Case Title: Hollingsworth v. Norfolk Southern Railway Co.

Citation: 

Docket Number: 090041

State: virginia

Court: Virginia Supreme Court

Date: 2010-02-25T00:00:00Z

Document:
Present:  Hassell, C.J., Keenan, Koontz, Kinser, Lemons, and 
Millette, JJ., and Lacy, S.J. 
 
JOSEPH C.B. HOLLINGSWORTH 
 
 
 
OPINION BY 
v.  Record No. 090041 
JUSTICE LAWRENCE L. KOONTZ, JR. 
 
 
 
     February 25, 2010 
NORFOLK SOUTHERN RAILWAY COMPANY 
 
FROM THE CIRCUIT COURT OF THE CITY OF ROANOKE 
William D. Broadhurst, Judge 
 
 
In this appeal, we consider whether a podiatrist is 
qualified to render an expert opinion as to the causation of a 
human physical injury.  Specifically, we consider whether the 
circuit court erred in granting the defendant’s motions in 
limine to exclude the testimony of two podiatrists on the 
basis that they were not medical doctors and, thus, were not 
qualified to render expert opinions as to the cause of the 
plaintiff’s alleged physical injuries.  Consequently, we also 
consider whether the court erred in granting the defendant’s 
motion for summary judgment based upon the court’s rulings on 
those motions in limine. 
BACKGROUND 
The material facts are not in dispute.  Joseph C.B. 
Hollingsworth filed a negligence action under the Federal 
Employers’ Liability Act, 45 U.S.C. §§ 51-60 (2006 & Supp. I 
2007), against his former employer Norfolk Southern Railway 
Company (“Norfolk Southern”).  Hollingsworth claimed that his 
job duties for Norfolk Southern “required him to walk on large 
ballast1 and debris scattered throughout the yards and areas he 
was working, causing injury to his . . . ankles, and feet.” 
Hollingsworth designated two licensed podiatrists, Steve 
G. Steffan and Charles Zelen, as expert witnesses.  The 
podiatrists would have testified that they treated 
Hollingsworth’s foot condition, and that the injuries they 
treated were caused by repeated walking on irregular surfaces 
such as the ballast in the rail yards.  Norfolk Southern filed 
motions in limine, arguing that the podiatrists could not 
testify as to the causation of Hollingsworth’s alleged 
injuries because neither is a medical doctor.  The circuit 
court granted the motions in limine, finding that an opinion 
concerning the causation of a human physical injury involves 
making a diagnosis, which may be conducted only by a medical 
doctor. 
Norfolk Southern then moved for summary judgment, arguing 
that because the podiatrists could not testify concerning 
medical causation and because the time to designate experts 
had elapsed, Hollingsworth could not prove that his alleged 
injuries were caused by Norfolk Southern’s negligence.  The 
circuit court granted the motion for summary judgment, finding 
                     
1 Ballast is rock laid on the roadbed of a railroad track 
for the purpose of providing foundation and facilitating 
drainage.  See Norfolk S. Ry. Co. v. Rogers, 270 Va. 468, 472, 
621 S.E.2d 59, 61 (2005); Norfolk S. Ry. Co. v. Trimiew, 253 
Va. 22, 25, 480 S.E.2d 104, 107 (1997). 
 
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that without the medical causation testimony of the 
podiatrists, Hollingsworth could not prove an essential 
element of his case.  We awarded Hollingsworth this appeal. 
DISCUSSION 
 
The principles guiding our resolution of the issues 
presented in this appeal are well established.  “Generally, a 
witness is qualified to testify as an expert when the witness 
possesses sufficient knowledge, skill, or experience to make 
the witness competent to testify as an expert on the subject 
matter at issue.”  Velazquez v. Commonwealth, 263 Va. 95, 103, 
557 S.E.2d 213, 218 (2002).  “Whether to permit a witness to 
qualify as an expert on a given subject matter is an issue 
submitted to the discretion of the trial court, and on appeal 
we will not reverse the trial court’s ruling in this regard 
unless it plainly appears that the witness was not qualified.”  
Conley v. Commonwealth, 273 Va. 554, 560, 643 S.E.2d 131, 134 
(2007). 
 
