Case Title: King v. Cooley

Citation: 

Docket Number: 062502

State: virginia

Court: Virginia Supreme Court

Date: 2007-09-14T00:00:00Z

Document:
PRESENT:  Hassell, C.J., Keenan, Koontz, Kinser, Lemons, and 
Agee, JJ., and Lacy, S.J.1 
 
BRADFORD L. KING, M.D., ET AL. 
 
v.     Record No.  062502 
OPINION BY 
JUSTICE BARBARA MILANO KEENAN 
 
                   September 14, 2007 
TAMATHA COOLEY  
 
FROM THE CIRCUIT COURT OF THE CITY OF FREDERICKSBURG 
Ann H. Simpson, Judge 
 
 
In this medical malpractice case, we consider issues 
related to the circuit court’s exclusion of testimony that a 
defendant sought to present from a patient’s treating 
physician. 
 
Tamatha Cooley filed a motion for judgment in the 
circuit court against Bradford L. King, M.D., and his 
employer, Surgical Associates of Fredericksburg (Surgical 
Associates), alleging that Dr. King was negligent in 
monitoring and treating Cooley after he performed gastric 
bypass surgery on her.  Cooley asserted that as a result of 
Dr. King’s negligence, she suffered rapid heart rate, 
decreased blood oxygen, and an intestinal leak, which caused 
her to sustain severe, permanent brain injury. 
 
The evidence at trial showed that Dr. King performed 
the gastric bypass operation in May 2003, and released 
                     
1 Justice Lacy participated in the hearing and decision 
of this case prior to the effective date of her retirement 
on August 16, 2007. 
 
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Cooley from the hospital five days after the surgery.  
Cooley returned to the hospital the day after her release 
because she was experiencing increased pain and shortness of 
breath. 
Dr. King testified that he was concerned Cooley had an 
intestinal leak and decided that she needed immediate 
surgery (the second surgery).  According to Dr. King, while 
he was “scrubbing” his hands in preparation for the second 
surgery, he witnessed Cooley retch during the anesthesia 
intubation process.  Dr. King also stated that he was told 
Cooley had vomited and had vomitus material in the back of 
her throat and mouth. 
Robert Harry, M.D., assisted Dr. King with the second 
surgery.  Dr. King testified that during the second surgery 
they discovered and repaired a small intestinal leak.  After 
this surgery, Cooley’s health deteriorated, and she 
ultimately suffered permanent brain injury. 
The parties disagreed concerning the cause of Cooley’s 
brain injury and presented conflicting expert medical 
testimony in support of their respective theories of the 
case.  Cooley presented witnesses who testified that her 
injuries resulted from Adult Respiratory Distress Syndrome 
(ARDS) and sepsis, which she alleged were caused by Dr. 
 
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King’s failure to timely diagnose and treat her intestinal 
leak. 
Dr. King and Surgical Associates (collectively, the 
defendants) presented testimony from Dr. King and three 
other physicians.  These witnesses testified that Cooley’s 
injuries were caused by Cooley’s aspiration of the vomitus 
material during preparation for her second surgery, which 
damaged her lungs and ultimately caused her brain damage. 
The defendants also sought to introduce testimony from 
Dr. Harry regarding Cooley’s condition after the second 
surgery, during the time Dr. Harry continued to care for 
Cooley as one of her treating physicians.  Cooley objected 
to this testimony on the ground that the defendants had not 
complied with the terms of the circuit court’s pre-trial 
discovery order, which required the parties to identify 
their “experts” and to provide a summary of the expected 
testimony of each “expert.”  Before ruling on Cooley’s 
objection, the circuit court permitted Cooley to question 
Dr. Harry outside the presence of the jury.  The following 
exchange took place between defense counsel and Dr. Harry: 
Q. Okay, and during the course of your treatment of 
Mrs. Cooley, after the surgery, did you form an 
impression as to what was wrong with her? 
A.  I did. 
Q.  And what was that impression? 
A.  I felt she was suffering from aspiration pneumonia.  
 
 
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Although Cooley objected to the admission of this 
testimony, she conceded that Dr. Harry’s conclusion would 
have been rendered to a reasonable degree of medical 
probability, and that his conclusion had been documented 
contemporaneously in the medical record during his treatment 
of Cooley.  The circuit court sustained Cooley’s objection 
and excluded Dr. Harry’s proffered testimony. 
The jury returned a verdict in favor of Cooley for 
$3,500,000.  The trial court reduced the amount of the 
verdict to $1,650,000 in accordance with Code § 8.01-581.15, 
and entered final judgment in favor of Cooley.2  The 
defendants appeal. 
 
