Title: Pollins v. Jones

State: virginia

Issuer: Virginia Supreme Court

Document:

Present:  All the Justices 
 
STUART W. POLLINS, ADMINISTRATOR OF THE 
ESTATE OF NICHOLAS VACCARO-POLLINS, DECEASED 
 
v.   Record No. 010425 
OPINION BY JUSTICE ELIZABETH B. LACY  
 
 
 
January 11, 2002 
RAYMOND JONES, M.D. 
 
FROM THE CIRCUIT COURT OF THE CITY OF FREDERICKSBURG 
John W. Scott, Jr., Judge 
 
 
In this appeal from a judgment in favor of the defendant 
doctor in a wrongful death case, we consider whether the 
evidence presented supported a jury instruction which told the 
jury to enter judgment in favor of the doctor if it found that 
the doctor chose one of "two or more alternative courses of 
action . . . recognized by the profession as proper." 
 
Nicholas Vaccaro-Pollins (Nicholas) was born on October 20, 
1993 with trisomy 21 (Down's Syndrome) and a congenital 
ventricular septal defect.1  On April 4, 1995, Nicholas underwent 
surgery to repair the defect in his heart at the Medical College 
of Virginia Hospitals (MCV Hospital).  Nicholas experienced 
post-operative complications, including two different episodes 
of pericardial effusion, a condition in which excessive fluid 
collects around the heart.  These effusions were drained on 
April 7 and 14 while Nicholas was still in the care of MCV 
Hospital.  Nicholas was discharged from MCV Hospital in stable 
condition on April 17 with instructions that he be given one 
baby aspirin every six hours and 5 mg. of Lasix twice daily.2  
 
On April 21, Nicholas began vomiting and suffering from 
diarrhea and a low-grade fever.  Nicholas' mother, Donna 
Vaccaro-Pollins, took Nicholas to see Raymond Jones, M.D., 
Nicholas' pediatrician.  Dr. Jones was aware of Nicholas' prior 
surgery and post-operative pericardial effusions.  Dr. Jones 
gave Nicholas a physical examination that included listening to 
and palpitating his heart and liver, and concluded that Nicholas 
had gastritis.  He prescribed Phenergan, an anti-emetic drug.  
He also instructed Mrs. Vaccaro-Pollins not to give Nicholas his 
evening dose of Lasix or aspirin and recommended that she 
contact Nicholas' doctors at MCV Hospital to report his current 
problems. 
 
In the early hours of April 22, 1995, Nicholas went into 
cardiac arrest and, after attempts to revive him failed, he was 
pronounced dead at 5:38 a.m.  The autopsy of Nicholas' body 
revealed that his pericardium contained 170 cc. of fluid, 
evidence that Nicholas died from congestive heart failure 
resulting from cardiac tamponade, a condition where excessive 
                                                                  
1 A ventricular septal defect is a condition in which there 
is a connecting hole between the lower two chambers of the 
heart. 
2 Lasix is a diuretic used to flush excess fluid from the 
body and is commonly prescribed after heart surgery. 
 
2
pressure is placed on the heart as a result of fluid in the 
pericardium. 
 
Stuart W. Pollins, Nicholas' father and the administrator 
of his estate (the Administrator) brought this wrongful death 
action against Dr. Jones.3  The Administrator presented three 
expert witnesses, who testified regarding the standard of care 
for treating a patient presenting Nicholas' symptoms and that 
Dr. Jones breached that standard of care.  Dr. Jones also 
offered the testimony of three expert witnesses who testified 
that Dr. Jones' actions did not constitute a breach of the 
standard of care of a physician presented with a patient in 
Nicholas' condition. 
 
Over the Administrator's multiple and strenuous objections, 
the trial court granted Dr. Jones' request that Instruction R be 
given to the jury.  The instruction stated: 
You have heard from the expert witnesses who have 
testified in this case with different views as to what 
would be the proper procedures to be followed by a 
physician in the position of Dr. Jones.  If you find 
from this testimony that two or more alternative 
courses of action would be recognized by the 
profession as proper, and that Dr. Jones in the 
exercise of his best judgment elected one of these 
proper alternatives, you should find for Dr. Jones.  
 
The jury returned a verdict in favor of Dr. Jones and the trial 
court entered judgment in accordance with the jury verdict.   
 
3
 
On appeal, the Administrator seeks reversal of the judgment 
on the ground that Instruction R was improperly given because 
there is no evidence to support such an instruction. 
 
