[Cite as Snyder v. Manuel, 2012-Ohio-5951.]

IN THE COURT OF APPEALS OF OHIO 

THIRD APPELLATE DISTRICT 

HANCOCK COUNTY 

 

JESSICA SNYDER, INDIVIDUALLY AND 

AS PARENT NATURAL GUARDIAN AND 

NEXT FRIEND OF COLTYN MEISNER, 

A MINOR CHILD, ET AL., 

 CASE NO. 5-11-39 

 PLAINTIFFS-APPELLANTS, 

 v. 

 

MICHAEL MANUEL, M.D., O P I N I O N 

 DEFENDANT-APPELLEE. 

 

Appeal from Hancock County Common Pleas Court 

Trial Court No. 2010 CV 00069 

Judgment Affirmed in Part, Reversed in Part and Cause Remanded 

Date of Decision: December 17, 2012 

 

APPEARANCES: 

Timothy J. Walerius and Ronald Simon for Appellants 

Jeanne M. Mullin and David R. Hudson for Appellee 
Case No. 5-11-39 

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ROGERS, J. 

{¶1} Plaintiffs-Appellants, Jessica Snyder (“Snyder”) and her minor child, 

Coltyn Meisner, (collectively “Plaintiffs”), appeal the judgment of the Court of 

Common Pleas of Hancock County granting Defendant-Appellee, Dr. Michael 

Manuel (“Dr. Manuel”), a directed verdict. On appeal, Plaintiffs contend that the 

trial court erred in granting Dr. Manuel a directed verdict, and that the trial court 

erred by limiting the testimony of their expert, Dr. Bruce Janiak. Based on the 

following, we affirm in part and reverse in part the trial court’s judgment. 

{¶2} At approximately 8:00 a.m. on February 13, 2009, Snyder, a 39-yearold woman and registered nurse, began, as she described, “having weird feelings” 

in her arm, jaw, and back as she was driving to work in Findlay. Trial Tr., p. 436. 

Upon the onset of these feelings, Snyder pulled into the nearest parking lot and 

called Dr. Manuel, a hospitalist with Blanchard Valley Regional Health Center 

(the “hospital”) and with whom she was professionally acquainted.1

 The call was 

placed at 8:23 a.m. At trial, Snyder could not recall the exact symptoms she 

conveyed to Dr. Manuel over the phone. But, she did agree with the following 

recitation of her deposition testimony as accurately describing the symptoms she 

communicated to Dr. Manuel during the phone call: 

 

1

 Hospitalist is defined as “a physician who specializes in treating hospitalized patients of other physicians 

in order to minimize the number of hospital visits by other physicians.” Merriam-Webster (2012), 

http://www.merriam-webster.com/dictionary/hospitalist, (accessed Dec. 11, 2012). 
Case No. 5-11-39 

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Q: You told me that - - when you described what you first told [Dr. 

Manuel] on that phone call that morning, you indicated that it started 

with your fingers in your left hand going numb and tingly. That it 

went up to your left arm going numb and tingly. That your jaw 

became numb and tingly. That you were in the most horrific pain of 

your life between your shoulder blades. That you became 

diaphoretic, meaning you were sweating and everything was getting 

wet. That you felt nauseous. That you looked in the mirror, your 

face was ashen and you looked dead. And that you feared you were 

going to die. Trial Tr., p. 520. 

Though Dr. Manuel did not testify at trial about the contents of the phone call, he 

maintains that Snyder only told him that she had “abdominal pain, nausea, 

vomiting, and diarrhea[.]” Appellee’s Br., p. 3.2

 After describing her symptoms 

to Dr. Manuel, Snyder testified that he told her to meet him in the hospital’s 

admissions office where he would admit her. Dr. Manuel, on the other hand, 

maintains that he told Snyder to go to the emergency room, as opposed to the 

admissions office.3

 After several minutes on the phone, Snyder informed Dr. 

Manuel that she had to hang-up and go into a nearby store because of diarrhea. 

Accordingly, the conversation ended and Snyder went to the store to relieve her 

diarrhea. After she regrouped, she drove to the hospital. 

