Title: Monahan v. Obici Medical Management

State: virginia

Issuer: Virginia Supreme Court

Document:

PRESENT:  All the Justices 
 
LAWRENCE J. MONAHAN 
 
Record Number 051592 
 
 
 
      OPINION BY 
v.    
 
 
 
 
 
 
JUSTICE G. STEVEN AGEE 
 
 
 
 
 
 
 
 
    April 21, 2006 
 
OBICI MEDICAL MANAGEMENT SERVICES, INC. 
 
FROM THE CIRCUIT COURT OF THE CITY OF SUFFOLK 
Rodham T. Delk, Jr., Judge 
 
The Circuit Court of the City of Suffolk entered judgment 
on a jury verdict in favor of Lawrence J. Monahan in his medical 
malpractice action against Obici Medical Management Services, 
Inc. (“Obici”) and awarding him damages in the amount of 
$215,000.  Monahan appeals from the trial court's decisions to 
instruct the jury on mitigation of damages and to deny his 
motion to strike certain evidence related to the issue of 
mitigation.  He requests a new trial as to damages only.  For 
the reasons set forth below, we will affirm the judgment of the 
trial court in part, and reverse in part. 
I. BACKGROUND AND MATERIAL PROCEEDINGS BELOW 
 
On the morning of Tuesday, August 28, 2001, Monahan, a 
construction subcontractor,1 was working on a construction 
project when he informed his supervisor, Johnnie Presson, that 
he felt unwell and had double vision.  Presson noticed that 
Monahan “wasn’t moving quite right” and contacted Monahan’s 
                                                 
1 Monahan was employed full-time as a subcontractor with 
Rickmond General Contracting, a general contractor. 
 
2
wife.  He had a co-worker drive Monahan to Wakefield Medical 
Center2 ("Wakefield") for a medical evaluation.3 
 
When Monahan arrived at Wakefield, the office was closed 
for lunch, but the receptionist admitted Monahan into the clinic 
building after observing that he was unusually “hot and sweaty.”  
Anita Curl, the practice manager, escorted Monahan to an 
examination room.  She testified that Monahan appeared “hot and 
tired,” and that he was walking “slow” and “unsteady.”  Barbara 
P. Carr, a licensed practical nurse, took Monahan’s vital signs 
and recorded his blood pressure to be “200 over 95.”  Carr also 
noted that Monahan felt dizzy and had double vision. 
 
Carrie Wiggins, a nurse practitioner at Wakefield, examined 
Monahan about 1:00 p.m.  Wiggins checked Monahan’s chart, retook 
his blood pressure twice, and performed a quick neurologic exam, 
which she determined was normal.  She concluded that Monahan was 
having a hypertension crisis and gave him some samples of 
Micardis (a blood pressure medication4).  Wiggins testified that 
she told Monahan to rest through Friday, August 31, 2001, 
scheduled him to return in two weeks to have his blood pressure 
                                                 
2 Wakefield is owned and operated by Obici.  Carrie Wiggins, 
the nurse practitioner who examined Monahan, was an employee of 
Wakefield and, thus, Obici.  At trial, Obici stipulated that 
Wiggins was one of its employees. 
3 Monahan had been a patient at Wakefield for many years. 
4 Monahan had a history of high blood pressure. 
 
3
checked, and wrote in his medical chart that if his condition 
did not improve Monahan “should come back the next day.” 
Monahan then left Wakefield and walked to the adjacent 
pharmacy.  Curl observed Monahan at the pharmacy and stated that 
he appeared “very sick and was walking to the front, walking 
like somebody that was drunk and dizzy.”  She returned to 
Wakefield and informed Wiggins, who went outside and found 
Monahan leaning against the building and again discussed his 
condition with him.  She then prescribed Meclizine for Monahan’s 
dizziness. 
There was considerable conflict in the evidence as to what 
Wiggins advised Monahan to do during their discussion of his 
condition at Wakefield.  Obici contends that Wiggins advised 
Monahan that his high blood pressure could lead to a stroke and 
that he should go to the emergency room at a hospital.  When 
Monahan did not respond to her, Wiggins assumed from his silence 
that he was refusing to go to the emergency room.  Monahan 
maintained that Wiggins never told him that he needed to go to 
the emergency room and never mentioned the possibility of him 
having a stroke. 
Wiggins testified on direct examination: 
I was really concerned about his blood pressure being 
elevated. 
And I said, [b]ecause your blood pressure is 
elevated, that could mean several things.  It could 
mean that you might be having a stroke.  So you really 
 
4
need to go to the emergency room for further 
evaluation. 
 
