality rule under § 115(a); satisfying subsection (b) does not establish compliance with subsection (a).

The case reinforces a critical, practical point for Tennessee health-care liability litigation: plaintiffs must lay a concrete, locality-specific foundation for their experts. Generalized assertions about “nationwide” standards and generic community similarities are not enough.

Background

Plaintiff Mikhaila Lenoir became a quadriplegic after an October 8, 2021 automobile accident. She received care at Regional One Health (operated by defendant Shelby County Health Care Corporation) in Memphis from October 8, 2021 through January 21, 2022. Lenoir alleged multiple lapses in care—e.g., failures to turn a bedbound patient, to restrain and attend while seated, to timely change diapers, to clean and treat pressure sores, to place call devices, and to honor informed-consent preferences—leading to worsening pressure ulcers, a fall and bruising, respiratory distress, pain and suffering, and delayed rehabilitation.

Tennessee’s medical malpractice statute requires plaintiffs to prove three elements, typically via expert testimony: (1) the “recognized standard of acceptable professional practice” in the relevant profession and specialty in the community where the defendant practices or in a similar community; (2) a breach of that standard; and (3) injury proximately caused by the breach. Tenn. Code Ann. § 29-26-115(a)(1)–(3); Shipley v. Williams, 350 S.W.3d 527, 537 (Tenn. 2011).

Lenoir designated Dr. Richisa Salazar, an emergency medicine physician licensed in Mississippi, Georgia, and Texas, as her expert. Dr. Salazar relied on her experience treating pressure injuries, review of Lenoir’s hospital records, and published literature. At deposition, however, Dr. Salazar acknowledged she had never practiced in Memphis and professed little to no knowledge of Memphis’s population, demographics, hospital landscape, teaching institutions, or details about Regional One Health beyond inferences from Lenoir’s chart. Pressed on the standard of care used, she answered “Nationwide.” A later affidavit asserted familiarity via medical school attendance in Tennessee, personal visits to Memphis, and her practice in Atlanta (which she described as “very similar” to Memphis).

The district court excluded Dr. Salazar’s opinions under Rule 702 and § 29-26-115(a)(1) for failure to satisfy the locality rule (while finding she met the competency requirements of § 115(b)), then ordered Lenoir to show cause why judgment should not be entered. Lenoir advised she could not proceed without Dr. Salazar and did not seek leave to substitute a new expert. The court entered judgment for the hospital. Lenoir appealed both the exclusion and the sua sponte judgment.

Summary of the Opinion

The Sixth Circuit affirmed. It held the district court did not abuse its discretion in excluding Dr. Salazar because she failed to demonstrate the required familiarity with Memphis or with a similar community, as required by Tennessee’s locality rule. The court emphasized that Rule 702 and the locality rule operate in tandem: in a Tennessee medical malpractice action, expert testimony that is not grounded in the local (or similar local) standard cannot “help the trier of fact,” and is therefore inadmissible.

The court also upheld the sua sponte summary judgment. The district court provided adequate notice (fourteen days) and an opportunity to respond, and once the indispensable expert testimony was excluded, plaintiff could not meet her proof burden under § 29-26-115(a). Summary judgment for the defense followed as a matter of law.

