Title: Sawyer v. Comerci
Citation: N/A
Docket Number: 011741
State: Virginia
Issuer: Virginia Supreme Court
Date: June 7, 2002

Present:  All the Justices 
 
NORMA SAWYER, ADMINISTRATRIX OF THE 
ESTATE OF NORMAN LEE PLOGGER, DECEASED 
OPINION BY JUSTICE LEROY R. HASSELL, SR. 
v.  Record No. 011741 
June 7, 2002 
 
CATHY COMERCI 
 
FROM THE CIRCUIT COURT OF ROCKBRIDGE COUNTY 
George E. Honts, III, Judge 
 
 
In this appeal of a judgment entered in favor of a 
physician in a medical negligence action, we consider whether 
the circuit court erred in granting a contributory negligence 
instruction, whether the evidence was sufficient to support 
the granting of a jury instruction on mitigation of damages, 
and whether the circuit court erred in limiting the scope of 
the plaintiff's cross-examination of the defendant's expert 
witness. 
I. 
 
Plaintiff, Norma J. Sawyer, administrator of the estate 
of Norman Lee Plogger, filed a motion for judgment against 
Cathy Comerci, D.O., and Stonewall Jackson Hospital.  She 
alleged that the defendants breached certain duties owed to 
the decedent, Norman Plogger, and that their acts and 
omissions were a proximate cause of his death.  The defendants 
filed grounds of defense and denied any breach of duties owed 
to Mr. Plogger. 
 
At the beginning of a jury trial, the plaintiff took a 
voluntary nonsuit of her action against the hospital, and the 
case proceeded against Dr. Comerci.  At the conclusion of the 
litigants' presentation of evidence, the jury was instructed, 
among other things, that it could consider whether Mr. Plogger 
was contributorially negligent.  The jury returned a verdict 
in favor of Dr. Comerci, and the plaintiff appeals. 
II. 
 
On the night of April 2, 1997, Norman Plogger, 
accompanied by his wife, Mary Plogger, went to the Stonewall 
Jackson Hospital emergency room.  Mr. Plogger sought help 
because he experienced continuous pain on the right side of 
his abdomen. 
 
Dr. Comerci, the emergency room physician "on call" that 
night, evaluated Mr. Plogger, ordered certain laboratory 
tests, and performed an examination upon him.  Mr. Plogger 
informed Dr. Comerci that he "just didn't feel well; that he 
hadn't felt well for a while."  Mr. Plogger had seen his 
family physician a few days earlier, and his physician 
informed Mr. Plogger that he had a viral illness.  Mr. Plogger 
also informed an emergency room nurse that he "had right 
abdominal soreness."  Even though Mr. Plogger had experienced 
abdominal pains for several months before he went to Stonewall 
Jackson Hospital on April 2, 1997, he had not mentioned this 
pain to his physician, Dr. Thomas Hamilton. 
 
Dr. Comerci concluded that Mr. Plogger should be admitted 
to the hospital as a patient because he had blood in his stool 
 
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and his white blood count was elevated.  The elevation in Mr. 
Plogger's white blood count led Dr. Comerci to believe that 
either "an inflammatory process or infection" was occurring in 
his body. 
 
Dr. Comerci felt that a surgeon should evaluate Mr. 
Plogger, and she made a telephone call to Dr. Robert Irons, 
the hospital's "on call" surgeon, seeking such evaluation.  
Summarizing her conversation with Dr. Irons, Dr. Comerci 
stated:  "By my calling Dr. Irons, I would be calling him for 
an admission. . . .  I . . . call[ed] him because I needed him 
to see a patient for admission. . . .  But my calling him, it 
is because I need[ed] [Mr. Plogger] admitted, and I need[ed] 
the surgeon to come in and evaluate the patient." 
 
Dr. Comerci informed Dr. Irons that Mr. Plogger "had 
blood in his stool" and that he "had a [gastrointestinal] 
bleed with an intermittent bowel obstruction probably being 
caused by a mass in his colon."  Dr. Comerci believed that Mr. 
Plogger needed surgical intervention to resolve the bleeding.  
Dr. Irons told Dr. Comerci that he did not believe that Mr. 
Plogger had "an acute surgical abdomen" and recommended that 
Dr. Comerci refer Mr. Plogger to Dr. Hamilton.  Dr. Comerci 
placed a telephone call to Dr. Hamilton. 
 
