Title: Gravitt v. Ward

State: virginia

Issuer: Virginia Supreme Court

Document:

Present: All the Justices 
 
BRENDA LOWERY GRAVITT 
 
 
 
 
 
 
 
 
OPINION BY 
v. Record No. 982269 
 
JUSTICE LAWRENCE L. KOONTZ, JR. 
 
 
 
 
 
 
   
  September 17, 1999 
PHILLIP D. WARD, M.D., ET AL.  
 
 
FROM THE CIRCUIT COURT OF HALIFAX COUNTY 
William L. Wellons, Judge 
 
 
 
On October 11, 1996, Brenda Lowery Gravitt instituted this 
medical malpractice action against Dr. Philip D. Ward, an 
obstetrician/gynecologist, and his employer, Fuller-Roberts 
Clinic, Inc. (Fuller-Roberts), seeking $1,000,000 in damages she 
alleged resulted from the defendants’ negligent failure to 
timely diagnose her breast cancer.  In response, Dr. Ward and 
Fuller-Roberts filed grounds of defense, denying that they were 
negligent and reserving the right to rely upon the defense of 
contributory negligence.  The action was tried to a jury on the 
issues of negligence and contributory negligence.  The jury 
returned its verdict for Dr. Ward and Fuller-Roberts and the 
trial court entered final judgment in accord with the jury’s 
verdict.  The sole issue we consider in this appeal is whether 
there was sufficient evidence to support the trial court’s 
granting the jury instruction on contributory negligence 
requested by the defendants. 
 
In 1993, Gravitt, then age 46, had been a patient at 
Fuller-Roberts since 1966.  Fuller-Roberts had performed her 
most recent mammogram on May 20, 1992.  The mammogram report 
documented the fact that Gravitt had a family history of breast 
cancer.  Gravitt’s sister had died from breast cancer before the 
age of 50.  Although the 1992 mammogram revealed no 
abnormalities in Gravitt’s breasts at that time, there is no 
dispute that Gravitt was subject to an increased risk of cancer 
because of her family history of breast cancer and that she was 
aware of that increased risk. 
On July 26, 1993, after discovering “a bruise and inverted 
sunken-in place” on her left breast, Gravitt made an appointment 
at Fuller-Roberts for later that day.  Since Gravitt’s regular 
doctor was unavailable, Dr. Ward examined her.  Dr. Ward’s chart 
notes initially indicated that Gravitt had complained of “a lot 
of redness and discomfort around the nipple of the left breast.”  
After conducting a breast exam, Dr. Ward found what he described 
in the chart as a “[l]ittle glandular area at six o’clock 
adjacent to the nipple.”  However, he found no redness or gross 
tenderness.  Dr. Ward further noted in the chart that since her 
condition “is resolving” he did not suspect that cancer was 
present because “if it was cancer, [he] would not expect 
resolution.”  Because Gravitt’s mammogram from the previous year 
was normal, Dr. Ward chose to have Gravitt observe her 
 
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condition, indicating that he would recommend repeating the 
mammogram only if the problem persisted. 
On August 30, 1993, Gravitt attended a previously scheduled 
appointment for a “Pap smear” with another doctor at Fuller-
Roberts.  During that appointment, Gravitt made no complaints 
about her breast. 
On October 18, 1993, Gravitt called Fuller-Roberts for an 
appointment and was examined again by Dr. Ward.  The events that 
took place during that visit were disputed at trial.  Gravitt 
testified that she and her husband found a lump in her left 
breast sometime in early October.  Gravitt further testified 
that she told Dr. Ward about the lump and that after conducting 
a breast exam he informed her that it felt like a cyst.  
According to Gravitt, Dr. Ward then asked her if she was having 
any pain.  When she answered affirmatively he said, “[w]ell, 
that’s a good sign because cancer doesn’t hurt.”  Dr. Ward told 
her to take vitamin E to get rid of the cyst.  To which Gravitt 
responded, “[t]his is wonderful.  I’m glad it’s just a cyst.”  
Gravitt contends that they did not discuss the need for a 
mammogram. 
At trial, Dr. Ward was never asked whether Gravitt informed 
him about the lump in her breast, and Dr. Ward never expressly 
stated that he had not been told about it.  Rather, Dr. Ward 
testified that Gravitt’s chief complaint during the visit was 
 