Analysis

Precedents Cited and Their Influence

Shipley v. Williams, 350 S.W.3d 527 (Tenn. 2011). Shipley is the Tennessee Supreme Court’s leading exposition of § 29-26-115. It confirms the three elements of proof, the general need for expert testimony, and explains the modern “same or similar community” locality rule adopted in 1975. It also identifies acceptable ways an expert can demonstrate locality familiarity (review of statistical/community data; discussions with local providers; visits to the community/hospital). The Sixth Circuit relied on Shipley for both the content of the locality rule and how a plaintiff may satisfy it.
Gales on behalf of Ranson v. Allenbrooke Nursing & Rehab. Ctr., LLC, 91 F.4th 433 (6th Cir. 2024). Gales articulates the functional relationship between Rule 702’s “helpfulness” and Tennessee’s locality rule: an expert unfamiliar with the local (or similar) standard cannot provide helpful testimony under Rule 702. Lenoir applies this framework to uphold exclusion, reinforcing that federal evidentiary gatekeeping respects and incorporates Tennessee’s substantive locality requirement in diversity cases.
Sommer v. Davis, 317 F.3d 686 (6th Cir. 2003). Sommer supports excluding experts who lack meaningful knowledge of the relevant community; it also supports the adequacy of a fourteen-day notice period before sua sponte summary judgment, which Lenoir cites to validate the district court’s procedure.
Mabon v. Jackson-Madison County Gen. Hosp., 968 S.W.2d 826 (Tenn. Ct. App. 1997) and Ledford v. Moskowitz, 742 S.W.2d 645 (Tenn. Ct. App. 1987). These cases caution that a “complete lack of knowledge” of the relevant community will not satisfy the locality rule. The Sixth Circuit used this line of authority to characterize Dr. Salazar’s knowledge as insufficient.
Stovall v. Clarke, 113 S.W.3d 715 (Tenn. 2003); Robinson v. LeCorps, 83 S.W.3d 718 (Tenn. 2002); Roberts v. Bicknell, 73 S.W.3d 106 (Tenn. Ct. App. 2001); Johnson v. Richardson, 337 S.W.3d 816 (Tenn. Ct. App. 2010). These decisions explain that when an expert relies on a “similar community,” the expert must provide concrete reasons for the similarity and show knowledge of both communities. Generalized assertions are inadequate. Lenoir follows this instruction, finding Dr. Salazar’s “Atlanta is similar to Memphis” claim too vague and unsupported.
Young v. Frist Cardiology, PLLC, 599 S.W.3d 568 (Tenn. 2020). Restates that, absent the narrow “common knowledge” exception, expert testimony is required to establish § 29-26-115(a)’s elements. Because no such exception applied, the lack of an admissible expert made summary judgment inevitable.
Bowen v. Nelson, No. W2024-00749-COA-R3-CV, 2025 WL 1504456 (Tenn. Ct. App. May 27, 2025). Confirms that the locality rule under § 115(a) is distinct from the competency requirements of § 115(b). Lenoir highlights this separation to reject plaintiff’s suggestion that satisfying § 115(b) resolves the locality inquiry.
Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993); Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999); Fed. R. Evid. 702. Provide the federal evidentiary standards and gatekeeping framework. Lenoir applies Rule 702’s “helpfulness” prong in light of Tennessee’s substantive locality rule.
Procedural precedents on sua sponte summary judgment: Shelby County Health Care Corp. v. Southern Council of Industrial Workers Health & Welfare Trust Fund, 203 F.3d 926 (6th Cir. 2000); Salehpour v. University of Tennessee, 159 F.3d 199 (6th Cir. 1998); Yashon v. Gregory, 737 F.2d 547 (6th Cir. 1984); Fed. R. Civ. P. 56(f)(1); Advanced Concrete Tools, Inc. v. Beach, 525 F. App’x 317 (6th Cir. 2013); Aubin Indus., Inc. v. Smith, 321 F. App’x 422 (6th Cir. 2008). These cases authorize sua sponte summary judgment with notice and opportunity to respond; they support the district court’s fourteen-day show-cause procedure.
Standards of review cases: Hardyman v. Norfolk & W. Ry. Co., 243 F.3d 255 (6th Cir. 2001); Ky. Speedway, LLC v. NASCAR, 588 F.3d 908 (6th Cir. 2009); Brown v. Raymond Corp., 432 F.3d 640 (6th Cir. 2005); Fisher v. Nissan N. Am., Inc., 951 F.3d 409 (6th Cir. 2020). These authorities frame the appellate lens (abuse of discretion for evidentiary rulings; de novo for summary judgment).
Policy commentary from Tennessee courts: Carpenter v. Klepper, 205 S.W.3d 474 (Tenn. Ct. App. 2006); Robinson v. LeCorps, 83 S.W.3d 718 (Tenn. 2002). Both criticize the continued utility of the locality rule and invite legislative reconsideration. Lenoir acknowledges these concerns but faithfully applies the current statute.