When Dr. Comerci was discussing Mr. Plogger's condition 
with Dr. Irons, or after she had spoken with Dr. Irons, the 
emergency room nurses approached Dr. Comerci and informed her 
 
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that Mr. and Mrs. Plogger were about to leave the hospital 
again.  The Ploggers had previously considered leaving the 
hospital before Dr. Comerci had spoken with Dr. Irons. 
 
Dr. Comerci testified that when Mr. and Mrs. Plogger 
began to leave the second time, she asked them to wait.  Dr. 
Comerci stated:  "I went back in, I talked to them and told 
them to wait; that I was trying to get ahold of his doctor, 
Dr. Hamilton.  And I talked with Dr. Hamilton and I told him 
that I had a problem, that I had a man that I felt needed to 
be admitted, and I told him why, but that the man didn't want 
to be admitted; apparently his wife had an appointment the 
next day in Roanoke; they wanted to get out of there; he was 
already on his way out of the door; Dr. Irons did not want to 
come in, and [he did not] want to come in and see this 
gentleman.  And [Dr. Hamilton] said, I guess if he doesn't 
want to stay, I will just see him tomorrow.  I said, I don't 
think you'll see him tomorrow, they're going to be in Roanoke.  
And he said, [f]ine, have him call the office tomorrow and 
I'll see him Monday." 
 
Approximately 10:15 that night, Mr. and Mrs. Plogger left 
the hospital's emergency room.  They had been in the emergency 
room since about 7:30 p.m.  Dr. Comerci testified that Mrs. 
Plogger "had said all along, [Mr. Plogger] can't stay; I have 
an appointment in the morning; we have to go to Roanoke." 
 
4
 
When Mr. Plogger was discharged from the hospital's 
emergency room at 10:15 p.m., Dr. Comerci tried to persuade 
him to remain.  However, he refused to do so.  Dr. Comerci 
recorded a statement on Mr. Plogger's progress notes after he 
had left the emergency room that stated, among other things:  
"Patient and especially the patient's wife are difficult to 
talk with and despite repeated explanation do not seem to 
understand the possibility of the seriousness of his 
condition; however, agree to follow up with Dr. Hamilton on 
Friday." 
 
Generally, a patient who leaves a hospital against the 
advice of the physician is asked to sign a document, described 
as an "against medical advice form."  Dr. Comerci did not 
think that this form was available in the emergency room at 
that time.  Consequently, Mr. Plogger did not sign this form. 
 
Mr. Plogger returned to the hospital's emergency room 
three days later on April 5, 1997 with complaints of a sore 
throat.  Dr. Comerci evaluated his abdomen, examined his 
throat, and diagnosed his throat condition as either oral 
candidiasis or oral thrush, conditions unrelated to his 
abdominal complaints. 
 
Even though the discharge instructions that Mr. Plogger 
received during his emergency room visit on April 2, 1997 
directed him to meet with Dr. Hamilton on April 4, Mr. Plogger 
did not do so.  When Dr. Comerci treated Mr. Plogger at the 
 
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emergency room on April 5, she "reiterated [that] he 
absolutely needed to follow up with his doctor on Monday 
[April 7] regarding [his] abdomen, and to come back if it was 
worse at all."  Dr. Comerci "was still concerned" about Mr. 
Plogger's abdominal condition.  According to Dr. Hamilton, Mr. 
Plogger failed to make an appointment to see him on April 4, 
1997.  Dr. Hamilton stated that "there is no record that [Mr. 
Plogger] made an appointment for any of those days after the 
2nd of April." 
 
On Monday morning, April 7, Mr. Plogger returned to the 
emergency room by ambulance.  He was acutely short of breath, 
his skin was very pale, his lips were blue, and he was 
sweating.  He was admitted to the hospital, where he died the 
following day. 
 
The plaintiff presented evidence at trial that Dr. 
Comerci failed to comply with the applicable standard of care 
imposed upon a reasonably prudent emergency room physician 
when she treated Mr. Plogger on April 2, 5, and 7, 1997, and 
that her acts and omissions were proximate causes of his 
death.  Dr. Comerci presented expert witness testimony that 
she complied with the standard of care and that Mr. Plogger's 
death was not caused by any act or omission by her. 
III. 
 
The circuit court instructed the jury, over the 
plaintiff's objection, that it shall find its 
 
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"verdict for the defendant Dr. Comerci for the care 
she rendered to Mr. Plogger on April 2, 1997 if she 
has proved by the greater weight of the evidence 
that Mr. Plogger was contributor[ially] negligent 
concerning the events that occurred on April 2, 1997 
and that this negligence was a proximate cause of 
Mr. Plogger's death." 
 