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premenstrual tenderness in her left breast.  Gravitt’s chart did 
not reflect the presence of any other symptoms or that she had 
found a lump in her breast.  Dr. Ward conducted a complete 
examination of her breasts and found the breast tissue to be 
“freely mobile.”  He did not locate any lesions, cancerous or 
otherwise.  According to Dr. Ward, part of a normal breast exam 
includes looking for dimpling or discharge and examining the 
patient’s lymph nodes and glands for swelling.  Dr. Ward 
testified that if dimpling, discharge, or swelling had been 
found it would have been noted in the patient’s chart. 
Dr. Ward testified that he concluded that the tenderness in 
Gravitt’s left breast was a result of fibrocystic changes 
associated with her menstrual cycle.  Therefore, he recommended 
that she decrease her caffeine intake and begin taking vitamin 
E.  Dr. Ward was aware of a history of breast cancer in 
Gravitt’s family, including the fact that Gravitt’s sister had 
died from breast cancer before the age of 50.  However, he chose 
not to order a mammogram because Gravitt had a normal mammogram 
within the past year and a half and her symptoms were consistent 
with a fibrocystic change.  Dr. Ward admitted that on occasion a 
mammogram would locate a cancerous abnormality not detected 
during a manual breast exam. 
During the next few months, Gravitt went on a low-fat diet, 
took vitamin E, and exercised.  However, the discomfort in her 
 
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left breast continued and worsened.  After her arm began to 
hurt, Gravitt made an appointment at Fuller-Roberts for a 
physical and a mammogram on May 11, 1994.  The mammogram 
indicated a mass in her left breast.  A biopsy was performed on 
May 18, 1994 and two doctors informed Gravitt that she would 
need to have a mastectomy.  By this time, Gravitt’s breast 
cancer had spread to her lymph nodes and metastasized throughout 
her body. 
At trial, in addition to the foregoing evidence, the 
parties introduced conflicting evidence from medical experts 
regarding the standard of care applicable to this case.  Gravitt 
presented expert testimony from Dr. Stephen E. Zimberg and Dr. 
George M. Kemp that Dr. Ward breached the standard of care by 
not ordering a mammogram during either the July 26, 1993 or 
October 18, 1993 visits.  Dr. Kemp testified that he thought a 
diagnosis of Gravitt’s breast cancer “could have been made and 
probably would have been made in July with a mammogram.”  Dr. 
Ward presented expert testimony from Dr. George Cornell 
supporting his contention that the decision not to order 
mammograms during either visit had not violated the applicable 
standard of care. 
At the close of all the evidence, Gravitt objected to Jury 
Instruction 15, which read as follows:  
 
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The defendants, in claiming contributory 
negligence as a defense in this case, have the burden 
of proving by the greater weight of the evidence that 
the plaintiff was negligent on October 18, 1993 in 
that the plaintiff failed to tell Dr. Ward about the 
lump in her breast, and that this negligence was a 
proximate cause of the plaintiff’s injuries.  
Contributory negligence may be shown by the 
defendant’s evidence or by the plaintiff’s evidence. 
 
Relying on Eiss v. Lillis, 233 Va. 545, 357 S.E.2d 539 (1987), 
and Lawrence v. Wirth, 226 Va. 408, 309 S.E.2d 315 (1983), 
Gravitt asserted that whether she told Ward about the lump was 
an issue of primary negligence not contributory negligence.  The 
court granted the contributory negligence instruction.*
The gravamen of Gravitt’s appeal is that the contributory 
negligence instruction should not have been granted because the 
trial testimony as a whole did not support it.  Our discussion 
is necessarily limited to the resolution of that issue in the 
context of the facts of this particular case.  Accordingly, we 
do not reach the broader issue raised at trial, viz., whether 
Gravitt’s acts of alleged negligence were solely issues 
concerning the primary negligence of Dr. Ward. 
With respect to the requirements for giving a contributory 
negligence instruction, we have said that “before either party 
                                                          
 
*In addition, the trial court granted Instruction 16 which 
provided, in pertinent part, that the jury should find its 
verdict for the defendants if it found “by the greater weight of 
the evidence that the plaintiff was contributorily negligent on 
October 18, 1993, and that her contributory negligence was a 
proximate cause of her injuries.” 
 