 

2

 We can find no evidence supporting Dr. Manuel’s assertion that the only symptoms Snyder told him over 

the phone were abdominal pain, nausea, vomiting, and diarrhea. Accordingly, as the record stands, there is 

no factual dispute concerning the symptoms Snyder told Dr. Manuel over the phone. Even if there was a 

factual dispute, as Dr. Manuel asserts, we must, for the purposes of this appeal, accept Plaintiffs’ version of 

events as true. 

3

 We can find no evidence supporting Dr. Manuel’s assertion that he told Snyder to go to the emergency 

room over the phone. In fact, in his answer, Dr. Manuel admitted to the allegation that he told Snyder to 

meet him at the admission’s office. (Docket No. 16, p. 3). Accordingly, as it stands, there is no factual 

dispute concerning where Dr. Manuel told Snyder to go for treatment. Even if there was a factual dispute, 

as Dr. Manuel asserts, we must, for purposes of this appeal, accept Plaintiffs’ version of events as true. 
Case No. 5-11-39 

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{¶3} At approximately 9:19 a.m., Snyder arrived in the admissions office, 

where she met with Dr. Manuel. Though the exact time when Snyder met with Dr. 

Manuel in the admissions office is disputed, there is no dispute that Snyder signed 

a consent to treatment form at 9:25 a.m. and that Dr. Manuel was her admitting 

physician. According to Snyder, when she met Dr. Manuel in the admissions 

office she told him about the same “symptoms that [she] had told him on the 

phone.” Trial Tr., p. 443. Dr. Manuel, however, testified that “when [Snyder] 

reported to the hospital” she informed him that she was suffering from “intractable 

nausea, vomiting, [and] diarrhea.” Trial Tr., p. 170. Sometime between meeting 

Snyder in the admissions office and 9:57 a.m., Dr. Manuel filled out a physician’s 

order form (Plaintiffs’ Exhibit 4), in which he noted that Snyder was admitted for 

intractable nausea, vomiting, renal failure, and anemia, and ordered several tests to 

determine the cause of those conditions. 

{¶4} After being admitted and meeting with Dr. Manuel, Snyder arrived on 

the hospital’s floor as an inpatient at approximately 10:00 a.m. According to 

Snyder, she did not see Dr. Manuel again until sometime after 5:00 p.m. Dr. 

Manuel, however, testified that he met with Snyder between 11:00 a.m. and 11:30 

a.m. to take her history and conduct a physical examination. According to Dr. 

Manuel, Snyder did not complain of jaw, arm, and shoulder pain during that 

meeting. 
Case No. 5-11-39 

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{¶5} At approximately 6:00 p.m., Snyder’s family physician visited Snyder 

in the hospital and filled out a physician order form (Plaintiffs’ Exhibit 7) ordering 

several cardiac tests, including but not limited to, an electrocardiogram (“EKG”) 

and a cardiac enzyme panel. The results from the EKG and cardiac enzyme panel, 

which were available at 6:45 p.m. and 6:47 p.m. respectively, indicated that 

Snyder was and had been suffering from a heart attack. It was later determined 

that Snyder’s heart attack was caused by a complete occlusion of her left anterior 

descending coronary artery (“LAD artery”). Snyder was transferred to the cardiac 

care unit at 7:48 p.m. Trial Tr., p. 311-2, see also Trial Tr., p. 468. Though it is 

not clear when the procedure to open the occlusion in the LAD artery began, it is 

undisputed that the LAD artery was opened at approximately 10:13 p.m. 

{¶6} On February 2, 2010, Snyder, individually and as parent, natural 

guardian, and next friend of Coltyn Meisner, a minor, and Ann Scott, Snyder’s 

mother, filed a complaint for medical malpractice against Dr. Manuel.4

 

Specifically, Snyder alleged that Dr. Manuel was negligent in his care and 

treatment by failing to timely diagnose her heart attack. As a direct and proximate 

result of Dr. Manuel’s alleged negligence, Snyder claimed that she suffered 

 

4

 In addition to Dr. Manuel, the complaint also named Blanchard Valley Regional Health Center, Blanchard 

Valley Medical Associates, Inc., and Dr. Randell Huff as defendants. These defendants, however, were 

voluntarily dismissed by Plaintiffs prior to trial. (Docket Nos. 78 & 132). Ann Scott was also dismissed 

from this matter prior to trial. October 17, 2011 Judgment Entry, p. 1. 
Case No. 5-11-39 

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damages, including but not limited to, irreparable injury to her heart, emotional 

distress, loss of earning capacity, and medical expenses. 