. . . . 
 
His response was nothing.  He didn’t say anything 
at that particular time. 
 
Wiggins then testified that she reiterated her advice that 
Monahan go to the emergency room when she talked with him 
outside the pharmacy: 
 
[W]hen I realized that he was dizzy, I sat out 
there with him on the side of the pharmacy and said, 
Mr. Monahan, I’m really, really concerned about you.  
I said, I saw you when you were walking, and I feel 
like you need to go to the emergency room. 
 
And he kept saying, Well, I just called my wife, 
and she’s going to be at home probably by the time I 
get there. 
 
 
However, on cross examination, Wiggins testified that her 
advice to Monahan was given in the form of alternatives, that 
either he could go to the emergency room or go home and rest to 
see if his condition changed. 
Q [Monahan’s Counsel:]  So you gave him the option of 
either going to the emergency department or telling 
his wife to take him to the emergency department . . . 
if there’s any change in the least? . . . [I]sn’t that 
what you told him? 
 
A [Wiggins:]  Yes. 
 
. . . . 
 
Q[:]  And in response to you saying to him either go 
to the emergency department or go home, lay down, and 
tell your wife to take you to the emergency department 
if you have any change, he said okay, didn’t he? 
 
A[:]  He said okay. 
 
5
. . . . 
 
Q[:]  And when you gave him the option of going home, 
laying down, and telling his wife to take him to the 
emergency department if there was any change in him in 
the least, that, you believe, was one option for his 
treatment at that time, correct? 
 
A[:]  Not for his treatment, definitely not for his 
treatment, but to make sure that he got to the 
emergency room. 
 
Q[:]  Right.  But that was one alternative you gave 
him? 
 
A[:]  That was one alternative I gave him. 
 
Monahan’s medical chart at Wakefield for August 28, 2001 
contained the written statement “Refused to go to ER now,” but 
no other entry regarding any discussion between Wiggins and 
Monahan on the need to go to an emergency room. 
At some time after 1:00 pm, Wakefield’s receptionist 
telephoned Sandra Rickmond, the wife of Monahan’s boss Richard 
E. Rickmond, and advised her that Monahan was ready to leave the 
facility.  According to Mrs. Rickmond, that is all anyone from 
Wakefield told her. 
Mrs. Rickmond then went to Wakefield and drove Monahan to 
his home.  On the drive home, Monahan complained of dizziness 
and double vision.  Upon arriving at his home, Monahan went to 
bed. 
 
Mrs. Monahan testified that when she arrived home, her 
husband said that Wiggins told him to go home, get in bed, and 
 
6
return on Friday.  Mrs. Monahan left the bedroom briefly, and 
when she returned, Monahan had fallen out of bed.  After failing 
to reach anyone at Wakefield on the telephone, Mrs. Monahan 
decided to drive her husband to Riverside Hospital in Newport 
News.  En route to the hospital, Mrs. Monahan telephoned 
Wakefield again and spoke to Curl.  She informed Curl that she 
was driving her husband to Riverside.  Curl testified that she 
encouraged Mrs. Monahan to drive her husband to the Smithfield 
rescue squad for transport to a hospital.  Their conversation 
ended abruptly apparently due to a disruption in the cellular 
telephone service. 
The Monahans arrived at Riverside at approximately 3:00 
p.m. and Monahan was diagnosed as having suffered a stroke.5  One 
of Monahan’s rehabilitation physicians, Dr. Mark A. Ross, 
testified that as a result of the stroke, Monahan had incurred 
permanent problems with his speech, vision, movement and 
mobility, and balance.  Ross further testified that Monahan 
needed “ongoing medical management” to prevent future strokes 
and “can’t be left alone for long periods of time and be counted 
on to tend to his own needs properly.”  A vocational specialist 
testified that the stroke had left Monahan “unable to perform 
                                                 
5 The exact time the stroke occurred is unknown because it 
was a “stroke in evolution” in that it “progresses – it starts, 
and it goes on for a few hours.”  One of Monahan’s expert 
witnesses testified that it most likely occurred “while 
[Monahan] was being transported to Riverside.” 
 
