Case Title: Webb v. Smith

Citation: 

Docket Number: 071008

State: virginia

Court: Virginia Supreme Court

Date: 2008-06-06T00:00:00Z

Document:
PRESENT: Hassell, C.J., Keenan, Koontz, Kinser, Lemons, and 
Agee, JJ., and Stephenson, S.J. 
 
TAMELA H. WEBB 
 
 
 
OPINION BY 
v.  Record No. 071008   SENIOR JUSTICE ROSCOE B. STEPHENSON, JR. 
 
 
 
June 6, 2008 
CHARLES WILLIAM SMITH, III, M.D. 
 
 
FROM THE CIRCUIT COURT OF THE CITY OF PETERSBURG 
Pamela S. Baskervill, Judge 
 
 
In this appeal, we determine whether, under the special 
facts and circumstances of this medical malpractice action, the 
plaintiff was required to present expert testimony on the issue 
of causation. 
I 
 
Tamela H. Webb filed an action against Charles William 
Smith, III, M.D., alleging medical malpractice by Dr. Smith for 
negligently performing surgery on her, which caused Webb to 
undergo a subsequent surgery and incur damages attendant 
thereto.  At the conclusion of Webb's case-in-chief and at the 
conclusion of all the evidence, Dr. Smith moved the court to 
strike Webb's evidence on the ground that Webb had not presented 
expert testimony on the issue of causation.  The trial court 
took the motions under advisement and submitted the case to the 
jury. 
 
The jury returned its verdict in favor of Webb in the 
amount of $75,000, with interest on $25,520.06 from August 30, 
2004, until paid.  Following the verdict, the trial court 
considered Dr. Smith's motion to strike Webb's evidence.  Upon 
the parties' post-trial briefs, the court sustained Dr. Smith's 
motion and entered judgment in his favor.  We awarded Webb this 
appeal. 
II 
 
For years, Webb had suffered pain associated with her 
menstrual cycle.  She had been advised by her long-time 
physician that she "might need" to undergo a bilateral salpingo 
oophorectomy (BSO).  Webb decided to undergo the BSO together 
with a hysterectomy, and she went to Dr. Smith for the surgery.  
Dr. Smith agreed to perform both procedures in a single surgery.  
Dr. Smith performed the hysterectomy, but he forgot to perform 
the BSO. 
 
At trial, Webb presented an expert witness who testified 
about the relevant standard of care for a doctor engaged in Dr. 
Smith's field of practice.  The expert witness also testified 
that Dr. Smith had breached the standard of care by agreeing and 
obtaining consent to perform the two procedures in one surgery, 
but failing to do so.  The expert witness did not offer any 
testimony regarding causation. 
 
Webb testified that, due to Dr. Smith's negligence in 
performing only one procedure, she had to undergo a second 
 
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surgery and endure a second round of trauma, associated pain and 
suffering, and mental anguish. 
III 
 
Webb contends that the verdict was improperly set aside 
because the present case presents one of the rare instances in 
which expert testimony was not necessary or appropriate.  Webb 
asserts that "[n]o specialized training was necessary for a 
juror to understand that when [Dr.] Smith neglected to perform 
the surgery he had agreed to perform, [she] would necessarily 
have to find another physician to finish what [Dr.] Smith had 
started, but failed to finish."  Webb testified that Dr. Smith 
told her he had forgotten to perform the second procedure.  Webb 
asserts that, as with forgetting to remove a sponge or scalpel 
from a patient's body during surgery, her damages for Dr. 
Smith's forgetting to perform the second procedure "are evident 
to any normal person" and are the direct and proximate result of 
Dr. Smith's negligence.  Therefore, Webb concludes, the jury did 
not need expert testimony to find, as it did, that she desired 
to have her ovaries removed, that Dr. Smith agreed to perform 
the procedure together with a hysterectomy, that Dr. Smith 
negligently failed to perform the procedure, and that Dr. 
Smith's negligence was the proximate cause of her having to 
undergo a second surgery. 
 