{¶7} The matter proceeded to a jury trial in September 2011. Plaintiffs 

presented three medical experts during their case-in-chief. Dr. Thomas Masterson 

(“Dr. Masterson”), a hospitalist, offered testimony on the issues of duty and 

standard of care. Dr. Masterson testified that an admitting physician is responsible 

for, at least, the initial care and treatment of the patient he or she admitted to the 

hospital. After reviewing the medical records associated with Snyder’s heart 

attack, it was Dr. Masterson’s opinion that Dr. Manuel did not meet the standard 

of care in treating Snyder. Given the symptoms Snyder allegedly communicated 

to Dr. Manuel over the phone and presented in the admissions office, Dr. 

Masterson testified that Dr. Manuel breached the standard of care by failing to 

“immediately have [Snyder] worked up for a heart attack” and admitting her to the 

a “regular medical floor * * * without having taken the test to find out whether 

[Snyder] was having a heart attack[.]” Trial Tr., p. 303, 305. Dr. Masterson 

further testified that “[t]he standard of care for [an] acute heart attack is aspirin 

when you first see the patient, and getting them to [the] cardiac catheterization 

laboratory in under 45 minutes.” Trial Tr., p. 311. 

{¶8} Dr. Bruce Janiak (“Dr. Janiak”), an emergency physician, testified, 

and Dr. Manuel agreed, that “[t]hings occur much more rapidly in the emergency 
Case No. 5-11-39 

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department than they do on a general medical floor in a hospital[.]” Trial Tr., p. 

201. According to Dr. Janiak, current guidelines set by the American Heart 

Association and the American Society of Chest Pain Centers provide that a patient 

being treated for a heart attack in a hospital’s emergency department should 

ideally have the occlusion causing the heart attack opened within ninety (90) 

minutes of the patient entering the emergency department. Dr. Janiak, however, 

acknowledged that this guideline cannot always be met due to the varying 

circumstances of each heart attack case. 

{¶9} Dr. Raymond Magorien (“Dr. Magorien”), a cardiologist, offered 

testimony on the issue of causation. Based on Snyder’s medical records, Dr. 

Magorien testified that her heart attack was caused by a complete occlusion of her 

LAD artery. In his opinion, the LAD artery was completely occluded at the onset 

of the heart attack. Though Dr. Magorien conceded that he was not able to 

pinpoint the exact time when Snyder’s heart attack began, he testified that based 

on Snyder’s symptoms and medical records, specifically the EKG reading and 

cardiac enzyme panel, it was his opinion that Snyder’s heart attack began in the 

morning with the onset of her symptoms. On direct examination, Dr. Magorien 

was asked to explain the injury experienced by the heart during a heart attack, 

resulting in the following colloquy: 

A: The majority of heart injury occurs in the first hour or two. 

Between three and four hours there is likely some on-going injury. 
Case No. 5-11-39 

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Beyond three and four hours, it’s pretty minimal, most of the 

damage is already completed. But there can be some salvage as late 

as four to five hours into the heart attack, but it’s fairly minimal. 

Q: And you told me actually five and a half hours at your deposition 

A: In some cases if there is off and on flow, in total occlusion the 

vast majority of injury occurs in the first two to three hours. Trial 

Tr., p. 35. 

{¶10} On cross-examination, Dr. Magorien was again asked to explain the 

injury experienced by the heart during a heart attack, resulting in the following 

colloquy: 

A: When the heart [is] starved of oxygen, there are a lot of things 

that happen but the heart tissue is very sensitive to blood supply. 

And within 15 to 30 minutes the heart tissue can start to show 

changes that are characteristic of diminished or no blood supply. By 

30 to 60 minutes you actually get irreversible damage [of the heart 

tissue]. * * * [W]hen you have a total obstruction with a plaque and 

then a clot on top of it, likely no collaterals, that process of 

irreversible damage is very rapid, 30, 60, 90, by 120 minutes you get 

a major amount of irreversible damage. It may continue out through 

four or five hours, beyond four hours there is no evidence that 

treatment improves survival from the initial clinical trials because 

the damage is irreversible and very extensive at that time. Trial Tr., 

p. 47-8. 

