Title: Coston v. Bio-Medical Applications

State: virginia

Issuer: Virginia Supreme Court

Document:

Present: All the Justices 
 
LISA COSTON 
 
 
      OPINION BY CHIEF JUSTICE LEROY R. HASSELL, SR. 
v.  Record No. 062449 
 January 11, 2008 
 
BIO-MEDICAL APPLICATIONS OF VIRGINIA, INC., 
d/b/a TIDEWATER RENAL DIALYSIS CENTER 
 
FROM THE CIRCUIT COURT OF THE CITY OF NORFOLK 
Norman A. Thomas, Judge 
 
I. 
 
In this appeal of a judgment in favor of a defendant in a 
medical negligence case, we consider whether the plaintiff was 
required to present expert testimony to establish that the 
defendant health care provider breached the applicable 
standards of care by placing the plaintiff in a defective 
chair. 
II. 
 
Plaintiff, Lisa M. Coston, filed her motion for judgment 
against Bio-Medical Applications of Virginia, Inc.  Coston 
alleged that on April 8, 2002, she received dialysis treatment 
from a facility that the defendant operated called the 
Tidewater Renal Dialysis Center in Norfolk. 
 
Plaintiff further alleged that while she was receiving 
her dialysis treatment, she was injured when a chair in which 
she was seated "failed[,] causing her to fall and strike the 
ground."  Continuing, plaintiff alleged that despite the 
chair's defective condition, the defendant's employees placed 
 
2
her back in the chair, "which failed again[,] causing her to 
strike the ground a second time." 
Plaintiff also alleged in her motion for judgment that 
the defendant health care provider breached the applicable 
standard of care owed to her as a result of the defendant's 
"false, misleading, reckless, negligent, careless and wrongful 
conduct, including acts of commission and omission, all of 
which fell below a reasonable standard of care for health care 
providers in their specialty practicing in Virginia as herein 
enumerated, [plaintiff] has been severely and permanently 
injured . . . ."  In its grounds of defense, the defendant 
denied that it breached any duty owed to the plaintiff. 
 
The circuit court entered a pretrial order that required 
the plaintiff to identify her expert witnesses on or before 
June 9, 2005.  Plaintiff failed to identify any expert witness 
who would testify about the applicable standards of care owed 
by the defendant to the plaintiff and deviations from those 
standards.  Subsequently, the defendant filed a motion for 
summary judgment and asserted that the plaintiff could not 
establish a prima facie case of medical negligence because she 
failed to identify any expert witnesses who would testify 
about the applicable standards of care. 
During the hearing on the motion for summary judgment, 
the plaintiff requested, and was granted, a voluntary nonsuit 
 
3
after the case had been submitted to the circuit court for 
decision.  This Court granted the defendant's appeal, and we 
held that the circuit court erred in granting the plaintiff's 
motion for a nonsuit because the case had been submitted to 
the court for decision.  This Court reversed the judgment of 
the circuit court and remanded the case so that the circuit 
court could rule on the defendant's motion for summary 
judgment.  Bio-Medical Applications of Virginia, Inc. v. 
Coston, 272 Va. 489, 495, 634 S.E.2d 349, 352 (2006). 
 
Upon remand, the circuit court held that the plaintiff 
was required to present expert testimony to establish the 
applicable standards of care and any deviations therefrom, and 
the court entered summary judgment on behalf of the defendant 
because the plaintiff had not identified an expert witness who 
would render such testimony.  The plaintiff appeals. 
III. 
The plaintiff argues that the circuit court erred in 
granting the defendant's motion for summary judgment.  The 
plaintiff contends that she was not required to establish the 
applicable standards of care and deviations therefrom with 
expert testimony because the issue whether the defendant was 
negligent by placing the plaintiff in a defective chair falls 
within the common knowledge and experience of a jury. 
 