3
 
Dr. Smith contends that Webb, because she brought a tort 
action for medical malpractice and not a breach-of-contract 
action, was required to establish the necessary elements of a 
medical malpractice action, which she failed to do.  Dr. Smith 
observes that, in medical malpractice actions, expert testimony 
is ordinarily required to establish the necessary elements, 
including causation, and he contends that the present case is no 
exception. 
IV 
 
We have said that, in medical malpractice cases, "expert 
testimony is ordinarily necessary to establish the appropriate 
standard of care, to establish a deviation from the standard, 
and to establish that such a deviation was the proximate cause 
of the claimed damages."  Raines v. Lutz, 231 Va. 110, 113, 341 
S.E.2d 194, 196 (1986); accord Bly v. Rhoads, 216 Va. 645, 653, 
222 S.E.2d 783, 789 (1976).  Exceptions to this rule exist only 
in "those rare cases in which a health care provider's act or 
omission is clearly negligent within the common knowledge of 
laymen."  Raines, 231 Va. at 113, n.2, 341 S.E.2d at 196, n.2; 
see, e.g., Coston v. Bio-Medical Applications of Va., Inc., 275 
Va. 1, 5, 654 S.E.2d 560, 562 (2008) (plaintiff placed in 
defective chair by health care provider); Easterling v. Walton, 
208 Va. 214, 218, 156 S.E.2d 787, 790-91 (1967) (foreign object 
left in patient's body by surgeon). 
 
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We conclude that the present case presents one of those 
"rare cases" in which expert testimony is not necessary to 
establish that Dr. Smith's deviation from the standard of care 
was the proximate cause of Webb's damages.  As a result of Dr. 
Smith's failure to perform the BSO, Webb had to undergo the 
second surgery and incur damages attendant thereto.  A 
reasonably intelligent juror did not need an expert to explain 
why Dr. Smith's negligence was the proximate cause of Webb's 
damages because the issue of causation was within the common 
knowledge of laymen. 
IV 
 
Accordingly, we will reverse the trial court's judgment, 
reinstate the jury's verdict, and enter judgment in favor of 
Webb. 
Reversed and final judgment. 
 
JUSTICE KINSER, with whom JUSTICE AGEE joins, dissenting. 
 
The majority concludes that “[a]s a result of Dr. Smith’s 
failure to perform the [bilateral salpingo oophorectomy (BSO)], 
Webb had to undergo the second surgery and incur damages 
attendant thereto.”  Only testimony from a medical expert could 
have established that Webb “had” to undergo the second surgery.  
Therefore, I respectfully disagree with the majority opinion and 
conclude that the trial court did not err in setting aside the 
 
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jury verdict in favor of Webb because she failed to present 
medical expert testimony on the issue of proximate causation. 
“In order to recover for medical negligence, the plaintiff 
ordinarily must prove through the use of expert testimony the 
applicable standard of care, a deviation from that standard, 
proximate causation, and damages.”  Rogers v. Marrow, 243 Va. 
162, 167, 413 S.E.2d 344, 346 (1992) (emphasis added) (citing 
Raines v. Lutz, 231 Va. 110, 115, 341 S.E.2d 194, 197 (1986)).  
As the trial court recognized, the issue was whether Webb 
presented sufficient evidence to establish that Dr. Smith’s 
breach of the standard of care proximately caused Webb’s claimed 
damages.  In holding that Webb did not present sufficient 
evidence of causation, the trial court concluded “that the need 
for a subsequent surgery is not within common knowledge of 
laymen and . . . that expert testimony is required to show 
causation.”  (Emphasis added.) 
Before this Court, Webb casts her argument in terms 
suggesting that the two medical procedures she consented for Dr. 
Smith to perform were “elective.”  Her testimony, however, was 
stated in terms of necessity.  Specifically, Webb testified, “I 
needed my ovaries and tubes out because they should have come 
out to begin with.”  However, Dr. Smith, in uncontradicted 
testimony, stated that, during the first surgery, he inspected 
Webb’s “tubes and ovaries” and found them “to be normal with no 
 