After this explanation, Dr. Magorien was asked whether it was probable that all of 

the clinically significant injury to Snyder’s heart had occurred within four hours of 

the onset of the heart attack, resulting in the following colloquy: 

A: Well, I will reiterate what I said. One hundred percent 

obstruction in the evening, the EKG, the blood tests, the clinical 

course suggested that this was a total blockage with rapidly 

progressing irreversible heart muscle injury. The vast majority of 
Case No. 5-11-39 

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that injury occurs in the first few hours. So by the time you get out 

to four to five hours, there may be some potential for reversing 

injury but not much, in terms of any clinical impact, the majority of 

the injury has already occurred. * * * 

* * * 

Q: * * * Based on what you just indicated, your training, your 

experience, the studies that you have referred to that have been wellestablished in your field, knowing the type of lesion that she 

presented with and that she had, the fact that she did not have any 

collateral vessels that would have been supplying blood supply to 

this heart, would you agree with me to a reasonable degree of 

probability that all of the damage that was done to her heart, at least 

clinically significant damage, was done in that four hour time 

window that we just discussed? 

* * * 

A: Yes, I would. Trial Tr., p. 49-50. 

{¶11} Also on cross-examination, Dr. Magorien was asked about the time it 

would take to open a complete occlusion, resulting in the following colloquy: 

Q: From everything that you’ve reviewed in this case, Dr. 

Magorien, can we agree that a 90 minute goal was not realistic for 

Miss Snyder? 

A: Based on the comorbidities and everything involved, the fact that 

it took longer than 90 minutes would be anticipated. 

* * * 

Q: And knowing all of the complicating factors in terms of 

[Snyder’s] medical history and comorbidities, [it does not surprise 

you that it took three hours and twenty eight minutes to open the 

occlusion after receiving a positive EKG reading], does it, Dr. 

Magorien? 
Case No. 5-11-39 

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A: It does not. Trial Tr., p. 53-54. 

{¶12} At the close of Plaintiffs’ case-in-chief, Dr. Manuel moved for 

directed verdict arguing that Plaintiffs’ expert testimony did not establish a causal 

link between his alleged negligence and Plaintiffs’ damages. The trial court 

subsequently granted Dr. Manuel’s motion, finding that the Plaintiffs’ failed to 

present evidence which could reasonably be construed as establishing a causal link 

between Dr. Manuel’s alleged negligence and Plaintiffs’ damages. 

{¶13} It is from this judgment Plaintiffs appeal, presenting the following 

assignments of error for our review. 

Assignment of Error No. I 

THE TRIAL COURT ERRED IN GRANTING A DIRECTED 

VERDICT IN FAVOR OF DEFENDANT BECAUSE THE 

TRIAL COURT IGNORED EVIDENCE THAT MS. SNYDER 

SUFFERED INJURY AS A DIRECT RESULT OF THE 

NEGLIGENCE OF DEFENDANT. 

Assignment of Error No. II

THE TRIAL COURT ERRED IN FINDING PLAINTIFFS 

PROVIDED NO EVIDENCE OF PROXIMATE CAUSE 

BECAUSE IT RELIED ON A FAULTY HYPOTHETICAL TO 

REACH A CONCLUSION THAT THE NEGLIGENCE OF 

DEFENDANT DID NOT CONTRIBUTE TO THE DELAY IN 

TREATMENT. 

Assignment of Error No. III

THE TRIAL COURT ERRED IN ARBITRARILY LIMITING 

THE TESTIMONY OF PLAINTIFFS’ EXPERT AND 
Case No. 5-11-39 

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PREVENTED EVEN FURTHER EVIDENCE OF THE 

PROXIMATE CAUSE OF INJURY. 

{¶14} Due to the nature of Plaintiffs’ assignments of error, we elect to 

address their first and second assignments of error together. 

Assignments of Error Nos. I & II

{¶15} In their first and second assignments of error, Plaintiffs essentially 

argue that construing the evidence in a light most favorable to them the evidence 

presented at trial could reasonably be construed to establish a causal link between 

Dr. Manuel’s failure to timely diagnose Snyder’s heart attack and the Plaintiffs’ 

damages. Conversely, Dr. Manuel argues that even when construing the evidence 

in a light most favorable to Plaintiffs, reasonable minds could not conclude that 

the occlusion causing Snyder’s heart attack could be opened in time to prevent 

clinically significant injury to her heart. Based on the following, we agree with 

the Plaintiffs. 

