Supreme Court of Louisiana 

FOR IMMEDIATE NEWS RELEASE NEWS RELEASE #023

FROM: CLERK OF SUPREME COURT OF LOUISIANA

The Opinions handed down on the 5th day of May, 2015, are as follows:

PER CURIAM: 

2014-C -1964 CLYDE SNIDER, JR., ET UX v. LOUISIANA MEDICAL MUTUAL INSURANCE 

COMPANY, ET AL. (Parish of Beauregard)

For the reasons assigned, the judgment of the court of appeal is 

reversed. The case is remanded to the court of appeal for 

further proceedings consistent with this opinion.

JOHNSON, C.J., dissents.

KNOLL, J., dissents and assigns reasons.

CRICHTON, J., additionally concurs and assigns reasons.
05/05/15

SUPREME COURT OF LOUISIANA

NO. 2014-C-1964

CLYDE SNIDER, JR., ET UX

VERSUS

LOUISIANA MEDICAL MUTUAL INSURANCE COMPANY, ET AL.

ON WRIT OF CERTIORARI TO THE COURT OF APPEAL, 

THIRD CIRCUIT, PARISH OF BEAUREGARD

PER CURIAM

In this case, we are called upon to decide whether a jury’s factual finding that

a physician did not breach the appropriate standard of care is manifestly erroneous. 

 For the reasons that follow, we find the jury’s verdict is supported by the evidence

and is not clearly wrong.

FACTS AND PROCEDURAL HISTORY

This case was previously before the court in Snider v. Louisiana Medical Mut.

Ins. Co., 13-0579 (La. 12/10/13), 130 So. 3d 922. The underlying facts were set forth

in our opinion as follows:

On May 13, 2007, within days of his twenty-seventh

birthday, Clyde Snider, Jr., was hospitalized at CHRISTUS

St. Patrick Hospital ("St. Patrick"), in Lake Charles,

Louisiana, for a suspected myocardial infarction. Mr.

Snider was treated by cardiologist Dr. Jean King White,

who diagnosed him with coronary artery disease and acute

coronary syndrome, which was treated with angioplasty and

the implantation of a heart stent in Mr. Snider's circumflex

artery. He was also placed on medications, including a

cholesterol-lowering medication, a beta-blocker, and a

blood thinner.

On August 28, 2007 Mr. Snider sought treatment at the

Beauregard Memorial Hospital ("Beauregard") emergency

room in DeRidder, Louisiana for shortness of breath, chest
pains, dizziness, lightheadedness, and faintness. Mr. Snider

disclosed his past medical history, which included the May

2007 heart attack and coronary artery disease treatment, as

well as diabetes, hypertension, hyperlipidemia, and a strong

family history of premature coronary artery disease.

Beauregard cardiologist Dr. Robin Yue diagnosed Mr.

Snider with symptomatic bradycardia, as his heart rate fell

as low as thirty-five beats per minute (a normal heart rate is

considered to be at least sixty beats per minute). Dr. Yue

recommended heart catheterization and implantation of a

pacemaker; Mr. Snider consented. The procedures were

performed later that day, and Mr. Snider was discharged

from the hospital the following day. 

On the day of his discharge from Beauregard, Mr. Snider

sustained an unrelated injury to the area of his pacemaker,

when, on his return home, his two-year-old daughter ran to

greet him and jumped into his arms, striking his chest and

causing injury to the surgical site. Mr. Snider returned to the

Beauregard emergency room that evening, complaining of

numbness in his left arm and pain in his shoulder. Mr.

Snider was examined by Dr. Yue, who noted redness,

swelling, severe tenderness at the pacemaker surgical site,

left shoulder pain, and left arm weakness. Because Dr. Yue

was leaving town on a previously-scheduled business trip,

Mr. Snider was left in the care of Dr. Flynn A. Taylor, who

ordered that Mr. Snider be monitored for signs of infection

and hematoma at the pacemaker implant site. Deeming

outpatient antibiotic treatment appropriate, Dr. Taylor

discharged Mr. Snider from Beauregard on September 3,

2007. 

On September 4, 2007 Mr. Snider returned to St. Patrick,

where he was previously treated for his May 2007 cardiac

problems, and was admitted to the hospital. He was

examined by his treating cardiologist there, Dr. White, who

found symptoms of infection at the pacemaker surgical site.

