Title: Brown v. Hoffman
Citation: N/A
Docket Number: 070304
State: Virginia
Issuer: Virginia Supreme Court
Date: February 29, 2008

PRESENT: Hassell, C.J., Keenan, Kinser, Lemons, Agee, and 
 
    Goodwyn, JJ., and Stephenson, S.J. 
 
JANET LIN BROWN, ADMINISTRATOR OF THE ESTATE OF 
CLIFFORD LEWIS FANUCCI, SR., DECEASED 
 
 
 
OPINION BY 
v. Record No. 070304    SENIOR JUSTICE ROSCOE B. STEPHENSON, JR. 
 
 
 
February 29, 2008 
DANIEL MARK HOFFMAN, M.D. 
 
FROM THE CIRCUIT COURT OF THE CITY OF FREDERICKSBURG 
J. Richard Alderman, Judge 
 
 
The sole issue in this appeal is whether the trial court 
erred in striking the plaintiff's evidence and entering summary 
judgment for the defendant. 
I 
 
Janet Lin Brown, Administrator of the Estate of Clifford 
Lewis Fanucci, Sr., Deceased (the Plaintiff), filed in the 
Circuit Court of the City of Fredericksburg a medical 
malpractice suit against Daniel Mark Hoffman, M.D., and others.∗  
The case was tried by a jury, and, at the conclusion of a three-
day trial during which both sides presented evidence, the trial 
court struck the Plaintiff's evidence and entered summary 
judgment for Dr. Hoffman.  We awarded the Plaintiff this appeal. 
II 
 
When a trial court strikes a plaintiff's evidence, we view 
the evidence in the light most favorable to the plaintiff, 
"giving [the plaintiff] the benefit of all inferences which a 
jury might fairly draw from the evidence."  If several 
inferences may be drawn from the evidence, though they may 
differ in degree and probability, we adopt those most favorable 
to the plaintiff "unless they are strained and forced or 
contrary to reason."  West v. Critzer, 238 Va. 356, 357, 383 
S.E.2d 726, 727 (1989); accord Economopoulos v. Kolaitis, 259 
Va. 806, 814, 528 S.E.2d 714, 719 (2000).  The evidence, viewed 
in the light most favorable to the Plaintiff, is as follows. 
 
In early August 2002, Fanucci saw Dr. Hoffman, a urologist, 
complaining of, among other things, difficult urination and 
blood in his urine.  Dr. Hoffman diagnosed Fanucci as having a 
cancerous growth on his left kidney.  On August 13, 2002, Dr. 
Hoffman performed surgery to remove Fanucci's left kidney.  Dr. 
Hoffman was assisted by his partner, Dr. Elmore J. Becker, Jr. 
 
Dr. Hoffman elected to use a surgical technique known as a 
hand-assisted laparoscopic nephrectomy.  In utilizing this 
technique, a surgeon operates primarily laparoscopically; 
however, the surgeon, in addition to the small incision made to 
insert the laparoscopic instruments, makes an additional 
incision through which to insert his hand to assist in the 
removal of the kidney. 
                                                                  
 
∗ The other defendants were either nonsuited or otherwise 
dismissed prior to trial. 
 
2
 
In order to remove the left kidney, it is medically 
necessary to first clamp the left renal vein and artery.  Dr. 
Hoffman found the left renal vein, which is normally in front of 
the left renal artery, and clamped it.  Dr. Hoffman then felt 
what he thought was the left renal artery and clamped it.  As 
Dr. Hoffman began to dissect the left kidney from the 
surrounding tissue, he noticed what he believed to be a second 
renal artery leading to the left kidney.  Dr. Hoffman was not 
concerned by this discovery because, according to him, "20 or 30 
percent of people will have two renal arteries" supplying the 
same kidney.  Dr. Hoffman clamped this second artery and 
continued to dissect the left kidney. 
 
After freeing the kidney, Dr. Hoffman noticed that the 
first artery he had clamped, but had not yet cut, was "going in 
the wrong direction" and was, in fact, the right renal artery.  
Dr. Hoffman then removed the clamp in order to restore the blood 
flow to the right kidney.  When he did so, Fanucci began 
bleeding from a tear in the right renal artery.  Dr. Hoffman was 
unable to stop the bleeding, so he called in Dr. Richard C. 
Earnhardt, a vascular surgeon who was on duty at the hospital. 
 