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is entitled to an instruction on negligence or contributory 
negligence, as the case may be, there must be more than a 
scintilla of evidence introduced on the subject.”  Yeary v. 
Holbrook, 171 Va. 266, 287-88, 198 S.E. 441, 451 (1938); see 
also Ring v. Poelman, 240 Va. 323, 327, 397 S.E.2d 824, 827 
(1990).  “When a defendant in a negligence action relies on the 
contributory negligence of the plaintiff, the burden rests on 
the defendant to show such negligence was a proximate, direct, 
efficient and contributing cause of the injuries unless such 
negligence is disclosed by the plaintiff’s own evidence or may 
be fairly inferred from all the circumstances.”  Charlottesville 
Music Center, Inc. v. McCray, 215 Va. 31, 37, 205 S.E.2d 674, 
679 (1974).  Moreover, “in order for a plaintiff’s negligence to 
bar recovery, it must concur with that of the defendant . . . .  
[I]n the medical malpractice context, that means the patient’s 
alleged contributory negligence must be contemporaneous with the 
main fact asserted as negligence on the doctor’s part.”  Eiss, 
233 Va. at 552, 357 S.E.2d at 543 (citing Lawrence, 226 Va. at 
412-13, 309 S.E.2d at 317-18). 
Instruction 15, and the related portion of Instruction 16, 
limited Gravitt’s alleged negligence to the events of the 
October 18, 1993 visit at Fuller-Roberts.  According to 
Gravitt’s theory of the case, this was the last missed 
opportunity for Dr. Ward to have ordered a mammogram that would 
 
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have led to the discovery and successful treatment of her 
cancer.  Thus, to resolve the issue presented our focus is 
necessarily drawn to the facts surrounding Dr. Ward’s 
examination of Gravitt on that day.  Specifically, we must 
consider the evidence to determine whether it presented a jury 
question whether Gravitt failed to act as a reasonable person 
would have acted for her own safety under the existing 
circumstances. 
There is unequivocal evidence in the record that on October 
18, 1993, Gravitt informed Dr. Ward of the lump in her left 
breast that she and her husband had detected.  In contrast, 
there is no evidence in the record to directly dispute her 
testimony on this point.  The testimony of Dr. Ward is 
conspicuously silent on this point, and thus did not raise a 
triable issue.  The only evidence that, at best, indirectly 
tends to create a factual dispute over Gravitt’s assertions is 
that Dr. Ward made no notation of a lump when he recorded his 
examination of her breast in the medical record.  More 
significantly, there is no dispute that Dr. Ward conducted a 
full breast exam on Gravitt.  Upon completion of this exam, Dr. 
Ward did not tell Gravitt that he had failed to detect any 
abnormality in her left breast.  To the contrary, he made a 
positive diagnosis that the condition was not cancer, informing 
 
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Gravitt that her symptoms were caused by “fibrocystic changes” 
related to her menstrual cycle. 
Neither Eiss nor Lawrence resolves the narrow issue 
presented by the facts of the present case.  Here, if there was 
evidence of contributory negligence on Gravitt’s part, it was 
contemporaneous with the main fact asserted as negligence on Dr. 
Ward’s part on October 18, 1993.  However, in Lawrence we noted 
that “[t]he physician-patient relationship differs substantially 
from that of the ordinary plaintiff and defendant.”  226 Va. at 
411, 309 S.E.2d at 317.  This is so because of the great 
disparity in medical knowledge between “doctor and patient.”  
Id.  Despite that disparity, it is common knowledge that the 
presence of a lump in a woman’s breast presents the possibility 
of the presence of a malignant tumor.  This is particularly the 
case where there is also a family history of breast cancer.  
Thus, under those circumstances, the woman patient seeks to 
obtain, through a breast examination, the benefit of the 
doctor’s medical knowledge to determine if a malignant tumor is 
in fact present in her breast, and, if so, to obtain appropriate 
treatment. 
In this context, it is inconsistent with common knowledge 
and human experience that such a patient, concerned for her own 
safety, would fail to inform her doctor with the fact that her 
discovery of a lump in her breast was the very reason she sought 
 
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the doctor’s examination of her breast.  While admittedly this 
might occur in a given case, the evidence in the present case 
does not establish that such was a proper issue for the jury to 
determine.  Rather, here there was no more than a scintilla of 
evidence that Gravitt failed to inform Dr. Ward of her discovery 
of a lump in her left breast.  That evidence flows only from the 
evidence that Dr. Ward did not note in her chart that she had 
discovered a lump.  That evidence further pales to no more than 
a scintilla in light of Dr. Ward’s positive diagnosis of non-
cancerous “fibrocystic changes” in Gravitt’s left breast that he 
communicated to her. 
For these reasons, we hold that there was not sufficient 
evidence from which the jury could reasonably find that Gravitt 
was contributorily negligent.  Therefore, it was error for the 
trial court to give the contributory negligence instruction.  
Because the issue of primary negligence was principally a 
classic “battle of the experts,” we cannot say that the 
erroneous instruction on contributory negligence did not affect 
the jury’s determination of liability.  See Clohessy v. Weiler, 
250 Va. 249, 254, 462 S.E.2d 94, 97 (1995).  We must presume the 
jury relied on the erroneous in reaching its verdict.  Id.
 
Accordingly, we will reverse the judgment in favor of Dr. 
Ward and Fuller-Roberts and remand the case for a new trial. 
Reversed and remanded. 
 
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