The applicable principles are well settled.  A jury 
instruction may be given only if there is evidence to support 
the instruction.  Van Buren v. Simmons, 235 Va. 46, 51, 365 
S.E.2d 746, 749 (1988).  Use of the instruction at issue in this 
case requires evidence from expert testimony supporting the 
propositions that (1) there were "two or more alternative 
courses of action," and (2) that "the profession recognized 
[such alternative courses of action] as proper." 
 
In objecting to this instruction, the Administrator argued 
that, while the experts disagreed on whether or not Dr. Jones 
violated the standard of care, there was no evidence presented 
that the standard of care involved two or more alternative 
courses of action recognized by the profession.  We agree with 
the Administrator. 
 
The record shows that the expert witnesses agreed that the 
standard of care was "the degree of skill and diligence in the 
care and treatment of his patients that a reasonably prudent 
doctor in the same field of practice or specialty in this state 
would have used under the circumstances of this case."  The jury 
                                                                  
3 MCV Hospital, Dr. Richard Schieken, and Dr. Richard Embrey 
were also named as defendants, but were dismissed from the case 
 
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was instructed on this standard of care in Instruction 12.  The 
Administrator's expert witnesses opined that Dr. Jones violated 
the standard of care by failing to obtain Nicholas' medical 
history from MCV Hospital and instead instructing Nicholas' 
mother to contact the treating physicians at MCV Hospital; by 
conducting a heart examination of a struggling, crying child by 
percussion; by failing to determine a change in heart size 
through an x-ray; by terminating the Lasix medication and 
prescribing Phenergan to a child less than two years of age; and 
by failing to include pericardial effusion or congestive heart 
failure in his diagnosis. 
 
Dr. Jones' expert witnesses opined that Dr. Jones did not 
violate the applicable standard of care because (1) an x-ray or 
echocardiogram was not required under the circumstances; (2) 
instructing the mother to contact the child's physicians at MCV 
Hospital was sufficient and those physicians could have 
contacted Dr. Jones if they "had any other questions;" (3) the 
child's past and current medical history and the physical 
examination supported a diagnosis of gastritis; and (4) 
terminating the Lasix medication and prescribing Phenergan to 
stem the vomiting was reasonable. 
 
All of this testimony addressed whether Dr. Jones' actions 
complied with the applicable standard of care.  The expert 
                                                                  
following a settlement. 
 
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witnesses did not agree that professionally accepted alternative 
procedures under the circumstances allowed Dr. Jones to order an 
x-ray or conduct only a percussive physical examination; the 
experts did not agree that Dr. Jones could either contact 
Nicholas' treating physicians or have Nicholas' mother contact 
those physicians; the experts did not agree that the Lasix 
medication could either have been terminated or continued under 
the circumstances, nor did they agree that Phenergan could 
either be prescribed or not be prescribed for a child of 
Nicholas' age; and, finally, the experts did not agree that 
reaching a diagnosis of either gastritis or pericardial effusion 
would comply with the applicable standard of care.  There was 
absolutely no expert testimony or other evidence that "two or 
more alternative courses of action were available" and "would be 
recognized by the profession as proper" in the course of the 
diagnosis and treatment of Nicholas on April 21, 1995.  
 
King v. Sowers, 252 Va. 71, 471 S.E.2d 481 (1996), relied 
upon by Dr. Jones, does not require a different result.  In 
King, the instruction at issue referenced a "difference in views 
[among] practitioners as to treatment, or as to medical judgment 
exercised."  Id. at 77, 471 S.E.2d at 485 (internal quotations 
omitted).  The Court in King found that the evidence did 
establish a "difference in views" among the experts and thus 
supported the instruction, even though the instruction itself 
 
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was an incorrect statement of the law.4  Id.  In the instant 
case, Instruction R would only have been proper if there was 
evidence to support a finding that alternative procedures "would 
be recognized by the profession as proper."  As discussed above, 
the evidence in this case failed to show that the experts 
"recognized" or agreed that alternative procedures were proper. 
 
For the above reasons we hold that the trial court erred in 
granting Instruction R.  Accordingly, we will reverse the 
judgment of the trial court and remand the case for a new trial. 
Reversed and remanded. 
                     
4 In King, the Court stated that the instruction was an 
incorrect statement of the law, but no objection to the content 
of the instruction had been raised in the trial court.  King v. 
Sowers, 252 Va. at 76–77, 471 S.E.2d at 484.  As in King, the 
Administrator in this case did not challenge Jury Instruction R 
on the basis of its legal content. 
 
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