7
. . . gainful, competitive employment” because of his 
“difficulty with walking, his balance difficulties, his 
communication impairments, and his fatigue.” 
 
Monahan filed a motion for judgment, which he later 
amended, against Obici alleging Obici failed to provide adequate 
medical care to him on August 28, 2001, and that he suffered a 
stroke as a result of Obici’s negligent treatment.6  Monahan 
asserted Obici deviated from established standards of care 
because Wiggins failed to properly diagnose Monahan’s condition 
and ensure that he received the immediate emergency room care 
that he needed to prevent or lessen the effect of a stroke.  
Monahan requested damages in the amount of $1,600,000.  Neither 
Obici’s grounds of defense nor its amended grounds of defense 
raised Monahan’s failure to mitigate damages as a defense.  
Apart from denying the allegations alleged in Monahan’s Motion 
for Judgment, Obici pled the affirmative defenses of 
contributory negligence and assumption of the risk. 
After the parties had presented their evidence to the jury, 
Monahan moved the trial court to “instruct the jury to 
disregard” the evidence concerning Mrs. Monahan’s actions in 
transporting her husband to Riverside Hospital rather than a 
                                                 
6 Monahan also named Wiggins as a party defendant, but later 
took a nonsuit as to her.  Wiggins is thus not a party to this 
appeal. 
 
8
closer hospital.7  Obici cross-examined Mrs. Monahan regarding 
her decision to drive her husband to Riverside Hospital even 
though it was “farther away” than two other emergency room 
facilities.  Mrs. Monahan admitted driving to Riverside even 
though it was “[n]ot quite 20 [minutes further away,] but I knew 
it was a little further” than [Obici].  Mrs. Monahan also 
acknowledged that she elected not to stop at “a rescue squad 
along the way in Smithfield.”  
Obici also questioned Dr. J. Gordon Burch, one of Monahan’s 
expert witnesses, regarding the time it took for Mrs. Monahan to 
drive to Riverside.  The cross-examination of Dr. Burch contains 
the following colloquy: 
Q [Obici’s counsel:]  [Y]ou’ve read that [Ms. Monahan] 
could have gotten [Monahan] to Obici in 30 minutes, 
and she took him to Riverside, and it took about 50 
minutes; is that correct? 
 
                                                 
7 This motion was only made orally, and Monahan did not 
elaborate as to what particular testimony he sought to strike.  
Similarly, Monahan’s brief does not indicate any specific 
testimony; instead, he claims “Obici failed to show that the 
decision to go to Riverside hospital, which was approximately 20 
minutes farther away than another hospital, can be used against 
Plaintiff to minimize his damages.” 
Mrs. Monahan testified that she chose to take her husband 
to Riverside as opposed to other area hospitals because she 
worked as a medical transcriptionist at Riverside and “I knew 
all the doctors there, because I knew exactly where to go to the 
emergency room.  I knew the emergency room physicians.  I knew 
the emergency room nurses, the techs.”  Obici did direct 
attention to that decision in its closing argument to the jury 
and the fact that may have delayed Monahan’s access to emergency 
room treatment. 
 
9
A [Dr. Burch:]  Yes.  I am aware of that.  There’s 
other testimony in the record that indicates that it 
might have been a harder trip to Obici because of 
lights and traffic and so on, and actually the time 
may have been very comparable.  Riverside is the 
better hospital to go to because of their expertise in 
neurological medicine and general medicine.  It’s a 
major medical center. 
 
Q[:]  But it added at least 20 minutes beyond the 
drive to Obici to take him to Riverside? 
 
