Case Title: Fuste v. Riverside Healthcare Assoc.

Citation: 

Docket Number: 020628

State: virginia

Court: Virginia Supreme Court

Date: 2003-01-10T00:00:00Z

Document:
Present:  All the Justices 
ROSA FUSTE, M.D., ET AL. 
v.  Record No. 020628  OPINION BY JUSTICE CYNTHIA D. KINSER 
 
 
 
 
 
 
 
  January 10, 2003 
RIVERSIDE HEALTHCARE ASSOCIATION, 
INC., ET AL. 
 
FROM THE CIRCUIT COURT OF THE CITY OF NEWPORT NEWS 
H. Vincent Conway, Jr., Judge 
 
 
 
In this appeal, the primary issue is whether alleged 
defamatory communications are statements of fact or 
expressions of opinion.  Because we conclude that certain 
of the alleged statements contain provably false factual 
connotations while other alleged statements are dependent 
upon the speaker’s viewpoint, we will reverse, in part, and 
affirm, in part, the judgment of the circuit court 
sustaining a demurrer. 
MATERIAL FACTS AND PROCEEDINGS 
 
The circuit court decided this case on a demurrer.  
Consequently, we recite the facts as alleged in the 
pleadings.  McMillion v. Dryvit Systems, Inc., 262 Va. 463, 
465, 552 S.E.2d 364, 365 (2001).  However, since the court 
sustained a demurrer to a second amended motion for 
judgment, which is complete and does not incorporate by 
reference allegations in the prior motions for judgment, we 
address only the allegations presented in the second 
amended motion for judgment.  Delk v. Columbia/HCA 
Healthcare Corp., 259 Va. 125, 129, 523 S.E.2d 826, 829 
(2000).  In doing so, we consider not only the facts stated 
but also those that are reasonably and fairly implied in 
the light most favorable to the nonmoving parties, Rosa M. 
Fuste, M.D., and Tien L. Vanden Hoek, M.D., the plaintiffs.  
McMillion, 262 Va. at 465, 552 S.E.2d at 365; Yuzefovsky v. 
St. John’s Wood Apartments, 261 Va. 97, 102, 540 S.E.2d 
134, 137 (2001). 
 
Dr. Fuste and Dr. Vanden Hoek were employed as 
pediatricians by Riverside Healthcare Association, Inc. 
(RHA), from 1994 until 1999.  In 1999, a dispute arose 
between the plaintiffs and RHA which resulted in both 
doctors terminating their employment with RHA.  Drs. Fuste 
and Vanden Hoek did not open a new medical practice until 
February 2000. 
 
Subsequently, the plaintiffs filed a second amended 
motion for judgment against RHA, Riverside Hospital, Inc. 
(Riverside Hospital), Riverside Physician Services, Inc. 
(RPS) (collectively the Riverside defendants), Peninsula 
Healthcare, Inc. (PHI), and Healthkeepers, Inc. 
(Healthkeepers).  Although the plaintiffs asserted claims 
of wrongful discharge, defamation, and conspiracy to injure 
 
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both doctors in the practice of their profession, the only 
issue on appeal concerns the allegations of defamation. 
 
As to that claim, the plaintiffs asserted that, after 
they left their employment with RHA, the defendants and 
their agents defamed them in order to harm the plaintiffs’ 
new medical practice.  Specifically, Drs. Fuste and Vanden 
Hoek alleged that Barry Gross and Dr. Eugene Temple, acting 
within the course and scope of their employment with RHA 
and as agents of the other Riverside defendants, along with 
C. Burke King and Mae Ellis Terrebonne, officers of 
Healthkeepers and PHI who were also acting in the course 
and scope of their employment, informed patients, agents of 
other hospitals, and credentialing officials at Mary 
Immaculate Hospital and Sentara Hampton General that Drs. 
Fuste and Vanden Hoek were “unprofessional” and 
“uncooperative,” that they had “left suddenly” and 
“abandoned their patients,” and that there were “concerns 
about their competence.”  The plaintiffs alleged that some 
of these false statements were made to individuals within 
the organizations who then repeated them to others outside 
the organizations. 
 