{¶16} A trial court properly grants a motion for directed verdict when it has 

been “properly made, and the trial court, after construing the evidence most 

strongly in favor of the party against whom the motion is directed, finds that upon 

any determinative issue reasonable minds could come to but one conclusion upon 

the evidence submitted and that conclusion is adverse to such party[.]” Civ.R. 

50(A)(4). In deciding a motion for a directed verdict, the trial court must assume 

that the evidence presented by the nonmovant is true, must give the nonmovant the 
Case No. 5-11-39 

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benefit of all reasonable inferences to be drawn from that evidence, and ascertain 

whether any substantial probative evidence supports the nonmovant’s claim. E.g.,

Ruta v. Breckenridge-Remy Co., 69 Ohio St.2d 66, 68-69 (1982). 

{¶17} A motion for a directed verdict presents a question of law. Goodyear 

Tire & Rubber Co. v. Aetna Cas. & Sur. Co., 95 Ohio St.3d 512, 2002-Ohio-2842, 

¶ 4, citing O’Day v. Webb, 29 Ohio St.2d 215 (1972), paragraph three of the 

syllabus. As such, we review a trial court’s decision to grant or deny the motion 

de novo. Cleveland Elec. Illum. Co. v. Pub. Util. Comm., 76 Ohio St.3d 521, 523 

(1996). 

{¶18} “In order to establish medical malpractice, a plaintiff must 

demonstrate three elements: (1) the applicable standard of care, typically through 

expert testimony, (2) the defendant’s negligent failure to render treatment in 

conformity with the applicable standard of care, and (3) that the defendant’s 

negligence proximately caused the resulting injury.” Martin v. Hixenbaugh, 179 

Ohio App.3d 49, 2008-Ohio-5397, ¶ 11 (3d Dist.), citing Bruni v. Tatsumi, 46 

Ohio St.2d 127 (1976), paragraph one of the syllabus. 

{¶19} Here, the trial court granted Dr. Manuel’s directed verdict on the 

issue of causation. Accordingly, our review is limited to determining whether, 

after construing the evidence in Plaintiffs’ favor, there was any substantial 
Case No. 5-11-39 

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probative evidence that Dr. Manuel’s alleged negligence proximately caused 

Plaintiffs’ alleged damages. 

{¶20} While difficult to define, proximate cause is generally established 

“‘where an original act is wrongful or negligent and in a natural and continuous 

sequence produces a result which would not have taken place without the act.’” 

Strother v. Hutchinson, 67 Ohio St.2d 282, 287 (1981), quoting Clinger v. 

Duncan, 166 Ohio St. 216, 217, 223 (1957). The Ohio Jury Instructions defines 

proximate cause as “an act or failure to act that in the natural and continuous 

sequence directly produced the (injury) (death) (physical harm) and without which 

it would not have occurred.” OJI CV 405.01(2). To establish proximate cause a 

plaintiff must present evidence upon which the trier of fact can reasonably 

determine that “‘it is more likely than not that the negligence of a defendant was 

the direct or proximate cause of plaintiff’s injury.’” Whiting v. Ohio Dept. of 

Mental Health, 141 Ohio App.3d 198, 203 (10th Dist. 2001), citing Stone v. Davis, 

66 Ohio St.2d 74, 82 (1981). “‘[W]here no facts are alleged justifying any 

reasonable inference that the acts or failure of the defendant constitute the 

proximate cause of the injury there is nothing for the jury [to decide], and, as a 

matter of law, judgment must be given for the defendant.’” Kemerer v. Antwerp 

Bd. of Edn., 105 Ohio App.3d 792, 796 (3d Dist. 1995), quoting Case v. Miami 

Chevrolet Co., 38 Ohio App. 41, 45-6 (1st Dist. 1930). 
Case No. 5-11-39 

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{¶21} Construing the evidence in Plaintiffs’ favor, reasonable minds could 

conclude that clinically significant injury to Snyder’s heart could have been 

avoided if the occlusion causing her heart attack was opened within four hours of 

the heart attack’s onset. Dr. Magorien testified that Snyder’s heart attack was 

caused by a complete occlusion of her LAD artery. On direct examination, Dr. 

