Title: Sami v. Varn

State: virginia

Issuer: Virginia Supreme Court

Document:

Present:  All the Justices 
 
VIDA SAMI 
 
v.  Record No. 992345     OPINION BY JUSTICE ELIZABETH B. LACY 
 
 
 
September 15, 2000 
MILES VARN, M.D. AND  
JULIAN ORENSTEIN, M.D. 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
M. Langhorne Keith, Judge 
 
 
In this appeal, we consider whether the trial court erred 
in holding that an obstetrician-gynecologist was not qualified 
to give expert testimony on the standard of care for a pelvic 
examination performed by an emergency room physician. 
 
Vida Sami went to the emergency room of Fairfax Hospital 
on January 26, 1994.  She told the hospital personnel she was 
pregnant and that she was in pain and experiencing vaginal 
bleeding.  Three separate pelvic examinations were performed 
on Sami:  one by a medical resident; another by an emergency 
room physician, Dr. Miles Varn; and a third by the resident 
obstetrician-gynecologist on call at the hospital, Dr. Barbara 
A. Dill.  Their conclusions were that Sami had undergone a 
spontaneous abortion or miscarriage and, according to Dr. 
Dill, the "miscarriage had completed itself."  Sami was 
discharged from the hospital and given instructions for a 
follow-up appointment within four weeks. 
 
Sami returned to the Fairfax Hospital emergency room in 
April of that year, and again in June, complaining of pain.  
Dr. Julian Orenstein, an emergency room physician, performed a 
pelvic examination and discharged Sami, instructing her to 
take a non-prescription pain medication. 
In late June 1994, Sami went to the office of Dr. Herbert 
Roberts, an obstetrician-gynecologist, complaining of 
continuing abdominal pain.  Dr. Roberts performed an abdominal 
examination, administered a sonogram, and found a "pelvic 
mass."  When Dr. Roberts operated on Sami to remove the mass, 
he discovered that the mass was a second uterus containing a 
twelve to fifteen-week-old dead fetus. 
 
Sami filed a motion for judgment against a number of 
physicians at Fairfax Hospital, including Drs. Varn and 
Orenstein, alleging negligence and "infliction of emotional 
distress."1  Sami filed a second motion for judgment against 
Fairfax Hospital on the same theories, claiming that the 
Hospital breached its duty to properly supervise its 
employees.  The motions for judgment were consolidated. 
 
During a jury trial, Sami sought to qualify Dr. Roberts 
as an expert witness on the standard of care.  Following voir 
dire of Dr. Roberts, the trial court concluded that Dr. 
Roberts was qualified as an expert on the standard of care 
applicable to the actions of Dr. Dill, an obstetrician-
                     
1 The other defendants in this action were dismissed by 
the trial court and are not involved in this appeal. 
 
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gynecologist, but that he was not qualified to testify to the 
standard of care applicable to Drs. Varn and Orenstein, 
emergency room physicians.  The trial court held that Dr. 
Roberts did not "demonstrate[] expert knowledge of the 
standards of defendant[s'] specialty," and that he did not 
"have an active clinical practice in ER" or a related field.  
Without Dr. Roberts' testimony, Sami did not have an expert to 
establish the standard of care and breach thereof by Drs. Varn 
and Orenstein, and the trial court sustained a motion by those 
defendants to dismiss Sami's claims against them. 
 
Following further testimony, the jury returned a verdict 
in favor of the hospital.  Sami filed this appeal asserting 
that the trial court erred in holding that Dr. Roberts was not 
qualified to offer expert testimony on the standard of care 
applicable to the pelvic examinations performed by Drs. Varn 
and Orenstein. 
 
The qualification of a witness as an expert is governed 
by Code § 8.01-581.20, which states, in relevant part: 
A witness shall be qualified to testify as an 
expert on the standard of care if he 
demonstrates expert knowledge of the standards 
of the defendant's specialty and of what 
conduct conforms or fails to conform to those 
standards and if he has had active clinical 
practice in either the defendant's specialty or 
a related field of medicine within one year of 
the date of the alleged act or omission forming 
the basis of that action. 
 
 
3
Drs. Varn and Orenstein argue that the trial court properly 
declined to qualify Dr. Roberts as an expert on the standard 
of care applicable to them on two grounds:  (1) because Dr. 
Roberts did not demonstrate expert knowledge of their 
specialty, emergency room medicine; and (2) because he had not 
had a clinical practice in their specialty or a related field 
within one year preceding the date of the alleged malpractice.  
We disagree with both of these arguments. 
 