Dr. Earnhardt tried to repair the tear in the right renal 
artery, but he was unsuccessful.  Fanucci's significant blood 
loss from the right renal artery tear forced Dr. Earnhardt to 
perform a bypass procedure on the damaged artery.  Dr. Earnhardt 
 
3
also noticed blood oozing from tears in Fanucci's spleen near 
where the left kidney had been located, and he removed the 
spleen.  As a result of the prolonged surgery, Fanucci suffered 
from a number of complications, and he ultimately died. 
 
Dr. John C. Hulbert, a practicing urologist and the 
Plaintiff's expert on the standard of care, testified that Dr. 
Hoffman's actions relating to the right renal artery were a 
deviation from the standard of care.  He opined that damaging 
the right renal artery while operating on the left kidney 
indicated that Dr. Hoffman had lost his anatomical bearings 
during surgery.  Nothing in the records that Dr. Hulbert 
reviewed indicated that the right renal artery was not in the 
normal location or that anything was distorting Fanucci's 
anatomy.  On cross-examination, Dr. Hulbert stated that he did 
not know if Fanucci had any anatomical abnormalities.  He 
agreed, however, that, if the right renal artery were located 
behind the left renal vein, then "that might be an 
understandable complication." 
 
Dr. Earnhardt testified that, at the time he was repairing 
the right renal artery, "there were no anatomic anomalies" with 
regard to the artery.  Dr. Earnhardt admitted, however, that 
Fanucci's anatomy "had changed significantly" from when Dr. 
Hoffman first started the surgery. 
 
4
 
Dr. Jose Abrenio, the pathologist who performed an autopsy 
on Fanucci, testified that the right renal artery was no longer 
normal because of the bypass surgery.  Dr. Abrenio also 
testified that there was nothing unusual about the right renal 
artery and that it was located in the proper place anatomically. 
 
Dr. Hoffman testified that the right renal artery "is not 
anywhere near the left renal vein in normal anatomy."  According 
to Dr. Hoffman, however, in Fanucci's anatomy, the right renal 
artery was located "where the left renal artery should have 
been." 
 
Dr. Becker, Dr. Hoffman's partner who assisted in the 
surgery, testified that he thought the right renal artery was 
the left renal artery based on its location and because it 
appeared to be going into the left kidney.  Dr. Becker also 
testified that there was nothing abnormal about the procedures 
performed by Dr. Hoffman. 
III 
 
The critical issue at trial was whether Fanucci's anatomy 
presented an anomalous situation in that his right renal artery 
was located where a reasonable urologist would anticipate that 
his left renal artery would be.  If that were the case, then the 
Plaintiff's expert agreed that Dr. Hoffman did not violate the 
standard of care. 
 
5
 
6
 
Although the two physicians who had performed the 
nephrectomy testified that such an anomaly existed, the 
testimony of Dr. Earnhardt and of Dr. Abrenio was otherwise.  
Dr. Earnhardt testified that, when he intervened in Fanucci's 
surgery, he found no anatomical anomalies.  Likewise, Dr. 
Abrenio testified that the right renal artery appeared in the 
normal location at the autopsy.  The weight to be given to the 
testimony of Dr. Earnhardt and Dr. Abrenio and the doctors' 
credibility were matters within the province of the jury.  See 
Burroughs v. Keffer, 272 Va. 162, 167, 630 S.E.2d 297, 300 
(2006). 
 
When this evidence is viewed in the light most favorable to 
the Plaintiff, giving her the benefit of all inferences that a 
jury might fairly draw from the evidence, we conclude that 
reasonable minds could differ whether an anomalous anatomical 
situation existed.  Therefore, the issue should have been 
decided by the jury, and the trial court erred in striking the 
Plaintiff's evidence and entering summary judgment for Dr. 
Hoffman. 
 
Accordingly, we will reverse the trial court's judgment and 
remand the case to the trial court for a new trial. 
Reversed and remanded.