A[:]  I don’t know the area well, and I don’t dispute 
that, but I understand from the record that there’s 
some difference of opinion as to the time it would 
take to get to both places. 
 
Responding to Monahan’s motion to instruct the jury, in 
effect a motion to strike, Obici contended that even though 
“[i]t’s true that there isn’t an expert that said by taking this 
patient to Riverside, that there was additional damage caused,” 
the evidence was relevant because Monahan’s theory of negligence 
was “predicated on the notion of timely presentation to an 
emergency department.” 
The trial court did not grant Monahan’s motion and ruled 
the act of Ms. Monahan in determining to take Mr. 
Monahan to Riverside Hospital for the reasons she said 
as opposed to Obici Hospital, that is – this is not 
causally connected in the sense of an act of 
negligence and some consequence . . . it is related to 
the issue of damages if that issue – if the jury gets 
[to] that issue. 
 
 
Monahan also moved to exclude Obici’s proposed mitigation 
of damages instruction on the grounds that Obici failed to plead 
mitigation of damages as an affirmative defense and there was 
 
10
insufficient evidence for an instruction.  The trial court 
overruled the motion finding that mitigation “is a duty on the 
part of every plaintiff, and I don’t find that it’s an 
affirmative defense.”  Over Monahan’s objection, the trial court 
gave Obici’s requested instruction to the jury: “The plaintiff 
has a duty to minimize his damages.  If you find that the 
plaintiff did not act reasonably to minimize his damages and 
that, as a result, they increased, then he cannot recover the 
amount by which they increased.” 
The jury returned a verdict in favor of Monahan in the 
amount of $215,000.  The trial court entered judgment approving 
the verdict by final order of April 15, 2005 to which Monahan 
objected on the basis of the mitigation instruction and the 
refusal to strike the testimony on the choice of hospital as 
proper evidence regarding mitigation of damages. 
 
We awarded Monahan this appeal. 
II. ANALYSIS 
 
Monahan’s assignments of error raise three issues for our 
review.  First, whether the trial court erred in finding that 
mitigation of damages was not an affirmative defense that must 
be specifically pled in order to be raised as a defense.  
Second, whether the trial court erred in denying Monahan’s 
motion to strike the evidence that Monahan’s wife chose to 
transport him to Riverside Hospital as opposed to a closer 
 
11
hospital.  And third, whether the trial court erred in finding 
sufficient evidence existed to support a mitigation of damages 
instruction.  We consider each issue in turn. 
A.  Pleading Mitigation of Damages 
 
Monahan contends that mitigation of damages cannot be 
raised as a defense unless it has been specifically pled by the 
defendant.  This is so, he asserts, because mitigation is an 
affirmative defense and “[i]t is axiomatic that an affirmative 
defense must be specifically pled, but also must be 
affirmatively pled.”  Monahan cites no case law to support his 
contention, but references a treatise that states: “[t]here are 
numerous issues that the defendant must himself plead as 
affirmative defenses.  If he fails to raise these issues they 
are deemed to be waived.”8  Monahan also argues that Rule 
3:18(e)9 “contemplates that affirmative defenses must be pled” 
because it states that they “may . . . be included in the same 
paper” as a defendant’s grounds of defense, counterclaims, 
cross-claims, pleas, demurrers, and other motions.  Because 
Obici did not raise mitigation in its initial or amended Grounds 
of Defense, or in any other written pleading, Monahan avers 
“Obici failed to properly place the question of mitigation in 
                                                 