Continuing, the plaintiffs alleged that one caller to 
Healthkeepers was told by someone named “Theresa” that Drs. 
Fuste and Vanden Hoek would “never be put back on the 
 
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Healthkeepers list of providers because of the way they 
left Riverside.”  Parents and grandparents of the 
plaintiffs’ former patients who inquired of “Riverside 
Pediatrics”1 as to the plaintiffs’ whereabouts were informed 
that Drs. Fuste and Vanden Hoek had “left suddenly,” “were 
not able to work in the area,” and “their whereabouts were 
unknown.”  One caller also asked an individual at 
Healthkeepers about the plaintiffs and was told that they 
had “left suddenly and that she should find another 
pediatrician.” 
 
Finally, the plaintiffs alleged that an employee of 
Riverside contacted one of their prospective staff members 
and stated that “Dr. Fuste’s and Vanden Hoek’s new practice 
would be immediately shut down the day it opened, and that 
if she took a job there she would never have a future job 
with Riverside.”  The plaintiffs alleged that all these 
statements were made intentionally, maliciously, and in bad 
faith to injure them in the practice of their profession. 
 
The defendants filed demurrers to the second amended 
motion for judgment.  After considering memoranda and 
argument of counsel at a hearing on the demurrers, the 
                     
1 In several paragraphs of the second amended motion 
for judgment, the plaintiffs refer to “Riverside 
Pediatrics.”  However, they did not identify any of the 
named defendants by that term. 
 
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circuit court, recognizing that it must view the pleading 
in the light most favorable to the plaintiffs, nevertheless 
concluded that the second amended motion for judgment did 
not state claims for wrongful discharge, defamation, or 
conspiracy.  Specifically with regard to the allegations of 
defamation, the court stated that “[t]he defamatory 
statements as alleged, on balance, appear to be opinion[s] 
by and between people involved in the health care field.”  
Incorporating its reasons stated from the bench, the court 
subsequently entered an order sustaining the demurrers and 
dismissing the case with prejudice.  This appeal followed. 
ANALYSIS 
 
Our review of a circuit court’s judgment sustaining a 
demurrer is guided by well-settled principles.  The purpose 
of a demurrer is to test the legal sufficiency of a 
pleading.  Welding, Inc. v. Bland County Service Authority, 
261 Va. 218, 226, 541 S.E.2d 909, 913 (2001).  “A demurrer 
admits the truth of all properly pleaded material facts.  
‘All reasonable factual inferences fairly and justly drawn 
from the facts alleged must be considered in aid of the 
pleading.’ ”  Ward’s Equipment, Inc. v. New Holland N. 
America, Inc., 254 Va. 379, 382, 493 S.E.2d 516, 518 (1997) 
(quoting Fox v. Custis, 236 Va. 69, 71, 372 S.E.2d 373, 374 
(1988)).  However, a demurrer does not admit the 
 
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correctness of the conclusions of law found in the 
challenged pleading.  Id.  On appeal, a plaintiff attacking 
a trial court’s judgment sustaining a demurrer need show 
only that the court erred, not that the plaintiff would 
have prevailed on the merits of the case.  Thompson v. 
Skate America, Inc., 261 Va. 121, 128, 540 S.E.2d 123, 127 
(2001). 
 
The plaintiffs assert that the circuit court erred in 
finding that the defamatory statements alleged in the 
second amended motion for judgment were merely opinions and 
therefore not actionable as defamation or defamation per 
se.  Conversely, the defendants claim that the alleged 
statements cannot form the basis of a cause of action for 
defamation because they were either mere expressions of 
opinion or privileged communications.  The defendants also 
argue that the plaintiffs failed to identify the 
circumstances and details of the alleged defamatory 
communications and that such failure is fatal to their 
case. 
 
At common law, defamatory words that “prejudice [a] 
person in his or her profession or trade” are actionable as 
defamation per se.  Carwile v. Richmond Newspapers, Inc., 
196 Va. 1, 7, 82 S.E.2d 588, 591 (1954).  A defamatory 
statement may be made “by inference, implication or 
 
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insinuation.”  Id., 82 S.E.2d at 592.  However, “[p]ure 
expressions of opinion, not amounting to ‘fighting 
words,’ ” are protected by the First Amendment of the 
Constitution of the United States and Article 1, § 12 of 
the Constitution of Virginia.  Chaves v. Johnson, 230 Va. 
112, 119, 335 S.E.2d 97, 101-02 (1985).  Thus, “speech 
which does not contain a provably false factual 
connotation, or statements which cannot reasonably be 
interpreted as stating actual facts about a person cannot 
form the basis of a common law defamation action.”2  Yeagle 
v. Collegiate Times, 255 Va. 293, 295, 497 S.E.2d 136, 137 
(1998), accord WJLA-TV v. Levin, 264 Va. 140, 156, 564 
S.E.2d 383, 392 (2002). 
 