4
Responding, the defendant asserts that plaintiff may not 
challenge the circuit court's ruling that her failure to 
designate an expert witness on the standards of care required 
the dismissal of her medical negligence action because she 
failed to assign cross-error to that ruling in the first 
appeal to this Court.  Continuing, the defendant argues that 
even if the plaintiff may assert her assignment of error in 
this appeal, she was required to produce expert testimony to 
establish the applicable standards of care and any deviations 
from those standards.  We disagree with the defendant's 
arguments. 
Contrary to the defendant's assertions, the plaintiff 
could not have assigned as cross-error in the first appeal the 
circuit court's ruling that is the subject of the present 
appeal.  As we have already noted, in the first appeal the 
sole issue before this Court was whether the circuit court 
erred by granting the plaintiff a nonsuit.  Coston was not 
required to assign cross-error in the prior appeal because in 
the former proceeding in the circuit court, that court did not 
grant the defendant's motion for summary judgment.  This Court 
remanded this case in the first appeal and directed the 
circuit court upon remand to rule on the defendant's motion 
for summary judgment that is the subject of this appeal.  Bio-
 
5
Medical Applications of Virginia, 272 Va. at 495, 634 S.E.2d 
at 352. 
We have stated on many occasions that issues involving 
medical negligence often fall beyond the realm of the common 
knowledge and experience of a lay jury, and, therefore, in 
most instances expert testimony is required to assist a jury.  
Expert testimony is usually necessary to establish the 
applicable standards of care, a deviation from those standards 
of care, and that such deviation was a proximate cause of a 
plaintiff's damages.  Perdieu v. Blackstone Family Practice 
Center, Inc., 264 Va. 408, 420, 568 S.E.2d 703, 710 (2002); 
Beverly Enterprises-Virginia, Inc. v. Nichols, 247 Va. 264, 
267, 441 S.E.2d 1, 3 (1994); Raines v. Lutz, 231 Va. 110, 113, 
341 S.E.2d 194, 196 (1986); Bly v. Rhoads, 216 Va. 645, 653, 
222 S.E.2d 783, 789 (1976). 
 
We have held, however, that in certain rare 
circumstances, expert testimony is not necessary in a medical 
negligence case because the alleged acts of negligence clearly 
lie within the range of the jury's common knowledge and 
experience.  For example, in Beverly Enterprises, we affirmed 
a circuit court's judgment confirming a jury verdict in favor 
of a plaintiff in a medical negligence action even though the 
plaintiff did not produce expert testimony.  247 Va. at 270, 
441 S.E.2d at 3-4. 
 
6
In that case, Blanche Nichols was diagnosed with 
Alzheimer's disease.  She could not care for herself, and she 
was unable to eat unassisted.  She was admitted to a nursing 
home, and an administrator at the home was informed that 
Nichols was unable to eat unassisted.  Nichols' sons also 
informed the administrator of prior incidents when Nichols had 
choked while eating.  Id. at 265-66, 441 S.E.2d at 2. 
 
Employees of the nursing home, on at least two occasions, 
delivered food to Nichols, but no one assisted her with her 
food.  Even though the nursing home personnel knew that 
Nichols "needed to be spoon fed" and that someone "had to keep 
an eye" on her, the employees failed to assist her and Nichols 
died when food obstructed a portion of her air passage and 
lodged in her windpipe.  Id. at 266-67, 441 S.E.2d at 2-3. 
 
We held that the plaintiff was not required to present 
expert testimony to establish a prima facie case of medical 
negligence because "the question whether a reasonably prudent 
nursing home would permit its employees to leave a tray of 
food with an unattended patient who had a history of choking 
and who was unable to eat without assistance is certainly 
within the common knowledge and experience of a jury."  Id. at 
269, 441 S.E.2d at 4. 
 
In Dickerson v. Fatehi, 253 Va. 324, 484 S.E.2d 880 
(1997), we also considered whether expert testimony was 
 
7
necessary to establish the appropriate standards of care and 
breaches thereof in a medical negligence case.  In Dickerson, 
the plaintiff alleged that during the course of surgery, a 
physician used a blunt tip hypodermic needle, including a 
plastic attachment to the syringe, and that the physician 
negligently failed to remove the hypodermic needle from her 
neck at the conclusion of the procedure.  After the surgery, 
Dickerson experienced severe pain in her right arm, hand, and 
neck.  Approximately 20 months after the surgery, another 
surgeon discovered and removed the needle and plastic 
attachment from Dickerson's neck.  Id. at 326, 484 S.E.2d at 
881. 
 
