Case Name: Brenda A. GUFFEY, Personal Representative of the Estate of James Fred Guffey, Appellant, v. COLUMBIA/COLLETON REGIONAL HOSPITAL, INC., W.W. King, M.D., and David E. Meacher, M.D., P.A., Respondents
Court: Supreme Court of South Carolina
Jurisdiction: South Carolina
Decision Date: 2005-04-25
Citations: 364 S.C. 158
Docket Number: No. 25974
Parties: Brenda A. GUFFEY, Personal Representative of the Estate of James Fred Guffey, Appellant, v. COLUMBIA/COLLETON REGIONAL HOSPITAL, INC., W.W. King, M.D., and David E. Meacher, M.D., P.A., Respondents.
Judges: WALLER, J., and Acting Justices REGINALD I. LLOYD and R. MARKLEY DENNIS, JR., concur. BURNETT, J., dissenting in a separate opinion.
Reporter: South Carolina Reports
Volume: 364
Pages: 158–173

Head Matter:
612 S.E.2d 695
Brenda A. GUFFEY, Personal Representative of the Estate of James Fred Guffey, Appellant, v. COLUMBIA/COLLETON REGIONAL HOSPITAL, INC., W.W. King, M.D., and David E. Meacher, M.D., P.A., Respondents.
No. 25974.
Supreme Court of South Carolina.
Heard Nov. 18, 2004.
Decided April 25, 2005.
John E. Parker and Bert G. Utsey, III, both of Peters, Murdaugh, Parker, Eltzroth & Detrick, P.A., of Walterboro, for appellant.
C. Mitchell Brown, Zoe Sanders Nettles, and Elizabeth Herlong Campbell, all of Nelson Mullins Riley & Scarborough, of Columbia, for respondent Columbia/Colleton Regional Hospital, Inc.
Stephen L. Brown, John Hamilton Smith, and D. Jay Davis, Jr., of Young, Clement, Rivers & Tisdale, of Charleston, for respondents W.W. King, M.D. and David E. Meacher, M.D., P.A.

Opinion:
Acting Chief Justice MOORE:
Appellant commenced this wrongful death action as personal representative of her husband's estate alleging medical malpractice. She appeals a directed verdict and the exclusion of evidence. We affirm.
FACTS
James Guffey (Decedent) suffered cardiac arrest at age fifty on September 3, 1997, twenty-five hours after he was discharged from the emergency room at respondent Columbia/Colleton Regional Hospital (Hospital). Decedent had previously undergone two angioplasty surgeries in 1995 to treat unstable angina and subsequently was on medication, including nitroglycerin as needed for pain. He had a check-up every month with his cardiologist, Dr. Reeves.
Two years after his surgeries, on September 2, 1997, Decedent came home early from work complaining of a headache and indigestion. During the course of the evening, Decedent took three doses of nitroglycerin. Finally, at about 11:00 p.m., Decedent said he needed to go to the hospital because he "felt like he did the last time," referring to his 1995 cardiac episode. At Hospital's emergency room, Decedent was treated with nitroglycerin paste and discharged by Dr. William King.
Decedent stayed in bed the next day still complaining of headache and indigestion. During the night, he suffered cardiac arrest. He was brain-dead by the time he arrived at the hospital and died several days later.
Dr. King testified he had attempted to contact Decedent's cardiologist, Dr. Reeves, while Decedent was at the emergency room. The call was answered by Dr. Reeves's associate, Dr. Grayson. Dr. Grayson told Dr. King that it was reasonable to send Decedent home but to have him see Dr. Reeves in the morning. Dr. King told Decedent to return to the emergency room if he had pain during the night and if he had no pain, he should call Dr. Reeves's office in the morning for an appointment. Decedent did not seek further medical care before suffering cardiac arrest the next night.
Appellant's medical expert, Dr. Wood, testified that Decedent's symptoms indicated he had unstable, as opposed to stable angina, and therefore he should not have been dis charged from the emergency room. Dr. Wood testified that the pain caused by stable angina is relieved with nitroglycerin whereas the pain from unstable angina is not. Decedent's history taken at the emergency room indicated he had "relief of the chest pain but still had tightness in his chest." From this history, Dr. Wood concluded Decedent was suffering unstable angina. It was his opinion that Dr. King deviated from the standard of care in not admitting Decedent to the hospital.
Hospital's medical experts, on the other hand, testified Decedent's symptoms indicated he had stable angina because he did have pain relief from the nitroglycerin -with only "residual tightness."
. The jury returned a verdict for Hospital on the issue of Dr. King's negligence in failing to admit Decedent to the hospital.
ISSUES
1. Did the trial court err in granting a directed verdict regarding conflicting discharge instructions?
2. Did the trial court err in excluding evidence of conflicting discharge instructions?
DISCUSSION
1. Directed verdict
Appellant accompanied Decedent to the emergency room. On cross-examination, she denied Decedent was told at the time of his discharge to contact his cardiologist, Dr. Reeves, in the morning. On re-direct, counsel referred to a document entitled "Aftercare Instructions" which Decedent was given by Hospital's staff when he was discharged. The document states: "THESE ARE YOUR FOLLOW-UP INSTRUCTIONS! Call Dr. Hiott [Decedent's family doctor] in 2 days if not much better. Call sooner if worsening." This document was admitted into evidence.