The defendants argue that the circuit court erred in 
excluding Dr. Harry’s testimony on the basis of the pre-
trial order because Code § 8.01-399(B) provides for the 
admission of such testimony by a treating physician.  
Relying on this Court’s opinions in Pettus v. Gottfried, 269 
Va. 69, 606 S.E.2d 819 (2005), and Holmes v. Levine, 273 Va. 
150, 639 S.E.2d 235 (2007), the defendants contend that Dr. 
Harry’s proffered testimony was admissible under Code 
§ 8.01-399(B) because his testimony was factual in nature 
                     
2 The damage recovery cap prescribed by Code § 8.01-
581.15 for medical malpractice actions set this amount as 
the limit for recovery at the time this action arose. 
 
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and constituted an impression formed contemporaneously with 
his treatment of Cooley. 
 
In response, Cooley argues that the circuit court did 
not err in excluding Dr. Harry’s testimony regarding 
Cooley’s condition after the second surgery because that 
testimony was an expert medical opinion that was not 
properly disclosed under the terms of the pre-trial order.  
Alternatively, Cooley asserts that if the circuit court 
erred in excluding Dr. Harry’s testimony, such error was 
harmless because several other physician witnesses testified 
that Cooley had aspirated and that such aspiration caused 
Cooley’s brain injury. 
 
In considering these issues, we initially observe that 
Dr. Harry’s proffered testimony is different from the type 
of medical testimony at issue in Pettus and Holmes.  Those 
cases involved our consideration of factual observations 
made by treating physicians and the admissibility of those 
observations under Code § 8.01-399(B), which provides: 
If the physical or mental condition of the patient 
is at issue in a civil action, the diagnoses, signs and 
symptoms, observations, evaluations, histories, or 
treatment plan of the practitioner, obtained or 
formulated as contemporaneously documented during the 
course of the practitioner’s treatment, together with 
the facts communicated to, or otherwise learned by, 
such practitioner in connection with such attendance, 
examination or treatment shall be disclosed but only in 
discovery pursuant to the  Rules of Court or through 
testimony at the trial of the action. . . . Only 
 
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diagnosis offered to a reasonable degree of medical 
probability shall be admissible at trial. 
 
In Pettus, we held admissible under Code § 8.01-399(B) 
a treating physician’s conclusion during the course of 
treatment that a patient’s change in mental status “could 
have been” a central nervous system problem.  269 Va. at 77, 
606 S.E.2d at 824.  We explained that although the 
challenged testimony was not stated to a reasonable degree 
of medical probability, the testimony was nevertheless 
admissible under the statute because the testimony did not 
constitute a diagnosis but was “factual in nature” and 
simply related the physician’s impression while treating the 
patient.  Id. at 78, 606 S.E.2d at 825.  
We applied this same principle in Holmes, in which we 
considered the admissibility of a treating physician’s 
testimony that she “did not think that an occasional red 
blood cell would qualify for microscopic hematura.”  273 Va. 
at 157, 639 S.E.2d at 240.  We held that the testimony was 
admissible even though not stated to a reasonable degree of 
medical probability because the testimony was not a 
diagnosis but only an impression the physician reached while 
rendering her treatment.  Id. at 162, 639 S.E.2d at 241. 
In the present case, Dr. Harry’s testimony was not 
merely a factual impression but imparted an actual diagnosis 
 
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because he identified the type and cause of a health 
condition based on a patient’s signs and symptoms.  See 
Combs v. Norfolk & Western Ry. Co., 256 Va. 490, 496-97, 507 
S.E.2d 355, 358-59 (1998).  Thus, Dr. Harry’s testimony was 
admissible under Code § 8.01-399(B), unless properly 
excluded under the terms of the pre-trial order, as a 
diagnosis offered to a reasonable degree of medical 
probability and contemporaneously documented in the medical 
record. 
We need not decide, however, whether the circuit court 
erred in excluding Dr. Harry’s testimony on the basis of the 
pre-trial order because, even if the circuit court erred in 
its ruling, such error was harmless.  Under the doctrine of 
harmless error, we will affirm the circuit court’s judgment 
when we can conclude that the error at issue could not have 
affected the jury verdict.  Forbes v. Rapp, 269 Va. 374, 
382, 611 S.E.2d 592, 597 (2005); Pace v. Richmond, 231 Va. 
216, 226, 343 S.E.2d 59, 65 (1986); see Code § 8.01-678. 
The defendants argue that the exclusion of Dr. Harry’s 
testimony was not harmless, particularly in view of the 
closing argument made by Cooley’s counsel.  In that 
argument, Cooley’s counsel emphasized that the defendants 
had not presented any witnesses who had observed the alleged 
aspiration.  The defendants also contend that they suffered 
 