Dr. White recommended removal of the pacemaker. The

next day, Dr. Michael C. Turner, a cardiovascular surgeon,

removed the pacemaker. 

Subsequently, Mr. Snider filed a medical malpractice

complaint against Dr. Yue, which was presented to a

medical review panel. The medical review panel concluded

that Dr. Yue had failed to comply with the appropriate

standard of care and that his conduct was a factor in the

"minor resultant damage." The medical review panel issued

the following reasons for their decision: 

2
Dr. Yue rushed the decision for implantation

of a permanent pacemaker in this patient. He

should have stopped the beta-blocker and the

rivaroxaban for 24-48 hours, and monitored

the patient for possible improvement or

deterioration in heart rate, before making the

decision about a permanent pacemaker.

Except for the relatively minor complication of

a hematoma, and the surgical scar after

pacemaker extraction, we found no evidence

of any long-term, major injury to this patient.

On December 16, 2010 Mr. Snider and his then-wife, Lisa

Snider, individually and on behalf of their minor child, filed

suit against Dr. Yue and his liability insurer, Louisiana

Medical Mutual Insurance Company, seeking recovery for

damages arising out of Dr. Yue's alleged negligence in the

treatment of Mr. Snider on August 28, 2007. The Sniders

alleged that Dr. Yue was at fault for: (1) failing to exercise

a reasonable degree of skill and competence possessed and

ordinarily exercised by members of his profession; (2)

failing to provide Mr. Snider with diligent and skillful care;

(3) failing to undertake conservative treatment to resolve

Mr. Snider's medical condition and failing to stop his blood

thinner medication prior to performing surgery; (4)

proceeding to surgery for implantation of a pacemaker

when Mr. Snider's condition and medications made said

treatment contraindicated; (5) failing to consult with Mr.

Snider's treating physician when Mr. Snider specifically

asked that he be consulted; (6) failing to educate Mr. Snider

on his true condition and the exact treatment being

recommended and implemented; and (7) performing

unnecessary surgery on Mr. Snider, resulting in

complications requiring further treatment and surgery. 

In March of 2012 this case was tried before a jury, which

ruled in favor of Dr. Yue, finding that Mr. Snider had not

proved by a preponderance of the evidence that Dr. Yue

breached the applicable standard of care owed to Mr.

Snider. The plaintiffs' subsequent motion for judgment

notwithstanding the verdict and, alternatively, for new trial

was denied by the district court judge, who stated that the

jury verdict was not clearly contrary to the law and

evidence. 

Snider, 13-0579 at pp. 1-5, 130 So. 3d at 926-27.

Plaintiffs appealed, assigning multiple errors. On appeal, the court of appeal

found merit to plaintiffs’ assignment of error asserting Dr. Yue failed to properly

3
obtain Mr. Snider's informed consent to the pacemaker implantation surgery, 

because he failed to provide all of the information required by La. R.S.

40:1299.40(E). Snider v. Louisiana Medical Mut. Ins. Co., 12-1068 (La.App. 3 Cir.

2/27/13), 129 So.3d 61.

Accordingly, the court of appeal rendered judgment in favor of the plaintiffs and

against defendants on the issue of liability and remanded the matter to the district court

to allow the parties an opportunity to complete the record as to damages. 1

Defendants sought review in this court. We granted writs and reversed the judgment

of the court of appeal. Snider v. Louisiana Medical Mut. Ins. Co., 13-0579 (La.

12/10/13), 130 So. 3d 922. In our opinion, we explained the court of appeal erred in

failing to apply a manifest error standard of review to the jury's factual finding that

informed consent was given in this case. Accordingly, we reversed the court of

appeal’s judgment and remanded the case to the court of appeal “to consider and rule

upon plaintiffs' assignments of error, including those assignments of error pretermitted

by the appellate court, in accordance with the views expressed herein.” Id. at p. 22,

130 So. 3d at 939.

On remand, the court of appeal again reversed the trial court, rendered judgment

as to liability, and remanded for determination of damages. Snider v. Louisiana

Medical Mut. Ins. Co., 12-1068 (La.App. 3 Cir. 8/27/14), 146 So.3d 965. In its

opinion, the court of appeal reasoned the jury was manifestly erroneous in failing to

find Dr. Yue’s actions fell below the acceptable standard of care.2

 The issue of damages had been severed from the issue of liability and no quantum evidence 1

was presented at trial after the jury verdict absolved the defendants of liability.

