Case Title: Rosen v. Greifenberger

Citation: 

Docket Number: 

State: virginia

Court: Virginia Supreme Court

Date: 1999-02-26T00:00:00Z

Document:
Present:  All the Justices 
 
LEONARD A. ROSEN, M.D., ET AL. 
 
OPINION BY 
v.  Record No. 980371 
JUSTICE LAWRENCE L. KOONTZ, JR. 
 
February 26, 1999 
DARLENE GREIFENBERGER 
 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
Michael P. McWeeny, Judge 
 
 
In this medical malpractice suit, we consider whether the 
trial court erred in giving a jury instruction on a physician’s 
duty to continue his services as long as they are necessary 
where the evidence shows that another physician within the 
treating physician’s group practice had been advised that the 
patient might need additional care during the treating 
physician’s temporary absence. 
BACKGROUND
 
“According to settled principles of appellate review, we 
will consider the evidence in the light most favorable to the 
plaintiff, who comes to this Court armed with a jury verdict 
approved by the trial judge.”  Salih v. Lane, 244 Va. 436, 438, 
423 S.E.2d 192, 194 (1992).  The parties dispute much of the 
evidence, including that relevant to the alleged primary 
negligence of the treating physician.  However, because we 
awarded an appeal limited to the issue of whether a particular 
jury instruction was proper, we will recount only those facts 
relevant to our resolution of that issue.  Jeld-Wen, Inc. v. 
Gamble, 256 Va. 144, 146, 501 S.E.2d 393, 395 (1998). 
 
Darlene Greifenberger first became a patient of Fairfax Ob-
Gyn Associates, P.C. (the group practice) in 1988.  The group 
practice, a Virginia professional corporation, is owned by and 
operates the medical practice of three physicians:  Felicia L. 
Donald, M.D., Leonard A. Rosen, M.D., and Robert L. Castle, M.D.  
In 1988 and 1989, Greifenberger was treated by all three members 
of the group practice in relation to her pregnancy and the 
successful delivery of her second child.  Dr. Donald was 
Greifenberger’s primary treating physician at that time, but Dr. 
Rosen treated Greifenberger during some obstetrical visits, and 
Dr. Castle delivered the child and administered Greifenberger’s 
post-partum care. 
 
Greifenberger continued as a patient of the group practice 
after this pregnancy, and on occasion received treatment from 
each of the three physicians.  In April 1992, Greifenberger 
requested that a Norplant contraceptive device be implanted.  
Dr. Donald performed the necessary procedure and later treated 
Greifenberger when she complained of complications from the 
implant.  Because of dissatisfaction with Dr. Donald’s 
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treatment, Greifenberger requested that she no longer receive 
treatment from Dr. Donald.1
On September 17, 1992, Greifenberger contacted the group 
practice and advised a nurse there that she believed she was 
pregnant and that she was considering terminating the pregnancy.  
Dr. Rosen saw Greifenberger in the group practice’s office that 
afternoon.  A pregnancy test confirmed that Greifenberger was 
pregnant.  Based upon her report of the date of her last 
menstrual cycle, Dr. Rosen estimated that the pregnancy was in 
the seventh or eighth week of the first trimester.  After 
discussing the options for continuation or termination of the 
pregnancy with Dr. Rosen, including the recommendation of the 
manufacturer of the contraceptive device that it be removed if 
the pregnancy were continued, Greifenberger indicated that she 
wished to terminate the pregnancy through a therapeutic 
abortion.  The next day she completed the necessary consent 
document and other paperwork required to schedule the abortion 
procedure. 
                     