Dickerson filed a motion for judgment against certain 
health care providers.  She asserted that based upon the facts 
alleged in her pleadings and the defendant's admissions, 
expert testimony was not necessary to establish the 
appropriate standards of care and breaches thereof.  Id. at 
327, 484 S.E.2d at 881.  We held that if the facts alleged by 
the plaintiff and admitted by the doctor were presented to a 
jury, the jurors, 
"absent expert testimony, reasonably could 
determine, by calling upon their common knowledge 
and experience, whether [the doctor] was negligent 
and whether his negligence was a proximate cause of 
Dickerson's injuries.  Therefore, the trial court 
erred in ruling that expert testimony was necessary 
to establish the standard of care." 
 
8
 
Id. at 328, 484 S.E.2d at 882. 
 
We also note that in Jefferson Hospital, Inc. v. Van 
Lear, 186 Va. 74, 76-77, 84, 41 S.E.2d 441, 441-42, 445 
(1947), we affirmed the judgment of a circuit court confirming 
a jury verdict in favor of a plaintiff in a medical negligence 
action without the presentation of expert testimony.  In 
Jefferson Hospital, the plaintiff fell and fractured his hip 
while trying to walk to a bathroom.  Even though the plaintiff 
had utilized a device that activated a signal light plainly 
visible to the floor nurse, neither the nurse nor any other 
attendant responded to his call during the 20 or 30 minute 
period that the signal light was activated.  We held that the 
evidence was sufficient to support a finding of negligence 
without expert testimony because the hospital personnel were 
aware of the plaintiff's physical condition and they knew, or 
should have known, that a delay in answering his call for 
assistance might induce him to leave his bed and attempt to 
use the bathroom without assistance.  Id. at 78-80, 41 S.E.2d 
at 442-43. 
 
We hold that in the present case, just as in Dickerson, 
Beverly Enterprises, and Jefferson Hospital, the plaintiff's 
allegations that she was injured after she was placed in a 
defective chair, if proven at trial, would be sufficient to 
 
9
establish a prima facie case of medical negligence against the 
defendant without the necessity of expert testimony.  Based 
upon these allegations, a jury could find that defendant's 
employees placed the plaintiff in a defective chair even 
though they had knowledge that the chair was not safe.  
Certainly, the issue whether the defendant's acts or omissions 
in this case constitute medical negligence is within a jury's 
common knowledge and experience and, therefore, expert 
testimony is not necessary. 
 
The defendant, nevertheless, relying upon our decision in 
Perdieu, argues that the plaintiff was required to establish 
the applicable standards of care and deviations therefrom with 
expert testimony.  We disagree with the defendant's argument.   
In Perdieu, we held that a plaintiff in a medical 
negligence action must produce expert testimony to establish:  
that a physician failed to supervise a resident physician; 
that a physician breached the standards of care by failing to 
timely diagnose an injury; that a nursing home was negligent 
in failing to attend, restrain, assist, diagnose, examine, and 
treat an inpatient; and that the nursing home was negligent in 
its failure to implement a care plan for the patient.  We held 
that the plaintiff was required to present expert testimony to 
establish a prima facie case of negligence because these 
issues were not within the common knowledge and experience of 
 
10
lay jurors.  264 Va. at 421-22, 568 S.E.2d at 711.  Unlike the 
standard of care issues that this Court discussed in Perdieu, 
in the appeal before this Court, the issue of the defendant's 
acts of medical negligence regarding the defective chair is 
quite simple and within the common knowledge and experience of 
a lay jury. 
IV. 
 
Accordingly, we will reverse the judgment of the circuit 
court, and we will remand this case to the circuit court for a 
trial on the merits. 
Reversed and remanded.