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visible pathology, nothing to suggest that there was anything in 
the slightest wrong with them, nothing that would indicate that 
they ought to come out or that she would benefit from such.”  
When asked if there was “any medical need” to remove Webb’s 
“ovaries and tubes” during the first surgery, Dr. Smith 
responded, “No.” 
Dr. John R. Partridge, who testified as a medical expert on 
behalf of Dr. Smith, agreed that Dr. Smith’s decision to not 
remove Webb’s “tubes and ovaries” during the initial surgery was 
appropriate since “[t]he ovaries looked normal [and] there was 
really no reason to take them out.”  Dr. Partridge opined that 
apart from elective plastic surgery, it is not within the 
standard of care to perform a medical procedure that is not 
needed.  Webb’s medical expert witness, Dr. Ezell S. Autry, did 
not disagree with that opinion.  Although Dr. Autry testified 
“that the standard of care was violated in respect that the 
patient had signed a permit for a procedure of vaginal 
hysterectomy, bilateral salpingo-oophorectomy and physician Dr. 
Smith did not do that,” he nonetheless acknowledged that, even 
though a patient consents to a BSO as part of a total 
hysterectomy, it would be appropriate for the surgeon to not 
perform that procedure if the surgeon decided it was 
unnecessary. 
 
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The majority, nevertheless, reasons that the necessity of 
the second surgery was within the common knowledge of lay 
persons.  I disagree.  Only a medical expert witness could 
testify as to whether Webb needed to have the BSO during the 
first surgery and, whether as a result of Dr. Smith’s failure to 
perform the BSO, it remained medically necessary for her to 
undergo that procedure, thereby requiring the second surgery.  
Cf. Combs v. Norfolk & W. Ry. Co., 256 Va. 490, 496-97, 507 
S.E.2d 355, 358-59 (1998) (holding that only a medical doctor is 
qualified to state an expert medical opinion regarding the 
causation of an injury to the human body).  Without such 
testimony, Webb could not establish that Dr. Smith’s negligence 
in failing to perform the BSO during the first surgery was a 
proximate cause of the damages she claimed as a result of 
undergoing the second surgery. 
The majority fails to recognize the distinction that the 
trial court correctly pointed out in its letter opinion, “[t]his 
cause of action is one for medical malpractice based on 
negligence, not breach of contract.  Yet, the thrust of 
plaintiff’s evidence and arguments supports a theory of failed 
expectations.”  See Filak v. George, 267 Va. 612, 618, 594 
S.E.2d 610, 613 (2004) (“[L]osses suffered as a result of the 
breach of a duty assumed only by agreement, rather than a duty 
imposed by law, remain the sole province of the law of 
 
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contracts.” (citing Sensenbrenner v. Rust, Orling & Neale, 
Architects, Inc., 236 Va. 419, 425, 374 S.E.2d 55, 58 (1988))). 
 
Indeed, the testimony from Dr. Autry, Webb’s only medical 
expert witness, supports the trial court’s conclusion.  As 
already noted, Dr. Autry based his opinion that Dr. Smith 
breached the standard of care solely on the basis that Dr. 
Smith, during the first surgery, did not perform a procedure 
that he had agreed to perform and that Webb had agreed to 
undergo by virtue of the consent form she signed.  Yet, the 
majority concludes that Webb “had” to undergo the second surgery 
because Dr. Smith failed to perform the BSO during the first 
surgery.  Whether Smith “had” to undergo the second surgery is a 
question of medical necessity requiring expert testimony from a 
physician. 
For these reasons, I conclude that this is not one of those 
“rare cases” in which a plaintiff can prevail without medical 
expert testimony to establish the requisite element of proximate 
causation.  Therefore, I respectfully dissent and would affirm 
the judgment of the trial court.