Magorien testified that in cases where the heart attack is caused by a complete 

occlusion “the vast majority of injury [to the heart] occurs in the first two to three 

hours.” Trial Tr., p. 35. On cross-examination, however, Dr. Magorien elaborated 

on the foregoing testimony, explaining: 

[W]hen you have a total obstruction * * * that process of irreversible 

damage is very rapid, 30, 60, 90, by 120 minutes you get a major 

amount of irreversible damage. It may continue out through four to 

five hours, beyond four hours there is no evidence that treatment 

improves survival from the initial clinical trials because the damage 

is likely irreversible and very extensive at that time. Id. at p. 48. 

Also on cross-examination, Dr. Magorien agreed “to a reasonable degree of 

probability” that clinically significant injury to Snyder’s heart occurred within the 

first four hours of its onset. Id. at p. 50. Given the foregoing and construing it in 

Plaintiffs’ favor, we find reasonable minds could conclude that clinically 

significant injury to Snyder’s heart could have been avoided if the occlusion was 

opened within four hours of the heart attack’s onset. 

{¶22} Bearing this four hour timeframe in mind, we turn to the facts to 

determine whether reasonable minds could conclude that but for Dr. Manuel’s 
Case No. 5-11-39 

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alleged negligence (i.e., delayed diagnosis) the occlusion causing Snyder’s heart 

attack could have been opened within four hours of the heart attack’s onset. 

{¶23} According to Dr. Manuel, when viewing the evidence in a light 

most favorable to Plaintiffs, there would have been a four hour and 39 minute 

delay from the onset of the heart attack until the LAD artery was opened. 

Specifically, Dr. Manuel maintains that the following timeline of events 

represents the most favorable timeline for Snyder: 

8:23 a.m. – The very latest time at which Snyder’s heart attack 

would have started. 

9:19 a.m. – The earliest time Snyder met Dr. Manuel at the hospital, 

triggering a duty to send her to the emergency department or 

otherwise work her up for a heart attack. 

9:34 a.m. – The earliest time at which an EKG could be completed 

and a positive result achieved.5

1:02 p.m. – The earliest time at which the occlusion would be 

opened. Appellee’s Br., p. 13. 

Given this timeline of events, Dr. Manuel argues that all of the clinically 

significant injury would have occurred even if he followed the standard of care, as 

articulated by Dr. Masterson, and sent Snyder to the emergency department or 

immediately initiated a cardiac work-up upon her arrival in the admissions office. 

As a result, Dr. Manuel maintains that even if he is found to have been negligent, 

his negligence was not the proximate cause of Plaintiffs’ damages. 

 

5

 At trial, Dr. Magorien testified that in his experience an EKG can be completed in “15 to 30 minutes.” 

Trial Tr., p. 55. Hence, construing the evidence in Plaintiffs favor, Dr. Manuel properly relies on the 

fifteen minute figure in determining the earliest time Snyder could have received a positive EKG result. 
Case No. 5-11-39 

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{¶24} Construing the evidence in Plaintiffs’ favor, we agree with the first 

three points in time detailed above, i.e., 8:23 a.m., 9:19 a.m., and 9:34 a.m., but 

find reasonable minds could conclude that the occlusion could have been resolved 

as soon as 11:59 a.m., not 1:02 p.m. In concluding that Snyder’s occlusion would 

have been opened at 1:02 p.m., Dr. Manuel relied on the time it took from the 

positive EKG (6:45 p.m.) to the time when the occlusion was opened (10:13 p.m.), 

which amounts to three hours and 28 minutes. Dr. Manuel’s reliance on this 

period of time, however, is questionable. This position assumes that Snyder was 

rushed to the catheterization laboratory immediately following the positive EKG. 

However, as the record stands, there is no evidence that Snyder was rushed to the 

catheterization laboratory after the positive EKG. Instead, the evidence reveals 

that Snyder, for reasons unknown, remained on the hospital floor until she was 

transferred to the cardiac care unit at 7:48 p.m. and then onto the catheterization 

laboratory.6

 Accordingly, reasonable minds could conclude that one hour and 

three minutes of Dr. Manuel’s three hour and 28 minute figure was not spent in the 

catheterization laboratory. 