8 W. Hamilton Bryson, Bryson on Civil Procedure 
§ 6.03[8][a], at 6-40 to –41 (4th ed. 2005). 
9 Former Rule 3:16(f). 
 
12
issue, and was not entitled to pursue it or obtain an 
instruction on it.” 
Obici responds by arguing that although Virginia case law 
identifies mitigation as an affirmative defense, it “has never 
mandated that mitigation of damages must be specifically pled.”  
Obici contends that an affirmative defense such as mitigation of 
damages does not have to be specifically pled, but “may be 
forthcoming from the evidence adduced at trial.” 
Whether mitigation of damages must be specifically pled is 
an issue of first impression in Virginia.  For the reasons that 
follow, we agree with Obici that mitigation of damages need not 
be specifically pled in order for a defendant to assert it, 
provided the issue has otherwise been shown by the evidence. 
We have held on numerous occasions that mitigation of 
damages is an affirmative defense.10  Forbes v. Rapp, 269 Va. 
374, 380, 611 S.E.2d 592, 596 (2005) (“An assertion that an 
injured party has failed to mitigate damages is an affirmative 
defense”); see also R.K. Chevrolet v. Bank of the Commonwealth, 
256 Va. 74, 77, 501 S.E.2d 769, 771 (1998); Marefield Meadows, 
Inc. v. Lorenz, 245 Va. 255, 266, 427 S.E.2d 363, 369 (1993); 
                                                 
10 The trial court was incorrect when, in reference to 
mitigation, it opined, “I don’t find that it’s an affirmative 
defense.”  However, this ruling was harmless error as it did not 
affect the ultimate conclusion that a specific pleading of 
mitigation was not required.  Blue Stone Land Co. v. Neff, 259 
Va. 273, 279, 526 S.E.2d 517, 519-20 (2000). 
 
13
Foreman v. E. Caligari & Co., 204 Va. 284, 290, 130 S.E.2d 447, 
451 (1963).  Consequently, the defendant bears the burden of 
proving that the plaintiff failed to mitigate his damages.  R.K. 
Chevrolet, 256 Va. at 77, 501 S.E.2d at 771. 
It has long been required that a party raise specific 
defenses (just as a plaintiff must give notice of claims) so 
that surprise and prejudice at trial from late revelation of 
unanticipated legal theories is avoided.  See, e.g., Chesapeake 
& O. Ry. v. Osborne, 154 Va. 477, 506, 153 S.E. 865, 873 (1930) 
(filing of a grounds of defense by defendant “limited in its 
defenses to the ground there stated”); see also City Gas Co. v. 
Poudre, 113 Va. 224, 226, 74 S.E. 158, 160 (1912) (purpose of 
requiring a grounds of defense is “to give the plaintiff 
reasonable notice of the particular defense upon which the 
defendant expects to rely, so that he may not be prejudiced by 
surprise”).  This has generally led to a requirement that 
affirmative defenses must be pled in order to be relied upon at 
trial.  See, e.g., Brooks v. Bankson, 248 Va. 197, 206, 445 
S.E.2d 473, 478 (1994) (defense of fraud). 
Exceptions to this general rule have been recognized in 
some factual contexts where the issue addressed by an 
affirmative defense was not disclosed in a plaintiff’s pleading, 
and only became apparent as the evidence was being received at 
trial.  In such instances, it has been held that an affirmative 
 
14
defense issue is properly heard even though it was not pled.  
See, e.g., Lawson v. States Constr. Co., 193 Va. 513, 521, 69 
S.E.2d 450, 455 (1952) (statute of frauds); McKee v. McKee, 206 
Va. 527, 532, 145 S.E.2d 163, 166 (1965) (condonation); Franklin 
Jewelry Co. v. Masch, 160 Va. 756, 764-65, 169 S.E. 583, 584 
(1933) (ultra vires); see also Twardy v. Twardy, 14 Va. App. 
651, 656-57, 419 S.E.2d 848, 851 (1992) (estoppel need not have 
been pled because “nothing of record suggested that the issue of 
estoppel would be involved” until later in the proceedings). 
Other affirmative defenses have been addressed by statute, 
which either obviate the need for pleading, or expressly require 
that a particular defense be pled.  Compare Roanoke Mtg. Co. v. 
Henritze, 151 Va. 220, 225, 144 S.E. 430, 431 (1928) (under 
prior law, usury shown on the face of the contract precluded 
recovery of interest, even if not pled), with, e.g., Jones v. 
Jones, 249 Va. 565, 571-72, 457 S.E.2d 365, 369 (1995) (under 
Code § 8.01-235 an affirmative defense of the statute of 
limitations must be specifically pled: “[t]he objection that an 
action is not commenced within the limitation period prescribed 
by law can only be raised as an affirmative defense specifically 
set forth in responsive pleading”). 
It is generally true that mitigation of damages, like other 
defenses, is routinely and properly raised in a defendant’s 
pleadings.  However, the requirements for raising mitigation of 
 