Statements that are relative in nature and depend 
largely upon the speaker’s viewpoint are expressions of 
opinion.  Chaves, 230 Va. at 119, 335 S.E.2d at 101.  
Whether an alleged defamatory statement is one of fact or 
opinion is a question of law and is, therefore, properly 
decided by a court instead of a jury.  Id., 335 S.E.2d at 
102. 
                     
2 In Milkovich v. Lorain Journal Co., 497 U.S. 1, 18-21 
(1990), the Supreme Court of the United States declined to 
exclude, in all instances, statements of opinion as the 
basis for a common law defamation cause of action. 
 
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Applying these principles, we hold that the alleged 
statements that Drs. Fuste and Vanden Hoek “abandoned” 
their patients and that there were “concerns about their 
competence” not only prejudice the doctors in the practice 
of their profession, see Carwile, 196 Va. at 7, 825 S.E.2d 
at 591, but also contain “a provably false factual 
connotation.”  WJLA-TV, 264 Va. at 156, 564 S.E.2d at 392.  
In other words, they are capable of being proven true or 
false.  For example, evidence could be presented to show 
whether there were, in fact, concerns about the plaintiffs’ 
competence.  Similarly, since the term “abandon” has a 
particular connotation in the context of a doctor’s 
professional responsibility to a patient, see Rosen v. 
Greifenberger, 257 Va. 373, 380, 513 S.E.2d 861, 865 (1999) 
(a doctor has a duty to continue services to a patient 
after accepting employment and cannot thereafter 
voluntarily “abandon” a patient); Vann v. Harden, 187 Va. 
555, 565-66, 47 S.E.2d 314, 319 (1948)(same), the statement 
that Drs. Fuste and Vanden Hoek “abandoned” their patients 
is demonstrably true or false.  See Blue Ridge Bank v. 
Veribanc, Inc., 866 F.2d 681, 685 (4th Cir. 1989) (a 
speaker’s choice of words and the context of an alleged 
defamatory statement within the speech as a whole are 
 
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factors to consider when deciding if a challenged statement 
is one of fact or opinion). 
 
Therefore, these alleged statements may form the basis 
of a cause of action for defamation per se.  The remaining 
alleged statements are either dependent on the speaker’s 
viewpoint and are, therefore, expressions of opinion, see 
Chaves, 230 Va. at 119, 335 S.E.2d at 101, do not prejudice 
the doctors in their professions, see Carwile, 196 Va. at 
7, 82 S.E.2d at 591, or, taken “in their plain and natural 
meaning,” are not defamatory.  Id.
 
Nevertheless, the defendants argue that the circuit 
court did not err in sustaining the demurrer because the 
plaintiffs failed to allege that Gross, Temple, King and 
Terrebone were acting within the scope of their employment 
with, or as agents of, any of the named defendants.  They 
also assert that the plaintiffs did not identify to whom, 
by whom, and under what circumstances the alleged 
defamatory statements were made.  However, upon reviewing 
the second amended motion for judgment, we conclude that 
the plaintiffs sufficiently pled the circumstances and 
details of the alleged communications to withstand 
challenge at the demurrer stage of the proceeding below. 
 
In paragraph 34 of the second amended motion for 
judgment, the plaintiffs alleged that “Defendants, through 
 
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their agents, intentionally combined and conspired with 
each other to harm Plaintiffs’ business maliciously and 
willfully.”  In that same paragraph, the plaintiffs 
identified Gross, Temple, King and Terrebone as those 
agents and alleged that each was acting within the scope of 
his or her employment.  Further, the second amended motion 
for judgment gives the exact words allegedly used by Gross, 
Temple, King, and Terrebone, or those acting at their 
direction, i.e., that the doctors “abandoned their 
patients” and that there were “concerns about their 
competence.” 
Contrary to the defendants’ argument, our decision in 
Federal Land Bank of Baltimore v. Birchfield, 173 Va. 200, 
3 S.E.2d 405 (1939), does not require that a pleading 
alleging defamation identify to whom the statements were 
made and under what circumstances.  In that case, we held 
that “[g]ood pleading requires that the exact words spoken 
or written must be set out in the declaration in haec 
verba.  Indeed, the pleading must go further, -- that is, 
it must purport to give the exact words.”  Id. at 215, 3 
S.E.2d at 410.  However, details such as the time and place 
of the alleged communication, the name of a defendant’s 
agent, and the names of the individuals to whom the 
defamatory statement was purportedly communicated can be 
 
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provided in a bill of particulars if not included in a 
plaintiff’s pleading.3  Id. at 217, 3 S.E.2d at 411. 
 