{¶25} Considering Dr. Masterson’s testimony, reasonable minds could 

conclude that Snyder should have been taken to the catheterization laboratory 

much sooner than one hour and three minutes after the positive EKG. According 

 

6

 Though there was no evidence at trial concerning the exact time when Snyder entered the catheterization 

laboratory, we will assume, for purposes of this appeal, that she entered the catheterization laboratory at 

7:48 p.m. 
Case No. 5-11-39 

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to Dr. Masterson, based on his understanding of the facts, Dr. Manuel should have 

sent Snyder to the emergency department or immediately initiated a cardiac workup when she arrived in the admissions office. In either scenario, when the 

evidence is construed in Plaintiffs’ favor, reasonable minds could conclude that 

Snyder could have been taken to the catheterization laboratory much sooner than 

one hour and three minutes after the positive EKG. At trial, there was general 

agreement among the medical experts that medical treatment happens quicker in 

an emergency department than on a hospital floor. Accordingly, had Snyder been 

sent to the emergency department, reasonable minds could conclude that she 

would have been taken to the catheterization laboratory in under one hour and 

three minutes after the positive EKG. 

{¶26} The same is true if Dr. Manuel decided to immediately initiate a 

cardiac work-up. Dr. Masterson testified that “[t]he standard of care for [an] acute 

heart attack is aspirin when you first see the patient, and getting them to the 

cardiac catheterization laboratory in under 45 minutes.” (Emphasis added.) Trial 

Tr., p. 311. Had Dr. Manuel followed the foregoing standard of care, reasonable 

minds could conclude that Snyder would have been taken to the catheterization 

laboratory well under one hour and three minutes after the positive EKG. Given 

the foregoing and construing the evidence in Plaintiffs’ favor, we find reasonable 

minds could conclude that had Dr. Manuel followed the standard of care, as 
Case No. 5-11-39 

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articulated by Dr. Masterson, Snyder, under the best case scenario, would have 

been rushed to the catheterization laboratory after the positive EKG, thus avoiding 

the one hour and three minute delay. 

{¶27} When we subtract one hour and three minutes from Dr. Manuel’s 

figure of three hours and 28 minutes we find that the occlusion could have been 

opened within two hours and 25 minutes of the positive EKG. When we add two 

hours and 25 minutes to 9:34 a.m., which represents the earliest time for a positive 

EKG result, we find that the occlusion could have been opened as soon as 11:59 

a.m. or three hours and 36 minutes after the onset of the heart attack. 

{¶28} Given the foregoing, we find that reasonable minds could have 

concluded that but for Dr. Manuel’s alleged negligence the occlusion could have 

been opened well within the four hour timeframe prescribed by Dr. Magorien, thus 

avoiding some clinically significant injury to Snyder’s heart and any other 

damages attendant to such injury. Consequently, we find that the trial court erred 

in granting a directed verdict in favor of Dr. Manuel as there was substantial 

probative evidence presented at trial on the issue of causation. 

{¶29} In so finding, we emphasize that our opinion should not be read as 

definitively establishing the time at which any event occurred on February 13, 

2009 or the timeframe in which the occlusion could have been opened. Instead, 

our opinion is merely intended to demonstrate that when the evidence presented at 
Case No. 5-11-39 

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trial is viewed in a light most favorable to the Plaintiffs, reasonable minds could 

have concluded that but for Dr. Manuel’s alleged negligence some clinically 

significant injury to Snyder’s heart could have been prevented. 

{¶30} Accordingly, we sustain Plaintiffs’ first and second assignments of 

error. 

Assignment of Error No. III 

{¶31} In their third assignment of error, Plaintiffs contend that the trial 

court erred when it limited the scope of Dr. Janiak’s testimony. Based on the 

following, we disagree. 

{¶32} Trial courts have broad discretion in the admission and exclusion of 

evidence. E.g., State v. Sage, 31 Ohio St.3d 173 (1987), paragraph two of the 

syllabus. Absent an abuse of discretion, a reviewing court will not reverse a trial 

court’s ruling concerning the admissibility of evidence. A trial court will be found 

to have abused its discretion when its decision is contrary to law, unreasonable, 

not supported by the evidence, or grossly unsound. See State v. Boles, 2d Dist. 