Whether a witness demonstrates expert knowledge of the 
appropriate standards of the defendant's specialty is a 
question largely within the sound discretion of the trial 
court.  Lawson v. Elkins, 252 Va. 352, 354, 477 S.E.2d 510, 
511 (1996)(citing Grubb v. Hocker, 229 Va. 172, 176, 326 
S.E.2d 698, 700 (1985)).  However, we will reverse a holding 
that a witness is not qualified to testify as an expert when 
it appears clearly from the record that the witness possesses 
sufficient knowledge, skill, or experience to make him 
competent to testify as an expert on the subject matter at 
issue.  Noll v. Rahal, 219 Va. 795, 800, 250 S.E.2d 741, 744 
(1979). 
In this case, Dr. Roberts testified that he was familiar 
with the standards of care applicable to pelvic examinations 
and that these standards were the same for an emergency room 
physician and an obstetrician-gynecologist.  Dr. Dill, a 
 
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defense witness, testified that she knew of no "variation 
among the medical profession on performance of a pelvic 
examination." 
Nothing in the record in this case contradicts the 
testimony of Drs. Roberts and Dill, that the standards 
applicable to the performance of a pelvic examination by an 
obstetrician-gynecologist and an emergency room physician are 
the same.  Dr. Roberts' lack of knowledge regarding certain 
procedures of emergency medicine might disqualify him from 
rendering expert testimony as to those procedures, but that 
lack of knowledge does not preclude him from giving expert 
testimony on procedures which are common to both emergency 
medicine and the field of obstetrics-gynecology and are 
performed according to the same standard of care.  See 
Griffett v. Ryan, 247 Va. 465, 472-73, 443 S.E.2d 149, 153-54 
(1994). 
In light of the record in this case, the trial court was 
not entitled to ignore the uncontradicted testimony that the 
standard of care for the performance of pelvic examinations 
was common to both specialties.  Cheatham v. Gregory, 227 Va. 
1, 4, 313 S.E.2d 368, 370 (1984).  In qualifying Dr. Roberts 
to testify as an expert regarding Dr. Dill's performance of a 
pelvic examination, the trial court acknowledged Dr. Roberts' 
knowledge of the relevant standard of care for that procedure.  
 
5
Therefore, we conclude that the trial court abused its 
discretion in holding that Dr. Roberts did not demonstrate 
sufficient knowledge of the standard of care at issue in this 
case to qualify as an expert witness on that standard. 
Drs. Varn and Orenstein also argue that the trial court's 
ruling was correct because Dr. Roberts did not have an active 
clinical practice in their specialty or a field related to 
their specialty, as required by § 8.01-581.20.  Dr. Roberts 
does not have an active clinical practice in emergency 
medicine, but he does have an active clinical practice in 
obstetrics-gynecology.  Sami argues that obstetrics-gynecology 
and emergency medicine should be considered related fields of 
medicine for the purposes of § 8.01-581.20 in the instant case 
because the procedure at issue is performed in both 
specialties and the standard for performance is identical.  We 
agree with Sami. 
We have not previously considered the application of the 
phrase "related field of medicine" in circumstances similar to 
those presented in this case.2  The phrase contemplates a 
clinical practice which differs from that of the defendant, 
                     
2 In Fairfax Hospital System, Inc. v. Curtis, 249 Va. 531, 
537, 457 S.E.2d 66, 70 (1995), the proffered expert had 
previously practiced as an attending physician in the 
defendant's specialty, but at the time of the alleged 
malpractice was the "director of a helicopter transport 
 
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but the statute provides no guidance for determining whether a 
clinical practice is "related."  The purpose of the 
requirement in § 8.01-581.20 that an expert have an active 
practice in the defendant's specialty or a related field of 
medicine is to prevent testimony by an individual who has not 
recently engaged in the actual performance of the procedures 
at issue in a case.  Therefore, we conclude that, in applying 
the "related field of medicine" test for the purposes of 
§ 8.01-581.20, it is sufficient if in the expert witness' 
clinical practice the expert performs the procedure at issue 
and the standard of care for performing the procedure is the 
same. 
In this case, as recited above, the procedure at issue, a 
pelvic examination, is governed by the same standard of care 
in both the emergency room and obstetric-gynecology practice 
settings.  Nothing in this record indicates that the emergency 
room setting required the procedure to be performed in a 
manner different than it would be performed under other 
circumstances.  Dr. Roberts had an active clinical practice 
which included the performance of pelvic examinations within 
one year of the alleged malpractice.  Thus, we conclude that 
                                                                
service," an activity which did not qualify as any type of 
clinical practice. 
 
7
Dr. Roberts had an active clinical practice in a related field 
of medicine for purposes of § 8.01-581.20. 
Because Dr. Roberts satisfied both requirements of 
§ 8.01-581.20, it was an abuse of discretion by the trial 
court to rule that Dr. Roberts was unqualified to give expert 
testimony on the standard of care for the performance of a 
pelvic examination by the emergency room physicians in this 
case.  Accordingly, we will reverse the judgment of the trial 
court and remand the case for further proceedings consistent 
with this opinion. 
Reversed and remanded. 
 
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