Finally, the defendants argue that any statements 
allegedly made by them during their own credentialing 
process or to the credentialing officials at other 
hospitals were privileged and are, therefore, not 
actionable.  While we have applied the doctrine of 
qualified privilege in cases involving alleged defamatory 
statements made “between persons on a subject in which the 
persons have an interest or duty,” we have also held that 
this qualified privilege may be defeated by proof that the 
defamatory statements were made maliciously.  Larimore v. 
Blaylock, 259 Va. 568, 572, 528 S.E.2d 119, 121 (2000); 
accord Chalkley v. Atlantic Coast Line R.R. Co., 150 Va. 
301, 306, 143 S.E. 631, 632 (1928).  Malice sufficient to 
overcome a qualified privilege is “behavior actuated by 
motives of personal spite, or ill-will, independent of the 
occasion on which the communication was made.”  Gazette, 
                     
3 In addition to the demurrer, Healthkeepers and PHI 
filed a motion for bill of particulars in response to the 
second amended motion for judgment.  In part, they 
requested that the plaintiffs identify each officer and 
agent of Healthkeepers and/or PHI alleged to have made 
defamatory statements as well as the substance of those 
statements, the dates they were made, and to whom the 
statements were communicated.  The circuit court took no 
action on this motion. 
 
 
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Inc. v. Harris, 229 Va. 1, 18, 325 S.E.2d 713, 727 (1985).  
 
It is a court’s duty to decide as a matter of law 
whether a communication is privileged.  But, the question 
whether a defendant “ ‘was actuated by malice, and has 
abused the occasion and exceeded [the] privilege’ ” is a 
question of fact for a jury.  Alexandria Gazette Corp. v. 
West, 198 Va. 154, 160, 93 S.E.2d 274, 279-80 (1956) 
(quoting Bragg v. Elmore, 152 Va. 312, 325, 147 S.E. 275, 
279 (1929)); see also Federal Land Bank, 173 Va. at 222, 3 
S.E.2d at 414; Chalkley, 150 Va. at 306, 143 S.E. at 632.  
Considering all the allegations in the second amended 
motion for judgment, not only those with regard to the 
alleged defamation but also the allegations concerning the 
circumstances attending the doctors’ decision to leave 
their employment with RHA, we hold that the plaintiffs pled 
sufficient facts to survive a demurrer with regard to the 
issue of malice if the two remaining communications, that 
the doctors “abandoned their patients” and that there were 
“concerns about their competence,” were privileged.  We 
express no opinion on the issue of privilege.4
                     
4 The defendants also assert that the federal Health 
Care Quality Improvement Act of 1986, specifically 42 
U.S.C. § 11111(a) (2000), provides immunity to them in the 
context of a professional review action.  However, that 
statute states that “no person . . . providing information 
to a professional review body regarding the competence or 
 
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CONCLUSION 
 
For these reasons, we will affirm, in part, and 
reverse, in part, the judgment of the circuit court and 
remand for further proceedings consistent with this 
opinion. 
Affirmed in part, 
reversed in part, 
 
 
 
 
 
 
 
 
   and remanded. 
                                                             
professional conduct of a physician shall be held, by 
reason of having provided such information, to be liable in 
damages under any law of the United States or of any State 
. . . unless such information is false and the person 
providing it knew that such information was false.”  42 
U.S.C. § 11111(a)(2) (emphasis added).  Similarly, Code 
§§ 8.01-581.16 and –581.19 provide immunity from civil 
liability only in the absence of bad faith or malicious 
intent.  Thus, while we do not decide whether any of these 
statutory provisions are applicable in this case, we do 
hold that, for the reasons already stated, the plaintiffs 
pled sufficient facts to survive a demurrer. 
 
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