No. 23037, 2010-Ohio-278, ¶ 16-18, citing Black’s Law Dictionary 11 (8 

Ed.Rev.2004). When applying the abuse of discretion standard, a reviewing court 

may not simply substitute its judgment for that of the trial court. State v. Nagle, 

11th Dist. No. 99-L-089 (June 16, 2000), citing Blakemore v. Blakemore, 5 Ohio 

St.3d 217, 219 (1983). 
Case No. 5-11-39 

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{¶33} Prior to trial, Dr. Manuel filed a motion in limine requesting, in 

relevant part, that the trial court preclude Dr. Janiak from testifying. The trial 

court determined that “Dr. Janiak may testify as to what standard of care any

physician in general may be held to in diagnosing a heart attack[,]” but “will not

be permitted to testify as to the standard of care as it pertains to an emergency 

room doctor.” (Emphasis sic.) (Docket No. 131, p. 5). 

{¶34} At trial, after Dr. Janiak’s cross-examination, Plaintiffs requested the 

trial court to reconsider its ruling limiting Dr. Janiak’s testimony. Plaintiffs 

argued that Dr. Manuel’s cross-examination of Dr. Janiak opened the door to ask 

questions about standard of care. In response, the trial court denied Plaintiffs’ 

request, stating: 

As I told you in my ruling, you can ask him what opinions he has as 

to a general doctor, what a doctor is taught, what a doctor should 

know. It’s just not an emergency room case. You can’t illicit (sic) 

an opinion from him that comes about because of his emergency 

room experience. If this had gone through the emergency room then 

we [would want to] know what an emergency room doctor standard 

of care was or should be. I’m not limiting you in the context of what 

he can tell us as a practicing physician. Trial Tr., p. 240. 

{¶35} We find that the trial court did not abuse its discretion when it 

limited Dr. Janiak’s testimony. As previously noted, in order to establish a 

medical malpractice claim the plaintiff must, in relevant part, establish the 

applicable standard of care and the defendant’s negligent failure to render 

treatment in conformity with the applicable standard of care. Contrary to 
Case No. 5-11-39 

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Plaintiffs’ arguments, the applicable standard of care in this matter is one a 

hospitalist is expected to practice, not an emergency room physician. As the trial 

court noted, the standard of care expected of an emergency room physician would 

be applicable if an emergency room physician, as opposed to a hospitalist, had 

negligently failed to diagnose Snyder’s heart attack. Since that is not the case, we 

find that the trial court did not abuse its discretion when it limited Dr. Janiak’s 

testimony. 

{¶36} Furthermore, we find that the Plaintiffs’ were not prejudiced by the 

limitation of Dr. Janiak’s testimony. At the core of Plaintiffs’ claim is the notion 

that had Dr. Manuel immediately sent Snyder to the emergency room, she would 

have avoided some of the clinically significant injury to her heart. In order to 

convince the trier of fact that this course of action would have avoided some of the 

clinically significant injury, the Plaintiffs’ had to demonstrate that medical care 

activities, such as diagnosis, happen quicker in an emergency room. Upon review 

of the record, we find that the limitation on Dr. Janiak’s testimony did not 

preclude the Plaintiffs’ from establishing this fact. Indeed, the record reveals that 

there was an agreement among the medical experts and parties that medical 

treatment happens quicker in an emergency room than on the hospital floor. 

Consequently, we find that the Plaintiffs’ were not prejudiced by the trial court’s 

limitation of Dr. Janiak’s testimony. 
Case No. 5-11-39 

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{¶37} Accordingly, we overrule the Plaintiffs’ third assignment of error. 

{¶38} Having found no error prejudicial to the Plaintiffs herein, in the 

particulars assigned and argued in the third assignment of error, but having found 

error prejudicial to the Plaintiffs, in the particulars assigned and argued in the first 

and second assignments of error, we affirm in part, and reverse in part, the 

judgment of the trial court, and remand this matter for further proceedings 

consistent with this opinion. 

Judgment Affirmed in Part, 

Reversed in Part and 

Cause Remanded 

SHAW, P.J. and WILLAMOWSKI, J., concur. 

/jlr