15
damages in a pleading have not been addressed by statute, and no 
prior case law has affirmatively noted that failure to plead 
this particular defense waives the right to rely on such proof 
at trial. 
While our prior cases have not directly addressed the 
pleading of mitigation, our decision in Chappell v. Smith, 208 
Va. 272, 156 S.E.2d 572 (1967), is instructive on the issue 
before us.  Our decision in Chappell addresses what evidence a 
defendant in default for failing to file either a responsive 
pleading or a grounds of defense could present during the trial 
for damages.  This Court held: “Neither [former] Rule 3:19 nor 
any statute prohibits counsel for a defendant in default from 
. . . offering evidence in mitigation of damages.”  Id. at 276, 
156 S.E.2d at 575.  The defendant was thus permitted to raise 
the affirmative defense of mitigation of damages despite that 
defense not having been specifically pled. 
Our holding in Chappell highlights the distinctive 
characteristics that mitigation of damages has as an affirmative 
defense.  Unlike most affirmative defenses, mitigation of 
damages is not a defense that, if proven, constitutes an 
absolute bar to the plaintiff’s claim.  Instead, a defense of 
mitigation recognizes that a plaintiff’s conduct following the 
defendant’s negligence “may be a reason for reducing damages,” 
but it does not necessarily bar all recovery.  Sawyer v. 
 
16
Comerci, 264 Va. 68, 77, 563 S.E.2d 748, 754 (2002).  This 
context distinguishes mitigation of damages from those other 
affirmative defenses or special pleas, which, if proven, 
constitute an absolute defense to the claim.  See, e.g., Nelms 
v. Nelms, 236 Va. 281, 289, 374 S.E.2d 4, 9 (1988) (listing as 
“[f]amiliar illustrations” such defenses as statute of 
limitations, absence of proper parties, res judicata, usury, a 
release, prior award, infancy, bankruptcy, denial of 
partnership, bona fide purchaser, and denial of an essential 
jurisdictional fact alleged in the bill) (citing E. Meade, 
Lile’s Equity Pleading and Practice, § 199, p. 114 (3d ed. 
1952)). 
Because neither statute nor our precedent requires that 
mitigation of damages be specifically pled as a condition 
precedent to its assertion as an affirmative defense, and taking 
into account the unique characteristics of this defense, we hold 
that mitigation of damages is not required to be specifically 
pled before a defendant may assert it, provided the issue has 
been otherwise shown by the evidence.11  The trial court thus did 
not err in permitting Obici to offer a mitigation of damages 
instruction despite its failure to plead that defense, subject 
to the presence of sufficient evidence, which we address below. 
                                                 
11 Our holding is limited solely to mitigation of damages as 
an affirmative defense and we express no opinion as to the 
specific pleading of any other affirmative defense. 
 
17
B. 
Choice of Hospital as Mitigation Evidence 
 
Monahan also assigns error to the trial court’s failure to 
grant his motion to instruct the jury to disregard the evidence 
regarding the emergency room facility to which Monahan was taken 
following his examination at Wakefield.  He asserts “[t]he 
evidence shows that the decision to take Monahan to Riverside 
hospital was made solely by his wife” and that her conduct 
cannot be imputed to him for the purpose of proving a failure to 
mitigate his damages.  Monahan emphasizes that Obici conceded at 
trial that no evidence suggested that the decision to take 
Monahan to Riverside “was a direct and proximate cause of any of 
his injuries or damages.” 
Obici responds that Monahan’s own theory of the case put at 
issue the timeliness of treatment, including the relevance of 
the delay in treatment caused by going to Riverside instead of a 
closer facility.  It argues that concluding the jury used the 
choice of hospital evidence to reduce damages is “the stuff of 
speculation” that ignores the other evidence supporting the 
defense of failure to mitigate damages. 
 