 Although our order of remand directed the court of appeal to review the jury’s informed 2

consent finding under a manifest error standard, the court of appeal pretermitted this issue, stating, “

it is not necessary for us on remand to visit the question of informed consent again because even if Snider

gave informed consent under Sections A or B of the statute, which the supreme court finds applicable, such

consent has no bearing on the question of whether Dr. Yue's actions fell below the standard of care when

(continued...)

4
Upon defendants’ application, we granted certiorari to review the correctness

of this determination. Snider v. Louisiana Medical Mutual Insurance Company, 14-

1964 (La. 12/8/14), 153 So. 3d 431.

DISCUSSION

It is well settled that a court of appeal may not set aside a trial court's or a jury's

finding of fact in the absence of "manifest error" or unless it is "clearly wrong," and

where there is conflict in the testimony, reasonable evaluations of credibility and

reasonable inferences of fact should not be disturbed upon review, even though the

appellate court may feel that its own evaluations and inferences are as reasonable. 

Rosell v. ESCO, 549 So.2d 840, 844 (La. 1989). This test dictates that a reviewing

court must do more than simply review the record for some evidence that may

controvert the trial court ruling. Rather, it requires a review of the entire record to

determine whether manifest error has occurred. Thus, the issue before the court of

appeal is not whether the trier of fact was right or wrong, but whether the fact-finder's

conclusion was a reasonable one. Clay v. Our Lady of Lourdes Regional Medical

Center, 11-1797 (La. 5/8/12), 93 So.3d 536, 543. The appellate court must not

reweigh the evidence or substitute its own factual findings because it would have

decided the case differently. Pinsonneault v. Merchants & Farmers Bank & Trust

Co., 01-2217 (La. 4/3/02), 816 So.2d 270, 278-79. Where the factfinder’s

determination is based on its decision to credit the testimony of one of two or more

witnesses, that finding can virtually never be manifestly erroneous. This rule applies

equally to the evaluation of expert testimony, including the evaluation and resolution

(...continued) 2

he rushed to implant a permanent pacemaker in the body of Snider.” Snider, 12-1068 at p. 5, 146 So.

3d at 967-68.

5
of conflicts in expert testimony. Bellard v. American Central Ins. Co., 07-1335 (La.

4/18/08), 980 So.2d 654, 672.

Considering these principles, we now turn to a review of the record. 

Specifically, we will look at the expert medical testimony to determine whether Dr.

Yue’s decision to implant the pacemaker was within the appropriate standard of care.

Dr. Michael Turner, tendered as an expert in cardiac pacing, cardiovascular

disease and internal medicine, testified on behalf of plaintiffs. Dr. Turner testified in

his opinion, the appropriate standard of care would have been to follow a conservative

treatment rather than implanting the pacemaker. He testified he would have observed

the patient for one day or several days and try drug therapy to alleviate the slow

heartbeat. However, on cross-examination, Dr. Turner admitted the guidelines for

pacemaker implantation were met in this case. He further acknowledged that it was fair

to say some cardiologists would have made the choice to implant the pacemaker, even

though he would not have done it.

Dr. Jean King White, Mr. Snider’s treating cardiologist, testified on plaintiffs’

behalf. Dr. White testified he did not have an opinion as to whether it was necessary

for Dr. Yue to implant the pacemaker. He stated he never recommended Mr. Snider

have a pacemaker because he had “never seen him with a slow heart rate except when

he was on a beta blocker.” 

Defendants called Dr. Yue. Dr. Yue testified he relied on four considerations

in recommending implantation of the pacemaker: (1) Mr. Snider had a very slow heart

rate, below 40; (2) Mr. Snider was symptomatic, with symptoms of shortness of

breath and chest pain; (3) Mr. Snider’s heart rate became very fast when he was not

on medication, and he needed to continue the medication to protect his heart; and (4)

Mr. Snider’s heart was weak, as shown by an echocardiogram. Dr. Yue testified he

6
did not see much benefit to waiting, pointing out that patients with low heart rates can

become unstable. 