The plaintiff contends that the circuit court erred in giving 
this jury instruction because Dr. Comerci failed to present 
sufficient evidence from which the jury could conclude that 
Mr. Plogger was guilty of contributory negligence.  The 
alleged act of contributory negligence related to Dr. 
Comerci's contention that Mr. Plogger left the emergency room 
against her advice. 
 
Responding, Dr. Comerci argues that she presented 
sufficient evidence to permit the jury to find that Mr. 
Plogger was guilty of contributory negligence because he left 
the emergency room even though she told him that he needed to 
be admitted.  We disagree with Dr. Comerci. 
 
The legal principles relevant to our resolution of this 
issue are familiar.  Contributory negligence is an affirmative 
defense that is based on the objective standard whether a 
plaintiff failed to act as a reasonable person would have 
acted for his own safety under the circumstances.  Ponirakis 
v. Choi, 262 Va. 119, 124, 546 S.E.2d 707, 710 (2001); Artrip 
v. E.E. Berry Equipment Co., 240 Va. 354, 358, 397 S.E.2d 821, 
823-24 (1990). 
 
7
 
"The essence of contributory negligence is carelessness."  
Ponirakis, 262 Va. at 124, 546 S.E.2d at 711; Artrip, 240 Va. 
at 358, 397 S.E.2d at 823-24.  Whether a plaintiff is guilty 
of contributory negligence is generally a question of fact to 
be decided by the trier of fact.  Ponirakis at 125, 546 S.E.2d 
at 711; Artrip, 240 Va. at 358, 397 S.E.2d at 823. 
 
We have consistently held that the defendant has the 
burden of proving contributory negligence by the greater 
weight of the evidence.  Id.  This means that "the burden is 
upon the defendant to establish by a preponderance of the 
evidence such contributory negligence, unless it is disclosed 
by the plaintiff's evidence or can be fairly inferred from the 
circumstances of the case."  Southern Railway v. May, 147 Va. 
542, 552, 137 S.E. 493, 496 (1927). 
 
Additionally, in order for contributory negligence to bar 
a plaintiff's recovery in a medical negligence action, the 
plaintiff's negligence must be concurrent with the defendant's 
negligence.  Ponirakis, 262 Va. at 125, 546 S.E.2d at 711; 
Gravitt v. Ward, 258 Va. 330, 335, 518 S.E.2d 631, 634 (1999); 
Eiss v. Lillis, 233 Va. 545, 552, 357 S.E.2d 539, 543 (1987); 
Lawrence v. Wirth, 226 Va. 408, 412, 309 S.E.2d 315, 317 
(1983).  We have stated that "[i]n the medical malpractice 
context, this requirement means that the patient's negligent 
act must be contemporaneous with the main fact asserted as the 
 
8
negligent act of the physician."  Ponirakis, 262 Va. at 125, 
546 S.E.2d at 711. 
 
And, just as a plaintiff is required to establish a prima 
facie case of negligence, a defendant who relies upon the 
defense of contributory negligence must establish a prima 
facie case of the plaintiff's contributory negligence.  Hence, 
a defendant who asserts a defense of contributory negligence 
is not entitled to a jury instruction on contributory 
negligence if that defendant only adduces a mere scintilla of 
evidence of the plaintiff's purported contributory negligence.  
A defendant who relies upon the defense of contributory 
negligence must prove that the plaintiff deviated from a 
standard of care and that the deviation was a proximate cause 
of damages.  Consequently, more than a scintilla of evidence 
is necessary to establish each of the elements of contributory 
negligence before such instruction may be given to a jury. 
 
We hold that Dr. Comerci was not entitled to a jury 
instruction on contributory negligence because she failed to 
establish a prima facie case that Mr. Plogger was guilty of 
contributory negligence.  Even though Dr. Comerci consulted 
Dr. Hamilton and requested that he "come in to see" Mr. 
Plogger, no physician with admitting privileges told Mr. 
Plogger that he should be admitted as a patient to  the 
hospital on April 2, 1997.  Dr. Comerci did not make any 
 
9
record in Mr. Plogger's medical chart that he should have been 
admitted to the hospital on April 2, 1997. 
 