Obici conceded that the evidence did not support a 
claim that the decision of which emergency care facility to 
use was a direct or proximate cause of any damages Monahan 
suffered.  Obici acknowledged to the trial court that  
“there isn’t an expert that said by taking this patient to 
 
18
Riverside, that there was additional damage caused.”  
Furthermore, Obici submitted it was not arguing that this 
evidence “was a superseding or intervening cause” of the 
stroke. 
As such, there was no evidence that by going to Riverside 
rather than another facility, Monahan’s injuries were in any way 
affected.  Thus, any evidence about choice of emergency room 
facility was irrelevant to whether Monahan failed to mitigate 
his damages.  The trial court therefore erred in refusing to 
instruct the jury to disregard that evidence as Monahan properly 
requested. 
Furthermore, this error cannot be considered harmless.  The 
jury was improperly permitted to consider this testimony when 
deciding a verdict and, as discussed below, the jury was 
erroneously instructed regarding mitigation of damages.  We have 
previously said, “where evidence and an instruction have been 
erroneously submitted to the jury and the record does not 
reflect whether such evidence and instruction formed the basis 
of the jury’s verdict, we must presume that the jury relied on 
such evidence and instruction in making its decision.”  Johnson 
v. Raviotta, 264 Va. 27, 39, 563 S.E.2d 727, 735 (2002).  
Accordingly, we must presume the jury’s consideration of damages 
was affected by the ability to consider the improper choice of 
hospital evidence under the mitigation instruction. 
 
19
C. 
Sufficiency of the Evidence to Support the Mitigation 
Instruction 
 
Monahan further contends the trial court erred in granting 
a jury instruction on mitigation of damages because the evidence 
did not support such an instruction.  Even if Obici was not 
required to specifically plead mitigation as we have decided, 
Monahan asserts there was no evidentiary basis for the 
mitigation instruction.  Monahan contends “there is insufficient 
evidence that Monahan refused any treatment recommended by 
Wiggins” and therefore there is no independent basis upon which 
the trial court could give a mitigation instruction.  We agree 
with Monahan. 
Wiggins testified that she gave Monahan a choice to go to 
the emergency room while at Wakefield or to go home to rest and 
have his wife take him to the emergency room if his condition 
worsened.  Monahan avers he complied with this instruction by 
choosing the given alternative of going home, getting into bed 
and waiting for his wife. 
Obici responds that there was “ample evidence” to support 
the mitigation instruction.  Obici cites the testimony of not 
only Wiggins, but also Monahan’s expert witnesses, to support 
its contention that “the jury was required to determine whether 
Monahan had ignored Wiggins’ medical advice and in doing so, 
failed to minimize his damages.” 
 
20
A patient’s duty to mitigate damages after receiving 
negligent medical care is a specific application of the general 
requirement that: 
One who is injured by the wrongful or negligent acts 
of another, whether as the result of a tort or of a 
breach of contract, is bound to exercise reasonable 
care and diligence to avoid loss or to minimize or 
lessen the resulting damage, and to the extent that 
his damages are the result of his active and 
unreasonable enhancement thereof or are due to his 
failure to exercise such care and diligence, he cannot 
recover. 
 
Lawrence v. Wirth, 226 Va. 408, 412, 309 S.E.2d 315, 317 (1983) 
(quoting Haywood v. Massie, 188 Va. 176, 182, 49 S.E.2d 281, 284 
(1948)).  A mitigation of damages instruction is thus 
appropriate when the evidence shows that a plaintiff failed to 
mitigate his damages by “neglect[ing] his health following his 
physician’s negligent treatment.”  Sawyer, 264 Va. at 77, 563 
S.E.2d at 754 (quoting Lawrence, 226 Va. at 412, 309 S.E.2d at 
317). 
When asked to review jury instructions given by a trial 
court, “our responsibility is to see that the law has been 
clearly stated and that the instructions cover all issues which 
the evidence fairly raises.”  Lombard v. Rohrbaugh, 262 Va. 484, 
498, 551 S.E.2d 349, 356 (2001) (quoting Swisher v. Swisher, 223 
Va. 499, 503, 290 S.E.2d 856, 858 (1982)) (internal quotation 
marks omitted).  Under well-settled principles, “[a] jury 
instruction may be given only if there is evidence to support 
 