Legal Reasoning

1) Excluding the expert: Locality rule and Rule 702 “tandem” analysis

Tennessee’s locality rule requires proof of the standard of acceptable professional practice “in the community in which the defendant practices or in a similar community.” The Sixth Circuit reiterated that an expert unfamiliar with the local or similar-local standard fails Rule 702’s “helpfulness” requirement in Tennessee malpractice cases. Dr. Salazar’s deposition reflected a “complete lack of knowledge” about Memphis: she did not know the city’s population, demographics, socioeconomic profile, the number of hospitals, teaching hospital presence, details of Regional One Health (e.g., bed count, trauma level), or much beyond what she inferred from the plaintiff’s chart. When asked what standard she applied, she answered “Nationwide.”

While an affidavit later asserted familiarity via medical school tenure in Tennessee, family visits to Memphis, and Atlanta’s supposed similarity, the court found these statements too conclusory and inconsistent with deposition admissions. Under Shipley, an expert can establish locality familiarity through concrete data, dialogue with local providers, or community/hospital visits. The record showed none of these in a meaningful way.

The court also rejected the “similar community” argument because an expert must demonstrate knowledge of both communities and provide a reasoned comparison across relevant metrics (e.g., hospital size and services, teaching status, availability of specialties, patient demographics, and access to resources). Here, Dr. Salazar lacked baseline knowledge of Memphis and offered no concrete, comparative analysis between Atlanta and Memphis.

Finally, the court clarified that competency under § 29-26-115(b) (licensure and practice in Tennessee or a bordering state in the year preceding the injury, and relevant specialty) does not itself satisfy the substantive locality proof under § 115(a). The district court had already found Dr. Salazar competent under § 115(b); the failure arose under § 115(a)(1).

2) Sua sponte summary judgment after expert exclusion

The district court issued an order to show cause granting Lenoir fourteen days to explain how she would proceed. Lenoir responded that she could not proceed without Dr. Salazar and did not seek leave to substitute a new expert. Under Sixth Circuit precedent, sua sponte summary judgment is permissible where the party has adequate notice and a reasonable opportunity to respond. Fourteen days is sufficient. On the merits, without expert testimony, Lenoir could not establish the essential elements under § 29-26-115(a). Summary judgment for the defense was therefore appropriate as a matter of law, even when viewing the evidence in the light most favorable to the plaintiff.

Impact and Practical Consequences

For plaintiffs and their counsel

Prepare locality foundations early and thoroughly. Experts must do more than claim general familiarity or invoke a “national” standard. They should compile concrete data about the defendant’s community and, if relying on a similar community, articulate a reasoned comparison using tangible metrics.
Use Shipley’s methods. Consider: gathering hospital and community statistics (bed count, trauma level, teaching status, available specialties), conducting interviews with Memphis-area providers, or visiting the facility to understand services and capabilities.
Affidavits must be specific and consistent. Vague, post-deposition affidavits that contradict deposition testimony are vulnerable. Prepare the expert to address locality topics before deposition.
Do not assume § 115(b) competency satisfies § 115(a). Licensure and specialty alignment do not prove the local standard or similarity of communities.
Act promptly after exclusion. If an expert is excluded, seek leave to substitute promptly. A show-cause order with a short response window may be the last opportunity to keep the case alive.