“Notwithstanding these general principles, we have 
concluded that certain subject matter is exclusive to a 
particular field of expertise such that only witnesses trained 
as professionals in that field of expertise are qualified to 
render expert opinions regarding that subject matter.” 
Fitzgerald v. Commonwealth, 273 Va. 596, 602, 643 S.E.2d 162, 
164 (2007).  Thus, we have repeatedly held that only a medical 
 
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doctor is qualified to testify about the cause of a human 
physical injury.  See Id. at 602, 643 S.E.2d at 164-65; 
Conley, 273 Va. at 561, 643 S.E.2d at 134; Norfolk & W. Ry. 
Co. v. Keeling, 265 Va. 228, 235, 576 S.E.2d 452, 457 (2003); 
John v. Im, 263 Va. 315, 321, 559 S.E.2d 694, 697 (2002); 
Combs v. Norfolk & W. Ry. Co., 256 Va. 490, 496-97, 507 S.E.2d 
355, 358-59 (1998).  But see Velazquez, 263 Va. at 104, 557 
S.E.2d at 218-19 (allowing a sexual assault nurse examiner 
(“SANE”) to express an opinion as to the cause of physical 
injuries in the context of a sexual assault).   
 
In Combs, we held that the trial court abused its 
discretion in permitting a biomechanical engineer to give an 
expert opinion regarding the cause of the plaintiff’s ruptured 
disc.  256 Va. at 497, 507 S.E.2d at 359.  Noting that “the 
question of causation of a human injury is a component part of 
a diagnosis,” and that the statutory definition of the 
“practice of medicine” contained in Code § 54.1-2900 includes 
making a “diagnosis,” we concluded that the question of 
causation of a human injury is a part of the practice of 
medicine.  Id. at 496, 507 S.E.2d at 358.  Thus, we 
established the general rule that only a medical doctor is 
qualified to give expert testimony about the cause of human 
physical injury.  Id. 
 
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In John, we held that the trial court properly ruled that 
that a licensed Ph.D. psychologist was not qualified to give 
an opinion that the plaintiff had suffered a “mild traumatic 
brain injury . . . as a result of the impact and the sudden 
acceleration-deceleration of her head” in a motor vehicle 
accident.  263 Va. at 318, 321, 559 S.E.2d at 695, 697.  We 
again reasoned that an opinion regarding the causation of a 
human physical injury is a component part of a diagnosis, 
which is a part of the practice of medicine, and because the 
psychologist was not a medical doctor, he was not qualified to 
give an expert opinion regarding the cause of the plaintiff’s 
injury.  Id. at 321, 559 S.E.2d at 697. 
 
In Keeling, we concluded that the trial court did not 
abuse its discretion in disallowing the testimony of a 
biomechanical engineer “that fistulas were generally caused by 
infection that caused bone or tissue to deteriorate.”  265 Va. 
at 235, 576 S.E.2d 457.  Stressing that Combs and John stand 
for the proposition that “only a medical doctor could give 
expert testimony about the cause of a human physical injury,” 
we held that the testimony given by the biomechanical engineer 
came within the prohibition recited in Combs and John.  Id. 
 
More recently, in Conley, we considered whether the trial 
court erred in permitting a licensed clinical social worker to 
testify concerning the diagnosis and treatment of post-
 
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traumatic stress disorder (“PTSD”).  273 Va. at 557, 643 
S.E.2d at 132.  Similarly, in Fitzgerald, we considered 
whether the trial court erred in permitting a licensed 
professional counselor to testify that the alleged victim 
suffered from PTSD.  273 Va. at 600, 643 S.E.2d at 163.  In 
both cases, Combs and John were distinguished by the fact that 
those cases involved causation issues regarding human physical 
injuries, while Conley and Fitzgerald involved PTSD, a mental 
disorder.  See Conley, 273 Va. at 561, 643 S.E.2d at 135 
(“Combs and John do not . . . establish a categorical rule 
. . . that only a medical doctor may qualify to render an 
expert opinion regarding the diagnosis of PTSD or any other 
recognized mental disorder.”)  Nonetheless, in reaching these 
decisions, we applied the same statutory analysis employed in 
Combs and John, finding that both licensed clinical social 
workers and licensed professional counselors were statutorily 
authorized to “diagnose” mental disorders and, thus, were 
qualified to provide expert testimony.  See Fitzgerald, 273 
Va. at 602-03, 643 S.E.2d at 165 (citing Code § 54.1-3500); 
Conley, 273 Va. at 562, 643 S.E.2d at 135 (citing Code § 54.1-
3700). 
 