Dr. Freddy Michel Abi-Samra testified for defendants as an expert in

cardiology, internal medicine and electrophysiology. Dr. Abi-Samra discussed the

categories set forth in the “Indications for Permanent Cardiac Pacing,” and explained 

Mr. Snider’s case presented a “clear type two indication for implantation.” He further

opined Dr. Yue was within the appropriate standard of care in performing the

pacemaker implantation. 

A review of the record in its entirety demonstrates the jury’s conclusion that Dr.

Yue did not breach the appropriate standard of care was reasonable. The defense

expert, Dr. Abi-Samra, testified that Mr. Snider’s condition clearly fell within Class II

category in the “Indications for Permanent Cardiac Pacing,” which permits

implantation of a permanent pacemaker. While plaintiffs’ expert, Dr. Turner, testified

that he would not have implanted a pacemaker under the facts, he admitted the

guidelines for pacemaker implantation were met in this case, and acknowledged some

cardiologists would have made the choice to implant the pacemaker, even though he

would not have done it. Faced with these different opinions, the jury obviously chose

to accept the testimony of the defense expert. This conclusion is not manifestly

erroneous.

Accordingly, we reverse the judgment of the court of appeal holding the jury

was manifestly erroneous in failing to find Dr. Yue’s actions fell below the acceptable

standard of care. Consistent with our prior judgment in Snider v. Louisiana Medical

Mut. Ins. Co., 13-0579 (La. 12/10/13), 130 So. 3d 922, the case is remanded to the

court of appeal to consider the remaining assignments of error in the appeal.

7
DECREE 

For the reasons assigned, the judgment of the court of appeal is reversed. The

case is remanded to the court of appeal for further proceedings consistent with this

opinion.

8
05/05/15 

SUPREME COURT OF LOUISIANA 

NO. 2014-C-1964

CLYDE SNIDER, JR., ET UX 

VERSUS 

LOUISIANA MEDICAL MUTUAL INSURANCE COMPANY, ET AL. 

ON WRIT OF CERTIORARI TO THE COURT OF APPEAL, 

THIRD CIRCUIT, PARISH OF BEAUREGARD 

JOHNSON, Chief Justice, dissents. 
 05/05/15 

 

SUPREME COURT OF LOUISIANA 

NO. 2014-C-1964

CLYDE SNIDER, JR., ET UX. 

VERSUS 

LOUISIANA MEDICAL MUTUAL INSURANCE COMPANY, ET AL. 

KNOLL, Justice, dissenting. 

The majority herein concludes the evidence supports the jury’s finding Dr. 

Robin Yue did not breach the applicable standard of care by emergently implanting 

a permanent pacemaker in the plaintiff without ambulatory monitoring or first 

regulating his prescribed drug therapy. However, after reviewing the entire record 

in this case, I can only conclude, as did the Court of Appeal, the jury did 

manifestly err in finding no malpractice. For this reason, I respectfully dissent 

from the majority’s decision reinstating the jury’s clearly erroneous findings. I 

would affirm the Court of Appeal’s judgment finding Dr. Yue’s actions fell below 

the acceptable standard of care. 

In a medical malpractice action against a physician, the plaintiff carries a 

two-fold burden of proof. The plaintiff must first establish by a preponderance of 

the evidence the doctor’s treatment fell below the ordinary standard of care 

expected of physicians in his medical specialty, and must then establish a causal 

relationship between the alleged negligent treatment and the injury sustained. 

Smith v. State through DHHR, 523 So.2d 815, 819 (La.1988). A determination of 

whether a physician breached the appropriate standard of care owed to a particular 

plaintiff depends upon the facts and circumstances of the case. Hunt v. Bogalusa 

Community Medical Center, 303 So.2d 745, 746 (La. 1974). An appellate court 
2

may not set aside a trial court’s or jury’s factual finding in the absence of “manifest 

error” or unless it is “clearly wrong.” Rosell v. ESCO, 549 So.2d 840, 844 (La. 

1989). Thus to reverse a trial court, the reviewing court must find from the record a 

reasonable factual basis does not exist for the finding, and further the finding is 

clearly wrong. Mart v. Hill, 505 So.2d 1120 (La. 1987). Though the standard of 

review is high, it does not require the reviewing court to abdicate its responsibility 

to review the trial court’s findings, nor does it require the court to rubber stamp a 

jury’s manifestly erroneous findings. 