For defendants and their counsel

Target the locality foundation in Daubert motions. Deposition testimony revealing ignorance of the community can be outcome-determinative under Rule 702 when Tennessee law supplies a locality-specific standard.
Build the record on community specifics. Obtain judicially noticeable facts or authenticated data about the local medical environment to demonstrate why an expert’s familiarity is inadequate.
Consider seeking a show-cause order post-exclusion. Where the plaintiff’s case turns on expert proof, exclusion can justify sua sponte summary judgment with proper notice.

For courts

Lenoir fits squarely within Gales and Shipley, confirming that Rule 702 gatekeeping must reflect state substantive standards in diversity cases.
The decision underscores that short, clear show-cause orders (ten to fourteen days) satisfy notice requirements for sua sponte summary judgment when expert exclusion leaves no triable issues.

Complex Concepts Simplified

Locality rule (Tenn. Code Ann. § 29-26-115(a)(1)): In Tennessee medical malpractice suits, the plaintiff must prove the standard of acceptable professional practice in the defendant’s community or a similar community at the time of the alleged negligence. This is a state-law, locality-specific requirement. Experts must show concrete familiarity with that local or similar-local standard.
Competency vs. locality (Subsections (b) vs. (a)): Subsection (b) addresses whether an expert is competent to testify (licensure in Tennessee or a bordering state, and practice within a year, in a relevant specialty). Subsection (a) addresses what the expert must prove—namely, the local or similar-local standard and its breach. Satisfying (b) does not satisfy (a).
“Similar community” proof: If not familiar with the defendant’s community, the expert may rely on a similar community. But the expert must show knowledge of both communities and articulate concrete reasons for similarity (e.g., population served; hospital size and level; teaching status; available specialties; resource access).
Rule 702/Daubert “helpfulness” in Tennessee cases: Because Tennessee requires a locality-specific standard, expert testimony that ignores the local/similar-local requirement won’t help the jury and is inadmissible.
Sua sponte summary judgment: A court may grant summary judgment on its own initiative if it gives notice and a reasonable time to respond (e.g., ten to fourteen days). If an essential element requires expert proof and the expert is excluded, summary judgment is typically warranted.
Common knowledge exception: In rare, obvious cases, a jury may infer negligence without expert testimony. Tennessee courts construe this narrowly; it did not apply to the complex medical issues here.

What the Court Did Not Decide

Whether Dr. Salazar’s reliance on a “national” standard, standing alone, would independently bar her testimony. The court did not need to reach this because the locality failure sufficed for exclusion.
Whether an alternative expert could have satisfied the locality rule; plaintiff conceded she could not proceed and did not seek substitution.
Any broad reappraisal of the locality rule’s policy merits. Although Tennessee courts have criticized its continued viability, the Sixth Circuit applied the statute as written.

Conclusion

Lenoir v. Shelby County Health Care Corp. delivers a clear message to litigants in Tennessee medical malpractice cases: the locality rule remains a meaningful, enforceable element of proof. An expert’s generalized invocation of national standards or superficial claims of community similarity will not pass Rule 702 gatekeeping when state law requires a local or similar-local standard. The decision also confirms that, after excluding an indispensable expert, a federal district court may enter sua sponte summary judgment following a brief, adequate notice period—particularly where the plaintiff declines to seek substitution or otherwise cannot proceed.

In practical terms, plaintiffs must invest early and specifically in the locality foundation of their expert’s opinions, aligning Rule 702 admissibility with Tennessee’s § 29-26-115 substantive requirements. Defendants, in turn, have a potent pathway to early resolution by testing that foundation through motion practice and targeted deposition questioning. While non-precedential, Lenoir robustly reinforces the Sixth Circuit’s post-Gales approach to integrating state locality requirements with federal evidentiary standards—and it will likely shape expert preparation, motion strategy, and case outcomes in Tennessee health-care liability litigation.

Sixth Circuit Reaffirms Tennessee’s Locality Rule and Permits Sua Sponte Summary Judgment After Expert Exclusion: Lenoir v. Shelby County Health Care Corp.