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prejudice from the exclusion of the proffered testimony 
because the circuit court’s ruling excluded the testimony of 
one of Cooley’s treating physicians. 
We find no merit in these arguments.  Dr. Harry’s 
proffered testimony did not reference any observations he 
had made concerning events that occurred in the operating 
room at the time of the second surgery.  Therefore, nothing 
in the proffered testimony would have enabled the defendants 
to produce a witness who could have testified to having 
observed the alleged aspiration. 
Additionally, we do not accept the defendants’ argument 
that Dr. Harry’s status as a treating physician, of itself, 
made the exclusion of the proffered testimony prejudicial 
error.  The limited scope of the proffer isolated Dr. 
Harry’s medical opinion from any factual context or 
explanation that could have rendered his testimony different 
from the testimony of the other physicians providing medical 
opinions for the defense.  Thus, Dr. Harry’s unexplained 
opinion of aspiration pneumonia was merely cumulative of the 
other medical opinions given by the defendants’ other 
physician witnesses. 
Dr. John C. Schaefer, who practices internal medicine 
with a subspecialty in infectious diseases, testified that 
Cooley’s inability to be oxygenated after the second surgery 
 
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was caused as a result of aspiration.  Dr. Gregory L. 
Schroeder, a surgeon whose practice incorporates both 
general and bariatric surgery, concluded that Cooley 
suffered an aspiration during the induction of general 
anesthesia that caused aspiration pneumonitis or pneumonia.  
Finally, Dr. Walter Pories, a bariatric surgeon, stated that 
Cooley’s injuries resulted from aspiration.  Because Dr. 
Harry’s proffered testimony was merely cumulative of this 
other testimony, we hold that the exclusion of Dr. Harry’s 
testimony could not have affected the jury’s determination 
and, thus, was harmless error.  See May v. Caruso, 264 Va. 
358, 363, 568 S.E.2d 690, 693 (2002); Bryan v. Burt, 254 Va. 
28, 32-33, 486 S.E.2d 536, 538 (1997); Owens-Corning 
Fiberglas Corp. v. Watson, 243 Va. 128, 138, 413 S.E.2d 630, 
636 (1992). 
Finally, the defendants complain that the circuit court 
erred in denying them the right to fully cross-examine one 
of Cooley’s expert witnesses, Julie Kim, M.D.  During her 
testimony, Dr. Kim stated that she had reviewed Cooley’s 
hospital records, and that Dr. Kim had “no document evidence 
to believe that [Cooley] aspirated.”  When defense counsel 
attempted to challenge Dr. Kim’s statement by asking her 
about the contents of an “intensive care admit note” 
contained in Cooley’s medical record, Cooley objected.  The 
 
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circuit court sustained Cooley’s objection on the basis of 
hearsay. 
We are unable to consider the merits of the defendants’ 
argument that the circuit court erred in preventing them 
from cross-examining Dr. Kim about this note, because the 
issue has not been preserved for appeal.  Although defense 
counsel stated that she intended to cross-examine Dr. Kim 
about the note in order to challenge Dr. Kim’s assertion 
that “nothing” in Cooley’s medical record indicated that 
Cooley aspirated, defense counsel did not proffer the 
testimony she expected to elicit from Dr. Kim.  In the 
absence of such a proffer, we are unable to determine 
whether the circuit court’s decision to exclude that 
testimony, if erroneous, prejudiced the defendants.  See 
Williams v. Harrison, 255 Va. 272, 277, 497 S.E.2d 467, 471 
(1998); Clagett v. Commonwealth, 252 Va. 79, 95, 472 S.E.2d 
263, 272 (1996); Chappell v. Virginia Elec. Power Co., 250 
Va. 169, 173, 458 S.E.2d 282, 284-85 (1995).  “[W]hen 
testimony is rejected before it is delivered, an appellate 
court has no basis for adjudication unless the record 
reflects a proper proffer.”  Chappell, 250 Va. at 173, 458 
S.E.2d at 285 (quoting Whittaker v. Commonwealth, 217 Va. 
966, 968, 234 S.E.2d 79, 81 (1977)). 
 
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For these reasons, we will affirm the circuit court’s 
judgment. 
Affirmed.