As the majority astutely notes “where the findings are based on 

determinations regarding the credibility of witnesses, the manifest error standard 

demands great deference to the findings of fact.” Slip Opinion at 5. This is so 

because “only the factfinder can be aware of the variations in demeanor and tone 

of voice that bear so heavily on the listener’s understanding and belief in what is 

said.” Rosell, 549 So.2d at 844. However, although the manifest error doctrine is 

not easily broached, “[w]here documents or objective evidence so contradict the 

witness’s story, or the story itself is so internally inconsistent or implausible on its 

face, that a reasonable fact finder would not credit the witness’s story, the court of 

appeal may well find manifest error or clear wrongness even in a finding 

purportedly based upon a credibility determination.” Menard v. Lafayette Ins. Co., 

09-1869, p. 15 (La. 3/16/10), 31 So.3d 996, 1008 (quoting Rosell, 549 So.2d at 

844-45). 

The following is the objective evidence I find so contradictions the 

defendants’ witnesses. Four physicians, including the three members of the 

medical review panel and plaintiff’s treating cardiovascular surgeon, opined Dr. 
3

Yue failed to comply with the appropriate standard of care. One member of the 

panel, Dr. Tommy Brown, testified on behalf of the entire panel, opining:1 

I do not [think Snider was a candidate for a pacemaker]. I think that 

he could have been managed by withholding his beta blocker and 

withholding his blood thinner.... Again, the big thing that we go back 

to, is that there’s different beta blockers, there’s different strength of 

beta blockers, there’s different action of beta blockers. And to say 

that we need a pacemaker because he requires a beta blocker and he 

failed one specific beta blocker at one specific dose, I don’t really 

think that’s what we do in private practice every day.... I think he 

should have had a little time to see if his heart rate would have came 

up.... I think that would have been better served to wait and see if his 

bradycardia persisted. Again, he was stable. He wasn’t in heart 

failure. He wasn’t having ongoing angina. So I didn’t think that there 

was an absolute rush to put the pacemaker in that day. 

When then asked whether Dr. Yue’s actions complied with the ordinary standard 

of care for cardiologists, Dr. Brown along with the other two members of the panel 

found Dr. Yue’s actions did not. See Slip Opinion at 2-3. Dr. Michael Turner, 

accepted as an expert in implanting cardiology, agreed testifying: 

Q. In your opinion, as far as the standard of care dealing 

with cardiologists implanting pacemakers, between the conservative 

treatment and implanting the pacemaker on this particular day that Dr. 

Yue saw him, what is your opinion about the standard of care there? 

A. If we define the standard of care as what most implanting 

cardiologists would have done at that time, it would have been to wait. 

Q. Wait and do what? 

A. Observe for a period of time, maybe a day, maybe 

several days, depending on the course. Very likely withdraw or try to 

alter drug therapy to alleviate the slow heartbeat. 

Moreover, the physician called by defendant, Dr. Freddy Michael AbiSamra, conceded, as suggested by the national guidelines, the implantation of a 

permanent pacemaker herein was not “emergent.” Significantly, a document was 

admitted into evidence entitled “Indications for a Permanent Cardiac Pacing,” 

listing the classifications for a permanent pacing as established by a joint task force 

 

1 The testimony of the other two members were stipulated to as their testimony would have been

identical to Dr. Brown’s.
4

formed by the American College of Cardiology, the American Heart Association, 

and the Heart Rhythm Society. These guidelines set forth three classifications: 

Class I—Conditions in which permanent pacing is definitely 

beneficial, useful, and effective. In such conditions, implantation of a 

cardiac pacemaker is considered acceptable and necessary, provided 

that the condition is not due to a transient cause. 

Class II—Conditions in which permanent pacing may be indicated but 

there is conflicting evidence and/or divergence of opinion; class IIA 

refers to conditions in which the weight of the evidence/opinion is in 

favor of usefulness/efficacy, while class IIB refers to conditions in 

which the usefulness/efficacy is less well established by 

evidence/opinion. 

Class III—Conditions in which permanent pacing is not 

useful/effective and in some cases may be harmful. 

Symptoms—Patients frequently present for consideration of 

pacemaker placement because of symptoms that may be due to 

bradyarrhythmias (e.g. dizziness, lightheadedness, syncope, fatigue, 

and poor exercise tolerance.) These patients will often have evidence 

of mild or intermittent sinus node dysfunction or conduction 

abnormalities. It is critical to attempt to establish a direct correlation 

between symptoms and bradyarrhythmias. This is done via a careful 

history and ambulatory monitoring. 