In the present case, Hollingsworth asserts that the 
intent of the General Assembly is that podiatrists may engage 
in the diagnosis of ailments involving the foot and ankle and, 
 
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thus, are qualified under Combs and its progeny to render an 
expert opinion as to the cause of physical injuries to the 
foot and ankle.  Alternatively, Hollingsworth contends that 
this Court should, as in Velazquez, recognize an exception to 
the general rule that only a medical doctor is qualified to 
testify as an expert regarding the cause of a human physical 
injury. 
 
Norfolk Southern responds that the General Assembly has 
drawn a clear distinction between the definition of the 
“practice of medicine,” which includes “diagnosis,” and the 
“practice of podiatry,” which does not.  Consequently, Norfolk 
Southern maintains that podiatrists are not qualified to 
testify as experts regarding the cause of a human physical 
injury.  We agree with Norfolk Southern. 
 
Code § 54.1-2900 defines the scope of practice for 
medical doctors and podiatrists.  The “[p]ractice of medicine” 
is defined as “the prevention, diagnosis and treatment of 
human physical or mental ailments, conditions, diseases, pain 
or infirmities by any means or method.”  Code § 54.1-2900 
(emphasis added).  In contrast, the “[p]ractice of podiatry” 
is defined as “the medical, mechanical and surgical treatment 
of the ailments of the human foot and ankle.”  Id. (emphasis 
added). 
 
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When interpreting statutes, we must ascertain and give 
effect to the General Assembly’s intention, which is to be 
ascertained from the plain meaning of the words used, unless a 
literal interpretation would result in a manifest absurdity. 
See Crawford v. Haddock, 270 Va. 524, 528, 621 S.E.2d 127, 129 
(2005); Horner v. Dep't of Mental Health, Mental Retardation, 
& Substance Abuse Servs., 268 Va. 187, 192, 597 S.E.2d 202, 
204 (2004).  Moreover, “we must assume that the General 
Assembly chose, with care, the words it used in enacting the 
statute, and we are bound by those words when we apply the 
statute.”  Halifax Corp. v. First Union National Bank, 262 Va. 
91, 100, 546 S.E.2d 696, 702 (2001).  “Additionally, when the 
General Assembly includes specific language in one section of 
a statute, but omits that language from another section of the 
statute, we must presume that the exclusion of the language 
was intentional.”  Id. 
 
Applying these principles to the statutory definitions at 
issue in this case, we find that while both medical doctors 
and podiatrists may engage in the treatment of a physical 
injury to the human foot and ankle, only a medical doctor may 
engage in the diagnosis of that injury so as to qualify to 
render an expert opinion regarding the causation of that 
injury.  Accordingly, Steffan and Zelen were qualified to 
render an expert opinion concerning the treatment they 
 
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provided to Hollingsworth.  The podiatrists, however, are not 
medical doctors and, thus, were not qualified to render an 
expert opinion as to the causation of Hollingsworth’s alleged 
injuries.2 
 
Hollingsworth, however, contends that the word “medical” 
in the definition of the practice of podiatry means that the 
General Assembly intended to incorporate the practice of 
medicine definition into the definition of podiatry.  An 
analysis of the context in which the word “medical” is used 
suggests otherwise.  See City of Virginia Beach v. Board of 
Supervisors of Mecklenburg County, 246 Va. 233, 236-37, 435 
S.E.2d 382, 384 (1993) (when determining statutory intent, the 
context may be examined by considering other language used in 
the statute). 
 
The “[p]ractice of podiatry” definition describes the 
forms of treatment–medical, mechanical, and surgical–a 
                     
2 The statutory scheme related to chiropractors further 
supports our analysis.  The definition of the “[p]ractice of 
chiropractic” does not contain the word “diagnosis.” See Code 
§ 54.1-2900.  Thus, in accord with our prior holdings, 
chiropractors would be prohibited from giving medical 
causation testimony.  The General Assembly, however, has 
enacted Code § 8.01-401.2, which provides that a chiropractor 
“may testify as an expert witness in a court of law as to 
etiology, diagnosis, prognosis, and disability . . . .”  
(Emphasis added.) 
The General Assembly has not enacted similar legislation 
relating to podiatrists; however, we take notice of proposed 
legislation that would amend and reenact the definition of 
podiatry.  See S.B. 82, Va. Gen. Assem. (Reg. Sess. 2010); 
H.B. 723, Va. Gen. Assem. (Reg. Sess. 2010). 
 