The record is devoid of any evidence that Mr. Plogger 
understood the severity of his condition and the consequences 
that might ensue if he were not admitted as a patient to the 
hospital.  There is no evidence in this record that Dr. 
Comerci told Mr. Plogger that he could die if he did not 
receive medical treatment.  And, even though Dr. Comerci 
claims that such evidence is found in the record, we conclude 
otherwise.  Dr. Comerci relies upon the following question and 
answer in support of her contention that such evidence exists 
in this record: 
 
"[Question]:  And certainly if you had told 
[Mr. Plogger] that he was in a life-or-death 
situation, I mean, he would have done – the guy came 
to the emergency room on a Wednesday night? 
 
 
"[Dr. Comerci]:  No.  I would think if the 
patient was in – and I had told him he was in a 
life-or-death situation and that I wanted him to be 
admitted, he would have been admitted.  There seems 
to be a marked misunderstanding.  He just didn't 
seem to comprehend, or actually Mr. Plogger seemed 
to comprehend, but Mrs. Plogger did not seem to 
comprehend." 
 
 
This testimony does not permit us to hold that a jury 
could conclude that Dr. Comerci had explained to Mr. Plogger 
that if he chose to leave the hospital without being admitted 
as a patient, without resolution of his internal bleeding, he 
could die.  Rather, this testimony is speculative and 
conjectural.  We also observe that Dr. Irons, the surgeon whom 
 
10
Dr. Comerci consulted, did not believe that Mr. Plogger needed 
to be admitted as a patient to the hospital and, therefore, we 
do not think that a jury should be permitted to infer that a 
layman could be guilty of contributory negligence because he 
left the emergency room under the facts and circumstances in 
this record. 
IV. 
 
The circuit court gave the following instruction to the 
jury, over the plaintiff's objection: 
 
"A patient who claims that he has been 
negligently treated by a physician has a duty to use 
ordinary care to avoid loss or minimize or lessen 
the resulting damage. 
 
 
"If the jury believes that Norman Plogger 
failed to use ordinary care to follow the 
instructions of Dr. Comerci to make an appointment 
with and see his family physician, his estate may 
not recover for any portion of the harm which, by 
such care, could have been avoided." 
 
The plaintiff contends that there was insufficient evidence to 
support this instruction and, therefore, the circuit court 
erred by granting it.  Responding, the defendant argues that 
there was evidence to support the instruction.  We agree with 
the defendant. 
 
We have held that a plaintiff has a duty to mitigate his 
damages.  In the context of a medical negligence claim, we 
have stated that "a patient's neglect of his health following 
his physician's negligent treatment may be a reason for 
reducing damages, but does not bar all recovery."  Lawrence, 
 
11
226 Va. at 412, 309 S.E.2d at 317.  Generally, whether a 
plaintiff acted reasonably to minimize his damage is a 
question for the jury.  Id. at 413, 309 S.E.2d at 318. 
 
We hold that there is sufficient evidence in this record 
that would permit the jury to find as a matter of fact that 
Mr. Plogger failed to mitigate his damages.  For example, Dr. 
Donald G. Gregg, who testified on behalf of the plaintiff as 
an expert witness, stated that Mr. Plogger should have been 
admitted to the hospital, "[a]nd one of the ways to do that 
was to go see his family doctor as instructed and be 
evaluated" and that had he done so, "he would have survived."  
As we have already stated, when Mr. Plogger was discharged 
from the emergency room on April 2, 1997, he received 
instructions that directed him to make an appointment with his 
family physician.  However, that physician, Dr. Hamilton, 
testified that Mr. Plogger failed to make any appointment to 
see him for treatment. 
V. 
 
At trial, Dr. David H. Lander qualified as an expert 
witness on the subject of emergency medicine.  He testified on 
behalf of the defendant that, among other things, Dr. Comerci 
complied with the standard of care owed to Mr. Plogger.  
Lander had testified on behalf of Dr. Comerci in an unrelated 
lawsuit, and the plaintiff sought to cross-examine Lander to 
show that he had previously testified on Dr. Comerci's behalf 
 
12
in an unrelated lawsuit and that he had received prior 
compensation from her.  The circuit court refused to permit 
the plaintiff to elicit this testimony.  The plaintiff asserts 
that she was entitled to cross-examine Lander on this subject 
and that the circuit court abused its discretion in 
prohibiting her from doing so.*
 
The defendant responds that the circuit court gave the 
plaintiff "appropriate latitude in cross-examining . . . 
Lander."  The defendant says that the plaintiff was allowed to 
cross-examine Dr. Lander about the compensation he received 
for testifying in this case.  Continuing, the defendant argues 
that the scope of cross-examination is a matter that rests 
within the discretion of the circuit court, and the circuit 
court may appropriately prohibit a particular line of 
impeachment if the court finds that the prejudicial effect of 
the impeachment outweighs the probative value of such 
testimony. 
 