A direct correlation between symptoms and bradyarrhythmias will 

increase the likelihood of recommending pacemaker placement. On 

the other hand, failure to document such a correlation or the 

presence of an alternative explanation for symptoms will make 

pacemaker placement less likely or even contraindicated. (Emphasis 

added). 

As the guidelines clearly provide, in non-emergent or non-life threatening 

situations, like the one herein, a cardiologist should “wait and see” before 

implanting a permanent pacemaker as a period of monitoring is necessary in order 

to ensure “the condition is not due to a transient cause.” These guidelines also 

caution failure to document a direct correlation between symptoms and 

bradycardia or the presence of an alternative explanation of the symptoms will 

make pacemaker placement less likely or even contraindicated. Here, the record 

undeniably shows Dr. Yue did not heed these warnings as he failed to do 
5

ambulatory monitoring or even determine if Snider’s condition was due to a 

transient cause, like the beta blockers. 

Regarding the proper classification herein and the need for immediate 

action, Dr. Abi-Samra testified there was a clear indication this was a Class II 

implantation and as such would “benefit the patient, especially in the lifestyle, 

rather than the immediate survival or immediate prevention of immediate death.” 

It was not, according to him, an emergency surgery or anything of that sort, 

specifically “[i]t was not necessarily emergent.”

Accordingly, the overall testimony and the objective medical evidence 

establish Snider’s presentation at the emergency room did not call for or require 

immediate surgery. The objective evidence clearly shows the jury’s factual error as 

it was not necessarily Dr. Yue’s performance of the procedure that breached the 

applicable standard, but rather his “rush,” or more appropriately his decision, to 

perform this particular procedure emergently based solely on the symptoms 

presented in the emergency room the very same day that constitutes malpractice. 

Though as the majority finds the evidence does reasonably show a young man at 

26 years of age, facing a lifetime of beta blockers and drug therapy, may very well 

be a candidate for a Class II implantation of a permanent pacing device, that same 

evidence nevertheless conclusively and objectively establishes the implantation 

herein was not emergent because plaintiff was stable, not in heart failure, and with 

no ongoing angina. Thus, under the facts and circumstances of this case, the 

objective medical evidence clearly shows Dr. Yue breached the ordinary standard 

of care in his rush to treat the plaintiff’s symptoms through the implantation of a 

permanent pacemaker. 

Given the medical guidelines, the medical testimony, and the panel’s 

undisputed medical findings—all agreeing Dr. Yue rushed the decision for 
6

implantation of a permanent pacemaker without first stopping the patient’s 

medication and monitoring for possible improvement in heart rate—a reasonable 

fact finder would not have found as this jury did on the issue of breach of the 

applicable standard of care. The Court of Appeal is an errors correcting court that 

properly reversed the jury’s verdict in its manifest error review. For these reasons, 

I would affirm the Court of Appeal. 
05/05/15 

SUPREME COURT OF LOUISIANA 

No. 2014-C-1964

CLIDE SNIDER, JR., ET UX. 

VERSUS 

LOUISIANA MEDICAL MUTUAL INSURANCE CO., ET AL. 

CRICHTON, J., additionally concurs and assigns reasons: 

 I concur in the per curiam opinion reversing the court of appeal. I write 

separately to emphasize the substantial weight given to a jury’s finding of fact 

under Louisiana law. See Rosell v. ESCO, 549 So. 2d 840, 844 (La. 1989). As 

esteemed late Justice Albert Tate, Jr. observed, the rule of limited appellate review 

in the absence of manifest error “requires that the appellate court will not disturb 

the trial court’s express or implied factual findings if the evidence is reasonably 

open to any interpretation in accord therewith.” A. Tate, “Manifest Error” –

Further observations on appellate review of facts in Louisiana civil cases, 22 La. 

L. Rev. 605, 611 (1962). 

 The court of appeal disregarded this mandate in this case, despite the fact 

that the evidence presented at trial was “reasonably open to any interpretation” in 

accordance with the jury’s verdict. Indeed, as the per curiam explains, even 

plaintiffs’ own expert testified on cross-examination that the guidelines for 

pacemaker implantation were met in this case. As a result, I believe that, 

consistent with prior jurisprudence of this Court, the case is properly reversed.