21
the instruction.”  Pollins v. Jones, 263 Va. 25, 28, 557 S.E.2d 
713, 714 (2002) (citing Van Buren v. Simmons, 235 Va. 46, 51, 
365 S.E.2d 746, 749 (1988)).  “The evidence presented in support 
of a particular instruction ‘must amount to more than a 
scintilla.’”  Schlimmer v. Poverty Hunt Club, 268 Va. 74, 78, 
597 S.E.2d 43, 45 (2004) (quoting Justus v. Commonwealth, 222 
Va. 667, 678, 283 S.E.2d 905, 911 (1981)).  
In the case at bar, the record is insufficient to sustain 
the mitigation of damages instruction because it does not 
reflect any act of neglect by Monahan following Wiggins’ 
treatment.  Wiggins’ testimony clearly reflects that she gave 
Monahan a choice of either going to the emergency room or going 
home: 
Q [Monahan’s counsel:]  [I]sn’t it true that you told 
Larry that he either needed to go to the emergency 
room or please tell your wife to take you there if 
there’s any change in the least? 
 
A [Wiggins:]  Yes. 
 
Q[:]  So you gave him the option of either going to 
the emergency department or telling his wife to take 
him to the emergency department . . . isn’t that what 
you told him? 
 
A[:]  Yes. 
 
The uncontradicted evidence shows that Monahan chose one of 
the options his health care provider, Wiggins, offered to him: 
he had someone drive him home and went to bed.  After his wife 
arrived home, his condition had worsened, and he was taken to an 
 
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emergency room, as Wiggins had suggested.  Because Wiggins gave 
Monahan the alternative course of action of either going to the 
emergency room or going home, and because Monahan complied with 
that advice by electing to go home, his decision cannot be the 
basis for a mitigation of damages instruction.  Monahan did not 
act contrary to the advice given to him by his health care 
provider, but followed one of the courses offered.  Therefore, 
no act of negligence supporting a failure to mitigate damages 
can be attributed to him based on his following the course of 
action offered by Wiggins.  Obici points to no other evidentiary 
basis for the instruction. 
 
The trial court thus erred in granting Obici’s instruction 
on mitigation of damages, as there was no evidentiary basis to 
support it.  “If an issue is erroneously submitted to a jury, we 
presume that the jury decided the case upon that issue.”  
Clohessy v. Weiler, 250 Va. 249, 254, 462 S.E.2d 94, 97 (1995).  
Accordingly, we cannot say that the trial court’s error in 
instructing the jury on the plaintiff’s duty to mitigate his 
damages was harmless. We must presume the jury’s consideration 
of damages was affected by the improperly given mitigation 
instruction. 
III. CONCLUSION 
Obici did not assign cross-error to the trial court’s 
judgment that it was negligent.  Thus, we do not review that 
 
23
issue and will affirm the trial court’s judgment as to Obici’s 
liability.  Upon retrial, the finding of liability is binding 
upon Obici, and Monahan will not be required to establish that 
Obici was negligent.  We will also affirm that portion of the 
trial court’s judgment that Obici was not required to 
specifically plead mitigation of damages as a condition 
precedent to asserting that defense.  However, we will reverse 
the trial court’s judgment as to damages because it was error to 
give the instruction on mitigation of damages and not to grant 
the motion to strike the evidence concerning the decision to 
drive Monahan to Riverside Hospital. 
We will therefore remand the case for a new trial limited 
to the issue of damages.  See Jenkins v. Pyles, 269 Va. 383, 
390, 611 S.E.2d 404, 408 (2005); Rawle v. McIlhenny, 163 Va. 
735, 750, 177 S.E. 214, 221 (1934) (“Where the verdict is for 
substantial though inadequate damages, it cannot upon any 
reasonable theory be considered a finding for the defendant, and 
it should be set aside, and a new trial granted which ordinarily 
should be limited to the question of the amount of damages”). 
Affirmed in part, 
reversed in part, 
                                           and remanded.