1Greifenberger named Dr. Donald as an individual defendant 
in the action from which this appeal arises, asserting that Dr. 
Donald was negligent with respect to the implantation of the 
contraceptive device, the follow-up treatment related thereto, 
and Greifenberger’s unwanted pregnancy.  The jury returned a 
verdict in favor of Dr. Donald on these issues, and 
Greifenberger has not appealed that aspect of the judgment.  
Accordingly, the claims against Dr. Donald individually are no 
longer at issue in this case.  
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On September 22, 1992, Greifenberger was admitted to Fair 
Oaks Hospital as an outpatient under the care of Dr. Rosen to 
terminate her pregnancy.  After a general anesthetic had been 
administered, but before the abortion procedure had been 
started, Dr. Rosen determined from an assessment of uterine size 
that the pregnancy was more advanced than he had previously 
thought, estimating that it was in the twelfth to fourteenth 
week of the first trimester.  Because Greifenberger had been 
unequivocal in stating her desire to terminate the pregnancy and 
because the dilation and evacuation procedure Dr. Rosen intended 
to perform is medically appropriate to terminate a late first 
trimester pregnancy, Dr. Rosen decided to go forward with the 
procedure. 
During the procedure, however, Dr. Rosen determined that 
the pregnancy had advanced beyond the fourteenth week.  Because 
a dilation and evacuation procedure is not medically appropriate 
to terminate a more advanced pregnancy, Dr. Rosen discontinued 
the procedure after approximately ten minutes.  Knowing that the 
procedure was incomplete, Dr. Rosen elected to send 
Greifenberger “home with a medication called Methargen to cause 
further medical uterine contractility to further expel whatever 
remaining products of conception were left behind” in the 
uterus.  He also prescribed a “broad spectrum antibiotic in the 
form of Keflex” to protect her from infection. 
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Dr. Rosen then contacted Greifenberger’s husband in the 
hospital waiting room and told him that “the operation went 
okay, that there [were] no problems.”  Dr. Rosen further told 
Greifenberger’s husband that Greifenberger “would pass a small 
amount, a very small amount of tissue . . . that she might bleed 
. . . a little heavier than her normal menstrual cycle.”  Dr. 
Rosen did not specifically advise Greifenberger’s husband that 
the abortion procedure was incomplete. 
Greifenberger was instructed by a hospital discharge nurse 
to take additional doses of the antibiotics and Methargen and to 
use a prescription pain medication as needed.  She was further 
instructed by the nurse to make an appointment with Dr. Rosen in 
one week and to “notify your doctor if you have heavy vaginal 
bleeding, severe abdominal pain or fever.”  Greifenberger was 
discharged from the hospital without having been informed that 
the abortion procedure was incomplete.  Although Dr. Rosen gave 
her medication intended to induce uterine contractions and a 
spontaneous abortion to expel the remaining fetal tissue, he did 
not inform Greifenberger that he would be temporarily 
unavailable to treat her or that, if necessary, Dr. Castle would 
be treating her during Dr. Rosen’s absence. 
Dr. Rosen was scheduled to attend a medical conference in 
Chicago on the day following Greifenberger’s surgery and was to 
leave that evening.  Before leaving the hospital, Dr. Rosen 
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contacted Dr. Castle, the only member of the group practice who 
would be available for patient consultation and treatment that 
night and for the next several days, and informed him that 
Greifenberger’s pregnancy had been more advanced than had been 
first thought.  Dr. Rosen further advised Dr. Castle “to expect 
a call” because “products of conception” had been left in the 
uterus and that Greifenberger had been sent home with 
antibiotics, pain medication, and the medication to cause 
uterine contractions to expel the remaining tissue. 
In the early morning hours of September 24, 1992, 
Greifenberger contacted Dr. Castle complaining of “cramping” and 
“slight bleeding.”  Dr. Castle was “expecting” the cramping 
because of the medication given to Greifenberger and advised her 
to take the prescribed pain medication and come to the group 
practice’s office the next day.  Several hours later, her 
husband took Greifenberger to the emergency room.  At that time 
she was in significant pain and had a temperature of 101.  Dr. 
Castle was called to the hospital and performed surgery to 
complete the abortion. 
On August 2, 1995, Greifenberger filed a motion for 
judgment against the group practice and against Dr. Rosen 
individually, alleging malpractice resulting from negligence or 
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gross negligence.2  Among the allegations of malpractice, 
Greifenberger alleged that “Dr. Rosen’s post-operative care 
manifested an utter disregard of prudence amounting to a 
complete neglect of the safety of plaintiff and lacked due 
care.” 
After a period of extended discovery, a jury trial was held 
in the trial court beginning on October 20, 1997.  Evidence in 
accord with the above recounted facts was received along with 
expert testimony on the relevant standard of care from witnesses 
for both parties.  Dr. John Partridge, an expert witness for Dr. 
Rosen, testified that the duty of continuing necessary treatment 
does not require that physicians “be held hostage in our own 
offices.”  Rather, “[t]he standard of care requires that a 
doctor have adequate backup, skillful backup, that there be a 
communication flow on issues of importance between one doctor 
and another [about what] the other doctor may have to handle.” 
At the conclusion of the evidence, Greifenberger proffered 
the following jury instruction: 
 
A doctor who has accepted a patient for treatment 
has a duty to continue his services as long as they 
are necessary.  A doctor may not abandon his patient 
while the services are necessary, unless he gives 
notice to the patient and makes arrangements for 
                     
2Greifenberger also advanced theories of lack of informed 
consent, battery, and emotional distress.  Theses claims have no 
direct relevance to the issue presented by this appeal. 
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continuing treatment by another doctor.  If a doctor 
fails to perform this duty, then he is negligent. 
 