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podiatrist can use in treating ailments of the human foot and 
ankle.  Code § 54.1-2900.  Surgical treatment generally 
involves the repair of the foot and ankle by an operative 
procedure.  Mechanical treatment generally involves repair or 
rehabilitation by a device, such as ankle braces or footpads.  
Medical treatment generally involves treatment by use of 
medicine.  Simply put, the word “medical” modifies 
“treatment.”  It does not mean that a podiatrist’s scope of 
practice is defined as broadly as that of a medical doctor.  
Furthermore, if the General Assembly intended the “[p]ractice 
of podiatry” to be equivalent to the “[p]ractice of medicine,” 
it could have easily used the same language in defining the 
two practices.  Instead, it clearly chose different language.  
Again, “[w]e must assume that the General Assembly chose, with 
care, the words it used in enacting the statute, and we are 
bound by those words when we apply the statute.”  Halifax 
Corp., 262 Va. at 100, 546 S.E.2d at 702. 
We also reject Hollingsworth’s contention that because 
podiatrists are members of the “[h]ealing arts” they may 
diagnose ailments involving the foot and ankle.  See Code 
§ 54.1-2903.  The term “[h]ealing arts” is defined broadly as 
the “arts and sciences dealing with the prevention, diagnosis, 
treatment and cure or alleviation of human physical or mental 
ailments, conditions, diseases, pain or infirmities.”  Code 
 
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§ 54.1-2900.  This definition is a general “catch-all” meant 
to encompass all healthcare practitioners, including 
respiratory care practitioners, radiologic technologists, 
athletic trainers, and various others who would not be 
qualified to render an expert opinion as to the cause of a 
physical injury.  See Code § 54.1-2903 (“Any person shall be 
regarded as practicing the healing arts who actually engaged 
in such practice as defined in this chapter . . . .” (emphasis 
added)).  In a situation where one statute speaks to a subject 
generally and another deals with that subject specifically, 
the more specific statute prevails.  See Crawford, 270 Va. at 
528, 621 S.E.2d at 129; Frederick County School Board v. 
Hannah, 267 Va. 231, 236, 590 S.E.2d 567, 569 (2004).  Thus, 
we conclude that the specific definition of the “[p]ractice of 
podiatry” prevails over the general language of the “[h]ealing 
arts.” 
 
We also decline to recognize another exception to the 
general rule that only a medical doctor may render an expert 
opinion regarding the cause of a human physical injury.  In 
Velazquez, we held that although the SANE was not a medical 
doctor, she was qualified to render an expert opinion 
concerning the “causation of injuries in the context of an 
alleged sexual assault.”  263 Va. at 104, 557 S.E.2d at 218.  
As we subsequently explained in John: 
 
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Because our holding in Velazquez is limited to the 
unique context of a SANE’s expert opinion concerning 
the causation of injuries in a sexual assault case, 
that holding does not change the general rule . . . 
that only a medical doctor may give an expert 
opinion about the cause of a physical human injury. 
 
263 Va. at 321 n.2, 559 S.E.2d at 697 n.2. (emphasis added).  
We are of opinion that, unlike the circumstances in Velazquez, 
the circumstances of the present case do not warrant an 
exception to the general rule.  Velazquez, 263 Va. at 103-04, 
557 S.E.2d at 218. 
 
To allow podiatrists to testify as experts regarding the 
causation of human physical injuries would require us to add 
“diagnosis” to the statutory definition of the “[p]ractice of 
podiatry.”  Such amendatory action must be left to the General 
Assembly.  See Carter v. Nelms, 204 Va. 338, 346, 131 S.E.2d 
401, 406-07 (1963) (“We must determine the legislative intent 
by what the statute says and not by what we think it should 
have said”); Virginia Transit Co. v. Tidd, 194 Va. 418, 425, 
73 S.E.2d 405, 409 (1952) (“It is not the function of the 
[C]ourt to legislate”). 
CONCLUSION 
 
For these reasons, we hold that the circuit court did not 
err in granting Norfolk Southern’s motions in limine to 
exclude the medical causation testimony of the two 
podiatrists.  Accordingly, we will affirm the circuit court’s 
 
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judgment awarding summary judgment in favor of Norfolk 
Southern. 
Affirmed. 
CHIEF JUSTICE HASSELL dissents. 
 
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