At the close of appellant's case, Hospital moved for a directed verdict on the allegation that Hospital was negligent in giving these aftercare instructions which conflicted with Dr. King's instructions to contact the cardiologist in the morning. The trial judge found appellant had presented no evidence the discrepancy in instructions was the proximate cause of Decedent's death and granted the motion.
A directed verdict should be granted where the evidence raises no issue for the jury as to the defendant's liability. Roberts v. Hunter, 310 S.C. 364, 426 S.E.2d 797 (1993). On review, we will affirm a directed verdict where there is no evidence on any one element of the alleged cause of action. First State Savings and Loan v. Phelps, 299 S.C. 441, 385 S.E.2d 821 (1989). In a medical malpractice action, the plaintiff must establish proximate cause as well as the negligence of the physician. Ellis v. Oliver, 323 S.C. 121, 473 S.E.2d 793 (1996).
There is no evidence Decedent relied on Hospital's aftercare instructions and for this reason did not call his cardiologist. Further, the record contains no expert testimony Decedent's death could have been prevented had he seen his cardiologist the next morning. See Bramlette v. Charter-Medical-Columbia, 302 S.C. 68, 393 S.E.2d 914 (1990) (expert testimony is required to establish proximate cause in a medical malpractice case if outside the common knowledge or experience of laypersons); Green v. Lilliewood, 272 S.C. 186, 249 S.E.2d 910 (1978) (medical malpractice plaintiff relying on expert testimony must introduce evidence that defendant's negligence most probably resulted in the injuries alleged). Because there is no evidence the conflicting discharge instructions proximately caused Decedent's death, the trial judge properly granted a directed verdict on this allegation of negligence.
2. Exclusion of evidence
Hospital moved to strike the "Aftercare Instructions," along with evidence of Hospital's internal policies regarding discharge instructions, after withdrawing comparative negligence as a defense. In light of counsel's assurance comparative negligence would not be argued to the jury, the trial judge found the contested evidence irrelevant and granted the motion to strike.
We find no error. When the directed verdict on the issue of Hospital's negligence for conflicting instructions was properly granted, this evidence became irrelevant. Comparative negligence was not argued in closing nor submitted to the jury. Because there was no issue of Decedent's negligence that might be explained by an inference he followed these instructions, there was no prejudice from the exclusion of this evidence. The exclusion of evidence that is not relevant to some matter in issue cannot be prejudicial. See Otis Elevator, Inc. v. Hardin Const. Co. Group, Inc., 316 S.C. 292, 450 S.E.2d 41 (1994) (no error in the exclusion of evidence absent a showing of prejudice).
CONCLUSION
Appellant's remaining issues are without merit and we affirm pursuant to Rule 220(b), SCACR. See Issue 2: Green v. Lilliewood, 272 S.C. 186, 249 S.E.2d 910 (1978) (medical malpractice plaintiff relying on expert testimony must introduce evidence that defendant's negligence most probably resulted in the injuries alleged); Issue 4: Keaton ex rel. Foster v. Greenville Hosp. System, 334 S.C. 488, 514 S.E.2d 570 (1999) (jury charge correct if when read as whole, charge contains correct definition and adequately covers law); see also State v. Smith, 315 S.C. 547, 446 S.E.2d 411 (1994) (jury instructions should be considered as whole, and if as whole they are free from error, any isolated portions which may be misleading do not constitute reversible error).
AFFIRMED.
WALLER, J., and Acting Justices REGINALD I. LLOYD and R. MARKLEY DENNIS, JR., concur. BURNETT, J., dissenting in a separate opinion.
. Dr. King was named as a defendant. The parties agreed before trial that the action would proceed solely against Hospital because Dr. King was acting as Hospital's agent. See Simmons v. Tuomey Reg. Med. Center, 341 S.C. 32, 533 S.E.2d 312 (2000) (hospital's liability for acts of doctor-agent).
. According to medical testimony in the record, stable angina occurs when the coronary arteries become occluded over time and smaller arteries take over to aid in cariying blood to the heart muscle. In this instance, the patient feels pain only on exertion because the smaller arteries cannot handle the extra need for blood. The pain of stable angina improves with rest or with nitroglycerin. Unstable angina, on the other hand, occurs when an artery is suddenly occluded by a blood clot. The patient feels pain, or more frequent pain, even when resting. The pain is not relieved with nitroglycerin. A patient with unstable angina should be admitted to the hospital to prevent the clot from getting bigger. If the blockage becomes too large, the patient will suffer a heart attack.
. Appellant makes a procedural argument that the trial judge should not direct a verdict on one specification of negligence if any other specification is supported by the evidence. The cases appellant cites do not stand for this proposition and we find it without merit. Cf. Young v. Charleston & W.C. Ry. Co., 229 S.C. 580, 93 S.E.2d 866 (1956) (where defendant moved for directed verdict to keep entire case from being submitted to jury, motion properly denied because evidence supported at least one specification of negligence).
. Further, the trial judge refused appellant's counter-motion that the discharge sheet with Dr. King's instructions also be struck. Dr. King's discharge instructions remained relevant since they indicated his treatment conformed to the standard of care.