The group practice and Dr. Rosen objected to the 
instruction, contending that it was not appropriate because the 
facts presented at trial did not establish a lack of continuing 
care.  Greifenberger contended that the instruction was 
appropriate because even if Dr. Rosen’s association with the 
group practice and his communication to Dr. Castle satisfied his 
duty to continue necessary treatment, Dr. Rosen’s failure to 
give notice to Greifenberger that he would not be available for 
consultation and further treatment nonetheless constituted a 
breach of that duty. 
The trial court ruled that there was sufficient “evidence 
upon which a correct statement of the law can be given” as to 
the duty to continue necessary treatment.  Based on this ruling, 
the trial court granted Greifenberger’s proffered instruction. 
The jury returned its verdict in favor of Greifenberger 
against the group practice and Dr. Rosen, awarding her $175,000 
in damages.  By order dated November 21, 1997, the trial court 
affirmed the jury verdict and award of damages.  We awarded the 
defendants this appeal limited to the issue whether the trial 
court erred in granting Greifenberger’s jury instruction on the 
duty to continue necessary treatment. 
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DISCUSSION 
It has long been the rule that a trial court should not 
give a jury instruction that, while a correct statement of the 
law as an abstract proposition, is inapplicable to the facts of 
the case.  Gordon v. Virginia Electric & Power Co., 150 Va. 442, 
450, 143 S.E. 681, 683 (1928); see also Parker v. McCoy, 212 Va. 
808, 814, 188 S.E.2d 222, 226 (1972).  Rather, the trial court 
should instruct the jury only on those theories of the case 
which find support in the evidence, see Neeley v. Johnson, 215 
Va. 565, 575, 211 S.E.2d 100, 108 (1975)(“an instruction should 
not be given which is unsupported by the evidence”), and the 
evidence relied on to support a proffered instruction must 
amount to “more than a scintilla.”  Hatcher v. Commonwealth, 218 
Va. 811, 814, 241 S.E.2d 756, 758 (1978); see also Ring v. 
Poelman, 240 Va. 323, 327, 397 S.E.2d 824, 827 (1990). 
The instruction at issue here, commonly known as an 
“abandonment” instruction, as an abstract proposition is 
arguably a correct statement of the law with respect to a 
physician’s duty to continue to render treatment to a patient as 
long as may be necessary.  We have previously addressed the 
nature of this duty, arising from the physician-patient 
relationship, by stating that “[a]fter a physician has accepted 
employment in a case it is his duty to continue his services as 
long as they are necessary.  He cannot voluntarily abandon his 
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patient.”  Vann v. Harden, 187 Va. 555, 565, 47 S.E.2d 314, 319 
(1948).  We have further stated that “under certain 
circumstances, the physician has a right to withdraw from a 
case, provided the patient is afforded a reasonable opportunity 
to acquire the services he needs from another physician.”  Lyons 
v. Grether, 218 Va. 630, 634, 239 S.E.2d 103, 106 (1977).  The 
essence of this duty is the responsibility of the treating 
physician to avoid a lapse in necessary treatment to the 
patient. 
In the present case, Dr. Rosen contends that his action in 
turning over Greifenberger’s treatment to Dr. Castle for the 
period of Dr. Rosen’s absence did not constitute an abandonment 
of his duty to render continuing necessary treatment to her.  
Limiting our holding to the specific facts of this case, we 
agree with Dr. Rosen. 
It is a matter of common knowledge and experience that 
physicians in a group practice regularly rotate “on-call” 
responsibility for a patient’s treatment during non-office 
hours.  Moreover, here the evidence showed that Greifenberger 
was aware that Dr. Rosen was a member of a group practice, that 
the other members of the group practice specialized in the same 
field of medicine, and that she had been treated by all three 
members of the group practice at various times.  In addition, 
Greifenberger does not challenge Dr. Castle’s qualifications to 
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provide the treatment she required in Dr. Rosen’s absence, and 
she made no claim against Dr. Castle individually in this suit.  
Finally, the evidence shows that although Dr. Rosen did not 
advise Greifenberger of his intended absence, it is undisputed 
that he made adequate arrangements for her to contact and 
receive continuing treatment from Dr. Castle during that time.  
Accordingly, the evidence does not support abandonment or lack 
of continuing care of the patient that would justify the 
instruction in question. 
Finally, Greifenberger contends that even if the trial 
court erred in giving the abandonment instruction, that error 
was harmless, and the judgment in her favor should be sustained 
since the evidence shows that Dr. Rosen was negligent in his 
entire course of treatment of her.  We express no opinion on the 
issue of Dr. Rosen’s primary negligence because that issue is 
not before us.  However, it is undisputed that Greifenberger 
presented both the issues of abandonment and negligence by Dr. 
Rosen to the jury.  The claim that a physician has abandoned a 
patient in need of urgent, continuing medical treatment, such as 
the present case, would undoubtedly tend to inflame the emotions 
of a jury.  Under such circumstances, giving an erroneous 
instruction is not harmless.  Rather, “[i]f an issue is 
erroneously submitted to a jury, we presume that the jury 
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decided the case upon that issue.”  Clohessy v. Weiler, 250 Va. 
249, 254, 462 S.E.2d 94, 97 (1995). 
CONCLUSION
For these reasons, we will reverse the judgment of the 
trial court and remand the case for a new trial. 
Reversed and remanded. 
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