As the litigants correctly observe, a circuit court has 
discretion to limit the scope of cross-examination.  Norfolk & 
Western Railroad Co. v. Sonney, 236 Va. 482, 488, 374 S.E.2d 
71, 74 (1988); see Basham v. Terry, 199 Va. 817, 824, 102 
S.E.2d 285, 290 (1958).  That discretion, however, is not 
                     
* We find no merit in the defendant's argument that this 
Court cannot adjudicate this issue. The circuit court clearly 
articulated the reasons it relied upon to limit the scope of 
the plaintiff's cross-examination of Dr. Lander. 
 
13
without limitations, and a litigant has a right to establish 
that a witness is biased.  We have stated: 
"The bias of a witness, like prejudice and 
relationship, is not a collateral matter.  The bias 
of a witness is always a relevant subject of inquiry 
when confined to ascertaining previous relationship, 
feeling and conduct of the witness . . . .  [O]n 
cross-examination great latitude is allowed and 
. . . the general rule is that anything tending to 
show the bias on the part of a witness may be drawn 
out." 
 
Henning v. Thomas, 235 Va. 181, 188, 366 S.E.2d 109, 113 
(1988) (quoting Henson v. Commonwealth, 165 Va. 821, 825-26, 
183 S.E. 435, 437 (1936)). 
 
Our decision in Henning is instructive in this case.  In 
Henning, a medical negligence action, the defense counsel 
sought to cross-examine the plaintiff's expert witness 
regarding how that witness became involved in the trial of 
that case.  The circuit court refused to permit defense 
counsel to cross-examine the expert witness on that subject 
other than allowing defense counsel to ask a narrow question 
whether the witness was being paid to give his testimony.  
Defense counsel argued that the circuit court erred in 
prohibiting them from revealing to the jury that the 
plaintiff's expert witness was employed by a company engaged 
in the business of providing expert testimony in medical 
negligence cases.  Id. at 187, 366 S.E.2d at 112-13.  We 
reversed the judgment of the circuit court in favor of the 
plaintiff, and we stated: 
 
14
"The defendant doctors were entitled to attempt to 
persuade the jury that [the plaintiff's expert 
witness] was a 'doctor for hire,' who was part of a 
nationwide group that offered themselves as 
witnesses, on behalf of medical malpractice 
plaintiffs.  Once the jury was made aware of this 
information it was for the jury to decide what 
weight, if any, to give to [the expert witness'] 
testimony.  This was a classic case of an effort to 
establish bias, prejudice, or relationship. 
 
"The trial court went too far when it limited 
defendants' cross-examination to the bare question 
whether [the expert witness] was being paid to 
testify." 
 
Id. at 188-89, 366 S.E.2d at 113. 
 
We applied our holding in Henning when we decided Lombard 
v. Rohrbaugh, 262 Va. 484, 551 S.E.2d 349 (2001), and we held 
that the circuit court did not err in permitting a plaintiff 
to cross-examine the defendant's expert witness to show that 
the witness had received over $100,000 per year in payments 
for the years 1998 and 1999 from the defendant's insurance 
company.  Id. at 495, 551 S.E.2d at 355.  We held that 
"testimony concerning liability insurance may be 
elicited for the purpose of showing bias or 
prejudice of a witness if there is a substantial 
connection between the witness and the liability 
carrier.  If a substantial connection is 
demonstrated, its probative value concerning 
potential bias or prejudice outweighs any prejudice 
to the defendant resulting from the jury's knowledge 
that the defendant carries liability insurance." 
 
Id. at 497, 551 S.E.2d at 356. 
 
Similarly, we hold that in this case the plaintiff was 
entitled to cross-examine the defendant's expert witness, Dr. 
Lander, to show that he had previously testified as an expert 
 
15
witness on behalf of Dr. Comerci and that he had been 
compensated.  The amount of money that Dr. Comerci paid Dr. 
Lander in a prior case was a relevant area of inquiry because 
that testimony may have indicated to the jury that he was 
biased in her favor.  The probative value concerning this 
potential bias outweighed any prejudice to Dr. Comerci 
resulting from the jury's knowledge that she had been a 
defendant in an unrelated lawsuit.  Therefore, the circuit 
court abused its discretion in failing to permit the plaintiff 
to elicit this testimony. 
VI. 
 
We will reverse the judgment of the circuit court and 
remand this case for a new trial consistent with the views 
expressed in this opinion. 
Reversed and remanded. 
 
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